Robotic Radical Hysterectomy Shows Limited Recovery Benefit Over Open Surgery in RACC Trial

The multicenter, phase 3 RACC randomized trial compared robot-assisted with open radical hysterectomy at European tertiary centers. It enrolled 900 adults with cervical cancer, FIGO 2018 stage IB excluding IB3, or IIA1, between 2019 and 2025. This report evaluated prespecified secondary outcomes: intraoperative complications, postoperative complications within 30 days, and health-related quality of life at one month.

Intraoperative complications occurred in 24 of 419 patients (5.7%) undergoing robotic surgery versus 39 of 390 (10.0%) undergoing open surgery, a risk difference of −4.3 percentage points (95% CI, −8.0 to −0.6). Most events were minor; major complications were infrequent and similar. Thirty-day postoperative complication rates were 33.4% versus 34.8% (risk difference, −1.4 percentage points; 95% CI, −7.9 to 5.2), with similar readmission and reoperation outcomes.

At one month, robotic surgery was associated with small improvements in physical functioning (+5 points), role functioning (+8 points), and pain (+5 points toward less pain). Most quality-of-life domains did not reach thresholds for clinically important differences. These exploratory analyses were not powered for confirmatory inference; outcome data were available for 80%–90% of randomized patients. The findings do not establish a clinically consequential postoperative or recovery advantage and do not resolve concerns about oncologic safety.