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Against expectations, keyhole radical hysterectomy for early cervical cancer led to more recurrences and more deaths than open surgery, reversing a decade of practice towards laparoscopic and robotic operations.
Phase 3 non-inferiority trial of 631 women with stage IA1 (with lymphovascular invasion) to IB1 cervical cancer randomised to minimally invasive (laparoscopic or robotic) or open abdominal radical hysterectomy.
Disease-free survival at 4.5 years was 86.0 percent with minimally invasive surgery against 96.5 percent with open surgery, with a hazard ratio for recurrence of 3.74 and for death of 6.00; the trial was stopped early for harm.
Open radical hysterectomy is again the standard for early cervical cancer; minimally invasive approaches are used only within protocols that avoid tumour spillage, and the trial is a lesson in adopting surgical innovation without randomised evidence.
Shares LACC (Laparoscopic Approach to Cervical Cancer), Early cervical cancer and fertility-sparing surgery.
Shares Early cervical cancer and fertility-sparing surgery, New England Journal of Medicine.