A Minimally Invasive Treatment Approach for Early-Stage Uterine Cervical Cancer: The Impact of the LACC Trial and a Literature Review

TL;DR

This paper reviews the impact of the LACC trial on minimally invasive treatment for early-stage cervical cancer, highlighting its benefits and the need for further research.

Contribution

The paper emphasizes the LACC trial's role in changing guidelines and identifies gaps in current evidence for minimally invasive cervical cancer surgery.

Findings

Minimally invasive treatment showed non-inferiority to open surgery for early-stage cervical cancer.

The LACC trial supported the advantages of minimally invasive approaches but highlighted the need for further studies.

Ongoing randomized trials are needed to confirm or refute the LACC trial's results.

Abstract

Background and Objectives: Recent studies have supported the non-inferiority of the minimally invasive treatment approach over the open approach. However, they have also underlined its inferiority regarding its oncological results, while preserving the short-term benefits. The direct effects of these results were represented by indication changes in international guidelines on the application of minimally invasive surgery for treating early-stage cervical cancer. Material and metods: Herein, a literature review, including studies between 1992 and 2017, was performed. Results: The results show that the studies published during this period supported the non-inferiority of the minimally invasive treatment approach for early-stage cervical cancer compared with the open approach. However, the studies included were unicentric, non-randomized and relied on a reduced number of patients. The results of the Laparoscopic Approach to Cervical Cancer [LACC] trial could not have been considered, since only studies published between 1992 and 2017 were included. This trial firmly supported the advantages of the minimally invasive approach in treating early-stage cervical cancer. The literature published after 2018 highlighted the necessity for new clinical studies, randomized and prospective ones, to cover the defects of this study and to verify (or not) its results. Conclusions: the studies published after 2018 mainly focused on the deficiencies of the LACC trial and also on developing new methods that could improve this surgical technique, thus enhancing the safety of the minimally invasive approach in treating early-stage cervical cancer. However, none of the included studies succeeded to provide enough evidence to oppose the results obtained in the LACC trial. Therefore, in order to clarify the state of this surgical approach, the results of three ongoing randomized clinical trials are expected.

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