Journal Article

Robot-assisted approach to cervical cancer (RACC): an international multi-center, open-label randomized controlled trial

Zahl Eriksson, Ane Gerda, Kimmig, Rainer, Stalberg, Karin, Falconer, Henrik, Wijk, Lena, Palsdottir, Kolbrun, Ottander, Ulrika, Lundin, Evelyn Serreyn, Dahm-Kähler, Pernilla, Mäenpää, Johanna, Jensen, Pernille Tine, Persson, Jan, Salehi, Sahar

2019

Overview

BackgroundRadical hysterectomy with pelvic lymphadenectomy represents the standard treatment for early-stage cervical cancer. Results from a recent randomized controlled trial demonstrate that minimally invasive surgery is inferior to laparotomy with regards to disease-free and overall survival.Primary ObjectiveTo investigate the oncologic safety of robot-assisted surgery for early-stage cervical cancer as compared with standard laparotomy.Study HypothesisRobot-assisted laparoscopic radical hysterectomy is non-inferior to laparotomy in regards to recurrence-free survival with the advantage of fewer post-operative complications and superior patient-reported outcomes.Trial DesignProspective, multi-institutional, international, open-label randomized clinical trial. Consecutive women with early-stage cervical cancer will be assessed for eligibility and subsequently randomized 1:1 to either robot-assisted laparoscopic surgery or laparotomy. Institutional review board approval will be required from all participating institutions. The trial is coordinated from Karolinska University Hospital, Sweden.Major Inclusion/Exclusion CriteriaWomen over 18 with cervical cancer FIGO (2018) stages IB1, IB2, and IIA1 squamous, adenocarcinoma, or adenosquamous will be included. Women are not eligible if they have evidence of metastatic disease, serious co-morbidity, or a secondary invasive neoplasm in the past 5 years.Primary EndpointRecurrence-free survival at 5 years between women who underwent robot-assisted laparoscopic surgery versus laparotomy for early-stage cervical cancer.Sample SizeThe clinical non-inferiority margin in this study is defined as a 5-year recurrence-free survival not worsened by >7.5%. With an expected recurrence-free survival of 85%, the study needs to observe 127 events with a one-sided level of significance (α) of 5% and a power (1−β) of 80%. With 5 years of recruitment and 3 years of follow-up, the necessary number of events will be reached if the study can recruit a total of 768 patients.Estimated Dates for Completing Accrual and Presenting ResultsTrial launch is estimated to be May 2019 and the trial is estimated to close in May 2027 with presentation of data shortly thereafter.Trial RegistrationThe trial is registered at ClinicalTrials.gov (NCT03719547).

• Publisher: Elsevier Inc,by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology,Elsevier Limited
• Subject: Biopsy / Cancer and Oncology / Cancer och onkologi / Cervical cancer / Cervix / Clinical Medicine / Clinical Protocols / Clinical trials / Disease-Free Survival / Female / Gynaecology, Obstetrics and Reproductive Medicine / Gynecology / Gynekologi, obstetrik och reproduktionsmedicin / Humans / Hysterectomy / Hysterectomy - adverse effects / Hysterectomy - methods / Klinisk medicin / Laparoscopy / Laparoscopy - adverse effects / Laparoscopy - methods / Laparotomy / Lymph Node Excision - adverse effects / Lymph Node Excision - methods / Lymphatic system / Lymphedema / Medical and Health Sciences / Medicin och hälsovetenskap / Minimally invasive surgery / Neoplasm Staging / Oncology / Prospective Studies / Quality control / Quality of life / Robotic Surgical Procedures - adverse effects / Robotic Surgical Procedures - methods / Robots / Skin cancer / Surgery / surgical oncology / Treatment Outcome / Uterine Cervical Neoplasms - pathology / Uterine Cervical Neoplasms - surgery / Vagina / Womens health