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Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.

The aim of this study was to compare overall survival between open and minimally invasive radical hysterectomy with participants followed for 4.5 years.

The primary objective was to evaluate whether minimally invasive surgery was noninferior in disease-free survival (DFS) to abdominal radical hysterectomy. Secondary outcomes included overall survival. Sample size was based on DFS of 90% at 4.5 years and 7.2% noninferiority margin for minimally invasive surgery.

A total of 631 patients were enrolled: 319 assigned to minimally invasive and 312 to open surgery. Of these, 289 patients (90.6%) underwent minimally invasive surgery and 274 (87.8%) open surgery.

At 4.5 years, DFS was 85.0% in the minimally invasive group and 96% in the open group (difference of –11.1, 95% CI –15.8 to –6.3, P=0.95 for noninferiority). Minimally invasive surgery was associated with lower rate of DFS compared with open surgery (hazard ratio [HR] 3.91, 95% CI 2.02-7.58], P<0.001). Rate of overall survival at 4.5 years was 90.6% versus 96.2% for the minimally invasive and open surgery groups, respectively (HR for death of any cause = 2.71, 95% CI 1.32-5.59, P=0.007).

Given the higher recurrence rate and worse overall survival with minimally invasive surgery, an open approach should be standard of care.

Read an interview about the study here and expert commentary about it here.