Association between resection margin and local recurrence in the treatment of primary squamous cell vulvar carcinoma.

Objective: Our aim was to assess the potential correlation between resection-free margin and local recurrence in the treatment of squamous cell vulvar carcinoma (SCC).

Methods: Seventy-five patients with primary SCC of the vulva and adequately follow-up that were operated in our university hospital between January 2008 to December 2018, were retrospectively evaluated with focus on resection-free margin and its impact on local recurrence. Several prognostic factors were analysed for possible correlation.

Results: Median patient age and follow-up was 62.8 years and 57.4 months, respectively. Among all patients, 27 (36%) local recurrences were documented, for a median local recurrence-free survival (LRFS) of 68.1 months for patients resected R0 and 65.6 months for those initially R1 resected (p=0.750). There was also no statistically significant difference (p=0.750) when evaluating the LRFS relative to the absence or not of inguinal lymph node involvement, although there was a numerical difference of approximately 17 months (73.9 vs. 57.3 months). For initially R0 resected patients, no significant influence of the resection-free margin in millimeters on LRFS was noted for a median of 58.4 versus 57.3 months for patients with a free margin of 0.1-3 mm and those with a free margin of >3 mm, respectively (p=0.800). Eleven patients received adjuvant chemoradiotherapy, all for nodal inguinal involvement. Among them, 5 patients developed recurrence, while the other 6 remained free of disease.

Conclusion: The extend of resection-free margin does not appear to adversely affect LRFS suggesting that smaller margins could be applied to minimize morbidity without compromising local control.