Vaginal Cuff Length and Time to Postoperative Stump Recurrence After Hysterectomy for Cervical Cancer: An Exploratory...

Backgroud/Objectives: In this exploratory study, we explored the relationship between the timing of recurrence and vaginal cuff length (VCL) in patients with vaginal stump recurrence after hysterectomy. Methods: This is a single-institution study which included 25 consecutive patients who developed postoperative stump recurrence of cervical cancer at Beijing Obstetrics and Gynecology Hospital, Capital Medical University, between January 2013 and December 2024. Patients were divided into early recurrence (≤24 months) and late recurrence (>24 months) groups according to the postoperative 2-year cutoff point. The relationship between VCL and recurrence time was analyzed with Spearman rank correlation analysis. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal VCL cutoff value using the Youden index. Kaplan-Meier curves and log-rank tests were used to compare the time to recurrence between groups, stratified by the data-derived VCL cutoff. Results: The median age of the 25 patients was 57 years (range, 36-78 years). Squamous cell carcinoma accounted for 68.0% (17/25) and adenocarcinoma for 24.0% (6/25). The median VCL was 0.7 cm (range, 0.1-2.0 cm), and the median time to recurrence was 22 months (range, 5-89 months). Spearman correlation analysis showed a significant positive correlation between VCL and recurrence time (r = 0.804, p < 0.001). ROC curve analysis identified 0.75 cm as the optimal cutoff for predicting early recurrence, with an area under the curve (AUC) of 0.902, a sensitivity of 86.7%, and a specificity of 80.0%. Patients with VCL ≤ 0.75 cm (n = 15) had a median recurrence time of 15 months, compared with 43.5 months in those with VCL > 0.75 cm (n = 10). The proportions of patients remaining free of recurrence at 24 months were 13.3% and 80.0%, respectively (log-rank p < 0.001). Conclusions: In this study, shorter VCL was associated with earlier recurrence, and a data-derived cutoff of 0.75 cm discriminated early (≤24 months) from late recurrence. Further multicenter studies are needed to validate this finding before changing clinical decisions, given the restricted sample size.