The Laparoscopic Approach to Cervical Cancer (LACC) trial, reported in November 2018, showed poorer disease-free and overall survival with minimally invasive vs open radical hysterectomy for early-stage cervical cancer. In a study recently reported in a letter in The New England Journal of Medicine, Lewicki et al found that use of minimally invasive surgery in this setting has significantly decreased since publication of the LACC trial results.

The investigators noted that other data subsequently supported the LACC study findings and that guidelines now favor open surgery.

Study Details

The study involved data from the Premier Healthcare Database covering the period from November 2015 through March 2020. The percentage of hysterectomies for cervical cancer performed with a minimally invasive approach was calculated for each month and the percentages before and after publication of the LACC trial results were compared. A 3-month period following publication was excluded from the analysis to allow time for dissemination of the LACC trial results.

Key Findings

The analysis population consisted of 2,437 women treated at 283 centers, including 1,482 (60.8%) treated at 141 academic centers (49.8%) and 955 (39.2%) treated at 142 nonacademic centers (50.2%). The minimally invasive approach was used in 58.0% vs 42.9% of hysterectomies prior to vs after publication of the LACC trial (P < .001). Minimally invasive surgery was used in 45.0% of hysterectomies in March 2020.

In analysis adjusting for hospital census region, age, race/ethnic group, Charlson comorbidity index score, and insurance, the odds ratio for use of the minimally invasive approach after vs before trial publication was 0.41 (95% confidence interval [CI] = 0.29–0.59, P< .001). The odds ratios for use of minimally invasive surgery after publication of trial results were 0.27 (95% CI = 0.17–0.43, P < .001) at academic centers and 0.81 (95% CI = 0.45–1.47, P = 0.49) at nonacademic centers (P = .004 for interaction).

The magnitude of reduction of use of minimally invasive surgery did not differ according to hospital census region, patient race/ethnicity, or insurance. Analysis of trends in hysterectomies for uterine fibroids (as an internal negative control) showed no change in proportions using a minimally invasive approach.

The investigators concluded, “We found a substantial reduction in the use of minimally invasive surgery for cervical cancer after publication of the results of the LACC trial. The use of this approach among nonacademic providers suggests an opportunity to improve outcomes. Our study builds on previous data suggesting changes in practice patterns…. These data highlight the effect on clinical practice of data generated by randomized, controlled trials of surgical approaches.”

Disclosure: The study was supported by grants from the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust and others. For full disclosures of the study authors, visit nejm.org.