The Role of Pathological Margin Distance and Prognostic Factors After Primary Surgery in Squamous Cell Carcinoma of the Vulva

Arvas, Macit; Kahramanoğlu, İlker; Beşe, Tugan; Turan, Hasan; Sozen, Işık; İlvan, Şennur; Demirkıran, Fuat

doi:10.1097/igc.0000000000001195

Cited by 24 publications

(15 citation statements)

References 24 publications

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“…Similar results to ours were obtained in other studies [8][9][10]. Arvas et al showed that a margin ≤2 mm may increase the risk of recurrence, but was not an independent predictive factor for PFS and OS [11]. Woelber et al showed a similar rate of local recurrence in patients with a margin <8 mm vs. ≥8 mm (12.6% vs. 10.2% respectively) [12].…”

Section: Discussionsupporting

confidence: 89%

Resection margins do not influence survival in vulvar cancer: treatment results in patients with a long-term follow-up

Piątek

Michalski

Bidziński

et al. 2021

Nowotwory. Journal of Oncology

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Introduction.The main purpose of the study was to assess margin resection as a prognostic factor of vulvar cancer in patients with a long term follow-up. Materials and methods. The study included 84 vulvar cancer patients who underwent radical treatment: surgery (n = 84), radiotherapy (n = 16), chemoradiotherapy (n = 5). Clinicopathological factors regarding survival and recurrence were analyzed. The median follow-up was 74 months. Results. Resection margins were not related to progression-free survival (PFS) (p = 0.93) and overall survival (OS) (p = 0.84). On the multivariate analysis, a maximum tumor size >25 mm (p = 0.026) and inguinal lymph node involvement (p = 0.028) were factors increasing the risk of death. The risk of recurrence was related to tumor dimension >25 mm (p = 0.011), but not to inguinal node metastasis (p = 0.086). Discussion. Inadequate surgical margin would be salvaged by adjuvant treatment. Conclusions. A maximum tumor dimension >25 mm and metastases in the inguinal lymph nodes are independent prognostic factors for the survival of patients with vulvar cancer.

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Section: Discussionsupporting

confidence: 89%

Resection margins do not influence survival in vulvar cancer: treatment results in patients with a long-term follow-up

Piątek

Michalski

Bidziński

et al. 2021

Nowotwory. Journal of Oncology

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“…The modern concept for the treatment of advanced vulvar cancer is radical excision of the vulvar tumor and inguinofemoral lymphadenectomy, knowing that the optimal range of the free margin is 8 mm. While a microscopic margin of 2 mm seems sufficient (80% of relapses occur in patients with surgical margins less than 2 mm), less radical surgery is associated with an increased risk of relapse 7. The condition of the margins is the most important predictor of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Secondary healing strategy for difficult wound closure in invasive vulvar cancer: a pilot case-control study

Dias-Jr¹,

Soares-Jr²,

Faria³

et al. 2019

Clinics

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OBJECTIVES: Despite the number of surgical advances and innovations in techniques over time, radical vulvectomy frequently results in substantial loss of tissue that cannot be primarily closed without tension, the mobilization of surrounding tissues or even the rotation of myocutaneous flaps. The aim of this study was to evaluate the feasibility of leaving the surgical vulvar open wound for secondary healing in situations where primary closure of the vulvar wound is not possible. METHODS: This case-control pilot study analyzed 16 women with a diagnosis of squamous cell carcinoma of the vulva who first underwent inguinofemoral lymphadenectomy, 6-week sessions of chemotherapy and 25 daily sessions of radiotherapy. Afterward, excision of the vulvar lesion with free margins was performed between January 2011 and July 2017. Twelve patients underwent primary closure of the wound (control), and in 4 patients, the surgical wound was left open for secondary healing by means of a hydrofiber (case). The inclusion criteria were a) FIGO-2009 stage II up to IIIC; b) squamous cell carcinoma; and c) no evidence of pelvic or extrapelvic disease or pelvic nodal involvement. The exclusion criteria were extrapelvic disease or pelvic nodal involvement, another primary cancer, or a poor clinical condition. ClinicalTrials.gov: NCT02067052. RESULTS: The mean age of the patients at the time of the intervention was 62.1. The distribution of the stages was as follows: II, n=6 (37 %); IIIA, n=1 (6%), IIIB, n=1 (6%) and IIIC, n=8 (51%). The mean operative time was 45 minutes. The hospital stay duration was 2 days. Full vulvar healing occurred after an average of 30 days in the control group and after an average of 50 days in the case group. CONCLUSION: A secondary healing strategy may be an option for the treatment of vulvar cancer in situations of non-extensive surgical wounds when primary closure of the wound is not possible.

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“…Although this study confirms the benefit of a more conservative approach to vulvar resection, the actual extent of the surgical margin has been controversial. Several recent studies have reported that the histopathological margin distance was not predictive of vulvar recurrence [12][13][14]18,[22][23][24][25]. However, there have been two recent exceptions, A meta-analysis of 10 studies reported by Nooij et al showed that a tumour-free margin of <8 mm was associated with a higher risk of local recurrence compared to a tumour-free margin of ≥ 8 mm (HR, 1.99; 95% CI: 1.13−3.51) [15], but in a cohort study of their own patients, they were unable to confirm this finding.…”

Section: Discussionmentioning

confidence: 99%

“…Nooij et al and Preti et al also suggested that "tumour positive margins" were the only risk factor [15,27]. Groenen et al recommended removing "no more than sufficient surrounding tissue" [12], while others have recommended that margins should be at least 2 mm [23], 5 mm [28,29] or ≥8 mm [30].…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Role of the Surgical Margins in Squamous Vulvar Cancer: A Retrospective Australian Study

Barlow

Jackson

Hacker

2020

Cancers

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For the last 30 years at the Royal Hospital for Women, unifocal vulvar squamous cancers have been treated by radical local excision, aiming to achieve a histopathological margin of ≥8 mm, equating to a surgical margin of 1 cm. The need for a margin of this width has recently been challenged. We aimed to determine the long-term outcome following this conservative approach, and the relationship between vulvar recurrences and surgical margins. Data were obtained retrospectively on 345 patients treated primarily with surgery for squamous vulvar cancer between 1987 and 2017. Median follow-up was 93 months. Five-year disease-specific survival was 86%. Of 78 vulvar recurrences, 33 (42.3%) were at the primary site and 45 (57.7%) at a remote site. In multivariable analysis, a margin < 5 mm showed a higher risk of all vulvar (Hazard ratio (HR), 2.29; CI, 1.12−4.70), and primary site recurrences (subdistribution hazard ratio (SHR), 15.20; CI, 5.21−44.26), while those with a margin of 5 to <8 mm had a higher risk of a primary site recurrence (SHR, 8.92; CI, 3.26−24.43), and a lower risk of remote site recurrence. Excision margins < 8 mm treated by re-excision or radiation therapy had a significantly decreased risk of recurrence. Guidelines should continue to recommend a surgical margin of 1 cm.

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The Role of Pathological Margin Distance and Prognostic Factors After Primary Surgery in Squamous Cell Carcinoma of the Vulva

Abstract: Our data suggest that a more than 2 mm tumor-free margins is associated with better local control. In addition, older age is an independent prognostic factor for survival.

Cited by 24 publications

References 24 publications

Resection margins do not influence survival in vulvar cancer: treatment results in patients with a long-term follow-up

Resection margins do not influence survival in vulvar cancer: treatment results in patients with a long-term follow-up

Secondary healing strategy for difficult wound closure in invasive vulvar cancer: a pilot case-control study

The Prognostic Role of the Surgical Margins in Squamous Vulvar Cancer: A Retrospective Australian Study

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