Background:
A tumor-free resection margin is considered state-of-the art in the operative treatment
of primary vulvar cancer. The optimal width of tumor-free margins is still under discussion
and published studies are inconsistant. The aim of this study was to investigate the
impact of pathological resection margin distance for locoregional control and recurrence-free
survival in a large cohort of patients.
Methods:
Patients surgically treated for primary squamous carcinoma of the vulva at the Tuebingen
University Women's Hospital between 2004 – 2016 were identified. Minimal margin distances
were pathologically determined in all dimensions after fixation. Cases were divided
into subgroups with margin distances < 1 mm, 1 – 3 mm, 3 – 8 mm and > 8 mm.
Results:
287 patients were identified, of which 80 had pT1a, 140 pT1b, 55 pT2, 11 pT3 and 1
pT4 tumors. Median age was 64,4 years. Median margin distance was 3,5 mm (< 1 mm:
n = 120; 1 – 3 mm: n = 36; 3 – 8 mm: n = 73; > 8 mm: n = 58). After a median follow-up
time of 3,2 years 93 cases recurred. Recurrence rates were 40% in patients with a
margin distance of < 1 mm, 25% with 1 – 3 mm, 30% with 3 – 8 mm and 24.1% with > 8
mm. A statistically significant impact was found between cases with < 1 – 8 mm and
> 8 mm (34,5% vs. 24,1%, p = 0.009). No significant association was found for overall
survival (p = 0,433).
Conclusion:
In our patient cohort pathological resection margin distance was found to be a significant
prognosticator for disease recurrence in vulvar cancer. So far no impact on overall
survival of the patient could be shown. Currently clinical follow-up is being updated
with final analyses to follow.
