Global Influence of our Research

LACE Trial

The LACE (Laparoscopic Approach to Cancer of the Endometrium) trial was a landmark international clinical trial designed to determine whether minimally invasive laparoscopic hysterectomy was as safe and effective as traditional open abdominal hysterectomy for women with early-stage endometrial cancer.

Before LACE, there was widespread belief that laparoscopic surgery offered better short-term outcomes (like less pain and quicker recovery), but there was no robust evidence comparing long-term survival and recurrence rates with traditional surgery. The LACE trial showed that total laparoscopic surgery had significant benefits for patients including lower rate of postoperative adverse events, shorter length of hospital stay, better quality of life as reported in The Lancet Oncology journal and European Journal of Cancer. Disease-free survival at 4.5 years was equivalent between laparoscopic (81.6%) and open surgery (81.3%), confirming that the less invasive method did not compromise cancer outcomes. Cost-effectiveness analyses was reported in the British Medical Journal (BMJ), showed that a decision to invest in laparoscopic surgery was cost effective for health funders in 98% of the time, and could save the Australian healthcare system $8 million annually.

This clinical trial remains the world's most influential randomised study in the surgical treatment of endometrial cancer and has shaped surgical practices worldwide.

Its results demonstrated that laparoscopic surgery should be the first line therapy, a result that has become embedded in national and international treatment guidelines. This outcome had a major effect on the world-wide use of laparoscopic surgery for patients with endometrial cancer and is estimated to save the health care system $3000 for each operation that can be done laparoscopically since the results of the trial were published in The Journal of the American Medical Association (JAMA) in 2017.

LACC Trial

Minimally invasive radical hysterectomy (laparoscopic or robotic) was widely adopted based on its benefits in other cancers—like faster recovery, less blood loss, and fewer complications. However, there was no high-quality evidence confirming that it was as safe as open surgery for cervical cancer in terms of long-term survival.

The results of the LACC Trial were practice-changing and had a global ripple effect.

The trial found that patients who underwent minimally invasive surgery had significantly lower disease-free survival (86% vs. 96.5%) and lower overall survival (93.8% vs. 99%) compared to those who had open surgery. That is to say, in contrast with endometrial cancer, results of the 10-year LACC Trial, suggest that laparoscopic or robotic radical hysterectomy for cervical cancer is more likely to result in disease recurrence and reduced survival rates than open abdominal surgery. 

Based on these findings, major clinical guidelines—including the NCCN Clinical Practice Guidelines in Oncology—were revised to recommend open radical hysterectomy as the standard of care for early-stage cervical cancer. Surgeons and hospitals worldwide re-evaluated their surgical approaches, with many reverting to open surgery for cervical cancer to ensure patient safety.

The results of the study were published in the New England Journal of Medicine and The Lancet Oncology journal. 

LiGHT Study

This study surveyed over 2300 women in Queensland who had a hysterectomy in the past. It was very interesting to find that 96% were happy they had the hysterectomy and only 4% reported they regretted the decision. Most women followed the advice of their doctor with regards to the type of hysterectomy suitable for them. Very few women sought a second opinion. 

Surgeon’s preference, recovery time or surgical risks were the three strongest influences on women’s preference for a surgical approach.

Recovery was good for most women, with those receiving laparoscopic or vaginal hysterectomy reporting quicker recovery than those who had an open abdominal hysterectomy. These women took up to 6 months to recovery completely. The results of this study were published in the journal of Patient Education and Counseling.

Imagine Trial

The IMAGINE Trial (Implementation of MinimAlly INvasivE hysterectomy ) was created to address a critical gap in surgical practice for women undergoing hysterectomy. Aiming to test a model for training gynaecological surgeons to transition from traditional open abdominal surgery to minimally invasive laparoscopic hysterectomy, which offers better outcomes and fewer complications for patients.

• Low uptake of laparoscopic hysterectomy: Despite its benefits, only about 1 in 10 OBGYN surgeons in Australia were performing laparoscopic hysterectomies seven years ago.
• Improving patient outcomes: Minimally invasive surgery typically results in faster recovery, fewer complications, and reduced hospital stays.
• Upskilling surgeons: The trial developed a structured surgical teaching program involving hospitals, universities, medical device companies, and charitable organisations to train surgeons in laparoscopic techniques.
• System-wide impact: As a result of the IMAGINE Trial, the proportion of surgeons performing laparoscopic hysterectomies has increased to around 50%

The trial was awarded an NHMRC Partnership Projects Grant and was later named one of the NHMRC’s “Ten of the Best” Research Projects, highlighting its national significance and impact on women’s health. The results of the study were published in the Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) and the American Journal of Obstetrics and Gynecology (AJOG).

feMMe Trial

The feMMe (Fertility-sparing Management for Endometrial Cancer) trial investigated whether women with endometrial cancer could be treated less invasively through the use of a common intra-uterine device to reduce the need for surgery and in some women, preserve their fertility. 165 women from 16 sites across Australia and New Zealand were enrolled in the study.

The findings included:

• 82% of women with endometrial hyperplasia with atypia (a precursor to endometrial cancer) and 42% of women with endometrial cancer responded to the new non-invasive treatment;
• The new treatment was more successful when combined with weight loss (67% response rate); and
• The treatment was well tolerated with minimal side effects.

The trial offered hope to younger women wishing to retain fertility after endometrial cancer.

This treatement option will benefit women around the world, diagnosed with endometrial hyperplasia with atypia or a well-differentiated endometrial cancer who have an unreasonably high risk of complications from endometrial cancer surgery; and younger women diagnosed with early stage cancer who wish to retain fertility to complete their families. The results of the study were published in the Gynecologic Oncology journal.

Finding out why some women responded well to the treatment and others didn't has led to the feMMe Molecular and SATELLITE Study, as all women deserve treatment options that suit their needs.

The feMMe trial has inspired further studies into conservative cancer treatments, especially in the context of rising obesity and delayed childbearing worldwide.

For further information read UQ’s article here.

Professor Obermair has been invited to speak at numerous prestigious international conferences, reflecting the global impact of his research and leadership in gynaecological oncology. Notable engagements include:

2025

• IDEAL Collaboration Conference: Innovations in Surgical Research, Bridging Science & Practice, Houston, USA

2024

• The International Gynecologic Cancer Society (IGCS) Annual Global Meeting, Dublin, Ireland
• American Society of Clinical Oncology (ASCO) Annual Meeting, Chicago, USA 

2023

• International Gynecologic Cancer Society (IGCS) Annual Global Meeting, Seoul, South Korea
• Stryker Asia-Pacific (APAC) iSPIES symposium, Tokyo, Japan
• Argentine Association of Gynecology Oncology (AAGO) annual congress, Buenos Aires, Argentina

2022

• IDEAL Collaboration International Meeting, Oxford, United Kingdom
• International Gynecologic Cancer Society (IGCS) Annual Global Meeting, New York, USA

2021 (No conferences due to COVID-19)

2020 (Due to COVID-19, these conferences were run virtually)

• International Gynecologic Cancer Society (IGCS) Virtual Global Meeting
• Society of Gynecologic Oncology (SGO) Annual Meeting on Women's Cancer, Toronto, Canada (Cancelled due to COVID-19)

2019

• European Congress for the European Society of Gynaecological Oncology (ESGO), Athens, Greece 
• International Gynecologic Cancer Society (IGCS) Global Meeting, Rio de Janeiro, Brazil 
• Society of Gynecologic Oncology (SGO) Annual Meeting on Women's Cancer, Honolulu, Hawaii

2018

• European Society for Medical Oncology (ESMO), Munich, Germany
• European Society for Gynaecological Endoscopy (ESGE), Vienna, Austria
• International Gynecologic Cancer Society (IGCS) Biennial Meeting, Kyoto, Japan
• Indonesian Society of Gynaecological Oncology (INASGO) Biennial Meeting,  Labuan Bajo, Flores, Indonesia
• Society of Gynecologic Oncology (SGO) Annual Meeting on Women's Cancer, New Orleans, USA

2016

• International Gynecologic Cancer Society (IGCS) Biennial Meeting, Lisbon, Portugal