How important is the pathological margin distance in vulvar cancer?
OBJECTIVE
The ideal pathological margin in vulvar squamous cell carcinoma (VSCC) is still debated. Our aim was to analyze the value of tumor-free pathological margin distance with regard to local recurrence in VSCC.


METHODS
We analyzed a series of 205 patients who were treated for VSCC from January 1980 to November 2007. Patients were categorized into 3 groups, based on pathological free margin (PFM): <3 mm (n = 18); ≥3 and <8 mm (n = 61); and ≥8 mm (n = 126).


RESULTS
The median age was 69 years. The median PFM was 10 mm (range: 1-65). Of 168 patients who underwent lymphadenectomy, 64 (38.1%) developed LN metastasis. After a median follow-up of 36.2 months, 78 (38%) cases recurred-47 (60.2%) experienced a local recurrence (LR). LR occurred in 16.7% of patients with a PFM of <3 mm, 24.6% with a PFM ≥3 and <8 mm, and 22.2% of those with a PFM ≥8 mm (p = 0.77). PFM did not correlate with LR when analyzed continuously (p = 0.98). The 5-year disease-free survival (DFS) for LR was 79.6%. Margin distance did not negatively impact DFS (p = 0.94); the presence of perineural invasion was the only variable that negatively influenced DFS (p = 0.009).


CONCLUSIONS
Although our results suggest no correlation between LR and pathological margin distance, the tumor-free resection margin remains significant with regard to locoregional control in vulvar cancer. A more conservative surgical approach may be considered in certain situations, such as margins near the clitoris, urethra, and anus.
Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil. Electronic address: glbaiocchi@yahoo.com.br.
G
G
Baiocchi
Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
H
H
Mantoan
Department of Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil.
L
L
de Brot
Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
L
L
Badiglian-Filho
Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
L Y
LY
Kumagai
Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
C C
CC
Faloppa
Department of Medical Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
A A B A
AA
da Costa
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000601:surgery
Margin distance; Prognosis; Recurrence; Vulvar cancer