Minimally Invasive Hysterectomy has Poorer Disease-Free Survival Than Open Surgery in Cervical Cancer

PHOENIX: Minimally invasive surgery was associated with lower survival rates than open surgery as a treatment for cervical cancer, according to the final analysis of data from the LACC trial. Results were presented today at the hybrid Society of Gynecologic Oncology 2022 Annual Meeting on Women's Cancer, the premier scientific conference focused on the delivery of high-quality gynecologic cancer care.

The Phase 3 Laparoscopic Approach to Cervical Cancer (LACC) trial (NCT00614211) compared long-term outcomes after laparoscopic or robot-assisted radical hysterectomy (minimally invasive surgery or MIS) with outcomes after open abdominal radical hysterectomy (open surgery) among women with early-stage cervical cancer. The trial enrolled a total of 631 patients, 319 of whom were assigned to MIS and 312 to open surgery, with a primary outcome measure of disease-free survival at 4.5 years.

A final analysis of data from the trial found the rate of disease-free survival was lower for MIS than open surgery: 43 MIS patients (13.5%) had disease at 4.5 years compared with 11 open surgery patients (3.5%). It also demonstrated that the MIS approach was associated with four times higher recurrence rates compared with the open approach.

A previously published study, based on an interim analysis of survival rates (59.7% of patients followed to 4.5 years) of the LACC trial patients, reported similar results.

"Radical hysterectomy remains the standard recommendation for patients with early-stage cervical cancer, and there have been no prospective data on outcomes for minimally invasive surgery – until the LACC trial," said principal investigator Pedro Ramirez, MD, professor of gynecologic oncology & reproductive medicine at The University of Texas MD Anderson Cancer Center, who was also first author on the previous study. "This final analysis of results from the LACC trial demonstrate that, despite being more invasive, open surgery offers these patients a lower recurrence rate and a better chance of disease-free survival than minimally invasive surgical approaches."

Subgroup analyses of the final data also showed that the poorer disease-free survival for MIS patients was associated with larger tumor size (≥ 2 cm), and rates of carcinomatosis (tumor spreading) at disease recurrence was higher for MIS patients (25%) than for open surgery patients (0%).

"Our results from this subgroup analysis suggest that the likely reason for worse outcomes in patients who undergo MIS is tumor spillage or contamination, as worse outcomes are accentuated in patients with larger tumors and the rates of carcinomatosis are significantly higher in the MIS group," said Ramirez.