Outcomes Research
Laparotomy Superior to Minimally Invasive Radical Hysterectomies
Final analysis of the first prospective randomized clinical trial comparing overall survival between open and minimally invasive radical hysterectomy for treating early-stage cervical cancer revealed that an open approach should be the standard of care.
The clinical trial update, published in the Journal of Clinical Oncology, reaffirmed conclusions drawn from the initial 2018 publication that analyzed results at 84% power. At the time of the initial publication, both laparotomy and minimally invasive techniques were acceptable radical hysterectomy approaches–despite limited retrospective study data evaluating survival rates of the robot-assisted surgery.
While researchers hypothesized that minimally invasive radical hysterectomy would not be inferior to laparotomy, results suggested otherwise. Of the 289 patients undergoing minimally invasive surgery and 274 undergoing open surgery, disease-free survival was 85% in the minimally invasive group and 96% in the open group at follow-up (4.5 years). Overall survival was also higher in the open surgery group (96.2% vs. 90.6%), revealing a 2.5 times higher risk of death from cervical cancer in the minimally invasive group. Further, rates of recurrence as carcinomatosis were 9% in the open group versus 23% in the minimally invasive group.

Pedro T. Ramirez, MD, FACOG
“Given the higher recurrence rate and worse overall survival with minimally invasive surgery, an open approach should be the standard of care for patients undergoing radical hysterectomy for early-stage cervical cancer,” said Houston Methodist’s Pedro T. Ramirez, MD, FACOG, study PI and Chair of the Department of Obstetrics & Gynecology. “Minimally invasive radical hysterectomy should only be performed in clinical trials.”
While the results were surprising to the field, there’s since been significant international shifts in how cervical cancer is surgically treated. Ramirez is proud to produce a final analysis solidifying the recommended standard of care.
“While new technologies are exciting and may provide some benefits, it’s important to remember that evidence-based medicine should be our highest priority,” Ramirez said. “We owe it to our patients to scrutinize medical advancements and refer to peer-reviewed research in designing care plans. That’s what leading medicine is all about–putting our patients’ health first, no matter the current trend.”
Pedro T. Ramirez, MD; Kristy P. Robledo, PhD; Michael Frumovitz, MD; Rene Pareja, MD; Reitan Ribeiro, MD; Aldo Lopez, MD; Xiaojian Yan, MD; David Isla, MD; Renato Moretti, MD; Marcus Q. Bernardini, MD; Val Gebski, MStat; Rebecca Asher, MSc; Vanessa Behan, BSN; Robert L. Coleman, MD; and Andreas Obermair, MD
Callie Rainosek Wren, MS
June 2025
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