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Robot-assisted approach to cervical cancer (RACC): an international multi-center, open-label randomized controlled trial
  1. Henrik Falconer1,
  2. Kolbrun Palsdottir1,
  3. Karin Stalberg2,
  4. Pernilla Dahm-Kähler3,
  5. Ulrika Ottander4,
  6. Evelyn Serreyn Lundin5,6,
  7. Lena Wijk7,
  8. Rainer Kimmig8,
  9. Pernille Tine Jensen9,
  10. Ane Gerda Zahl Eriksson10,
  11. Johanna Mäenpää11,
  12. Jan Persson12 and
  13. Sahar Salehi1
  1. 1 Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
  2. 2 Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
  3. 3 Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
  4. 4 Department of Clinical Sciences, Umeå Universitet Medicinska fakulteten, Umea, Sweden
  5. 5 Obstetrics and Gynecology, Linkopings universitet, Linkoping, Sweden
  6. 6 Linkopings Universitet Institutionen for klinisk och experimentell medicin, Linkoping, Sweden
  7. 7 Faculty of Medicine and Health, Örebro University, Örebro, Sweden
  8. 8 Gynecology and Obstetrics, University Hospital of Duisburg-Essen, Essen, Germany
  9. 9 Faculty of Health Science, Aarhus University, Aarhus, Denmark
  10. 10 Gynecologic Oncology, Universitetet i Oslo, Oslo, Norway
  11. 11 Faculty of Medicine and Medical Technology, Tampere University, Tampere, Pirkanmaa, Finland
  12. 12 Department of Obstetrics and Gynecology, Lund University Hosptial, Lund, Sweden
  1. Correspondence to Dr Henrik Falconer, Department of Women's and Children's Health, Karolinska Institutet, Stockholm 171 77, Sweden; henrik.falconer{at}


Background Radical 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 Objective To investigate the oncologic safety of robot-assisted surgery for early-stage cervical cancer as compared with standard laparotomy.

Study Hypothesis Robot-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 Design Prospective, 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 Criteria Women 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 Endpoint Recurrence-free survival at 5 years between women who underwent robot-assisted laparoscopic surgery versus laparotomy for early-stage cervical cancer.

Sample Size The 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 Results Trial launch is estimated to be May 2019 and the trial is estimated to close in May 2027 with presentation of data shortly thereafter.

Trial Registration The trial is registered at (NCT03719547).

  • cervical cancer
  • surgical oncology

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  • Contributors HF, KP, SS, and JP are members of the RACC steering committee and designed the trial. AGZE, PTJ, and JM are national coordinators and contributed to the final design of the trial. PD-K, UO, LW, KS, ESL, and RK are local principal investigators. All authors were involved in revising the article critically for important intellectual content and final approval of the version to be submitted.

  • Funding This study was funded by Stockholms Läns Landsting (

  • Competing interests HF, RK, and JP are proctors for Intuitive Surgical Inc.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.