The impact of close surgical margins after radical hysterectomy for early-stage cervical cancer

Abstract

Objective While it is known that positive surgical margins increase the risk of cervical cancer recurrence, little is known about the effect of close surgical margins (CSM). Therefore, we set out to determine the impact of margin status on recurrence and survival in patients with early-stage cervical cancer. Methods A retrospective review was conducted of patients undergoing radical hysterectomy from 2000 to 2010 with Stage IA2-IIA cervical cancer. CSM were defined as ≤5 mm; association with other clinicopathologic factors as well as recurrence and survival was evaluated. Results Of the 119 patients, 75 (63%) with CSM had a recurrence rate of 24% compared to 9% without CSM. Though not independently associated with recurrence, CSM were significantly associated with positive lymph nodes (44% vs. 18%), positive parametria (33.3% vs. 2.3%), larger tumors (3.5 vs. 2.5 cm), greater depth of stromal invasion (DOI) (84% vs. 33%), and lymphovascular space invasion (LVSI) (61.3% vs. 34.1%). We failed to find an association between adjuvant therapy and recurrence in those with CSM. Exploratory analysis revealed that a surgical margin of ≤2 mm was significantly associated with an increased risk of overall recurrence (36% vs. 9%, p=0.009) as well as loco-regional recurrence (22% vs. 4%, p=0.0034). Conclusions Surgical margins of ≤5 mm on radical hysterectomy specimens are often associated with other high or intermediate risk factors for recurrence. While not a proven independent risk factor, the distance to surgical margin may warrant further investigation as an intermediate risk factor along with tumor size, DOI and LVSI.

Predicting Factors for Positive Vaginal Surgical Margin Following Radical Hysterectomy for Stage IB1 Carcinoma of the Cervix

“…In the recent study by McCann et al (2013), although not an independent predicting factor for recurrence, close vaginal margin of ≤5 mm was associated with other high or intermediate-risk pathological factors including nodal metastasis, parametrial involvement, larger tumor, deeper cervical stromal invasion, and LVSI. At our institution, patients with positive vaginal surgical margin are generally offered postoperative adjuvant radiotherapy; vaginal brachytherapy for patients with positive margin for intraepithelial lesion and pelvic radiation with concurrent chemotherapy for those with positive margin for carcinoma.…”

Margins for cervical and vulvar cancer

“…The earliest study on the subject found that adjuvant radiotherapy significantly improved 5-year survival (P < 0.05) and recurrence (P < 0.01) although 6 of the 13 patients evaluated in the study had other intermediate or high risk features [14]. However, a more recent study failed to find any association between adjuvant radiotherapy and recurrence for patients with close surgical margins although [16]. In both studies, the numbers of patients without other intermediate or highrisk features were small.…”

“…One study found that operative route does impact the likelihood of having close surgical margins. Of the twenty patients in one study found to have close surgical margins on final pathology, eighteen were performed robotically as compared to open, which was statistically significant ( P = 0.005) . The authors of that study did not hypothesize as to the reason although magnification of tissue may be the underlying etiology.…”

Management of Isolated Vaginal Metastasis in Squamous Cell Cervical Cancer: 23 Years' Experience at a Single Center

“…LVSI was found to be a significant factor by univariate regression analysis in a study evaluating risk factors for local recurrence [8]. McClan et al [9 ]reported significant relationships between close surgical margins and LVSI, DOI, and tumor size. We found LVSI, anemia, and tumor size to be statistically significant risk factors for IVM according to multivariate and univariate analyses in this study.…”