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Influence of resection distance on vulvar cancer relapse: a retrospective analysis
Jan-Philipp Cieslik1,2, Annika Sophia Beerbaum1,2, Tanja Fehm1,2
1Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
Objective:
This study evaluates the effect of resection margin distance on disease-free survival (DFS) and (local) recurrence rates in patients with vulvar squamous cell carcinoma (SCC) while assessing the impact of associated factors such as lichen sclerosus (LS) and lymph node metastasis.
Methods:
A retrospective single-center analysis was conducted on 150 patients treated for vulvar SCC between 2004 and 2014 at University Hospital Düsseldorf. Univariate and multivariate regression analyses were performed to evaluate the impact of clinical and pathological factors on DFS. Additionally, a literature review was conducted to summarize existing evidence on resection margins.
Results:
The findings suggest that a resection margin exceeding 8 mm does not significantly improve DFS (HR 1.14, CI 1.01-1.28, p = 0.029). LS was significantly associated with recurrence (HR 2.36, CI 1.13-4.91, p = 0.02) and reduced DFS. Univariate analysis identified lymph node metastasis as a significant predictor of DFS; however, this association was not retained in multivariate analysis.
Conclusion:
Although current guidelines advocate for resection margins >8 mm, our findings suggest that smaller margins may be acceptable in selected patients, particularly those without LS and tumors located near critical structures (e.g., the anus, clitoris, or urethra). These considerations should inform personalized treatment strategies and follow-up care.
