title: Tumour-free margins in vulvar squamous cell carcinoma: Does distance really matter?
abstract: There is no consensus on the width of tumour-free margins after surgery for vulvar squamous cell carcinoma (VSCC). Most current guidelines recommend tumour-free margins of ≥8 mm. The aim of this study was to investigate whether a margin of <8 mm is associated with an increased risk of local recurrence in VSCC.
  
  
  
  A meta-analysis of the available literature and a cohort study of 148 VSCC patients seen at a referral centre from 2000 to 2012 was performed. The primary end-point of the cohort study was a histologically confirmed ipsilateral local recurrence within 2 years after primary treatment in relation to the margin distance.
  
  
  
  Based on 10 studies, the meta-analysis showed that a tumour-free margin of <8 mm is associated with a higher risk of local recurrence compared to a tumour-free margin of ≥8 mm (pooled risk ratio, 1.99 [95% confidence interval {CI}: 1.13-3.51], p = 0.02). In the cohort study, we found no clear difference in the risk of local recurrence in the <8 versus ≥8 mm group; however, 40% of the patients in the <8 mm group received additional treatment. Tumour-positive margin was the only independent risk factor for local recurrence in the multivariable analysis (hazard ratio, 0.21 [95% CI: 0.08-0.55]).
  
  
  
  This work provides important data to question the commonly used 8-mm margin as a prognosticator for local recurrence. More research is needed to address the question of whether additional treatment improves the prognosis in patients with a tumour-free margin of <8 mm.
authors: Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands.
authors: L S
authors: LS
authors: Nooij
authors: Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands.
authors: M A
authors: MA
authors: van der Slot
authors: Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors: O M
authors: OM
authors: Dekkers
authors: Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands.
authors: T
authors: T
authors: Stijnen
authors: Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.
authors: K N
authors: KN
authors: Gaarenstroom
authors: Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands.
authors: C L
authors: CL
authors: Creutzberg
authors: Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands.
authors: V T H B M
authors: VT
authors: Smit
authors: Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands.
authors: T
authors: T
authors: Bosse
authors: Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: M.I.E.van_Poelgeest@lumc.nl.
authors: M I E
authors: MI
authors: van Poelgeest
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D000072662:Margins of Excision; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D018365:Neoplasm, Residual; D011379:Prognosis; D016016:Proportional Hazards Models; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Local recurrence; Meta-analysis; Surgical treatment; Tumour-free margin; Vulvar cancer