Does Vaginal Cuff Length After Radical Hysterectomy Predict a Localized Recurrence of Cervical Cancer? [236

Abstract

OBJECTIVE: The recurrence for cervical cancer after radical hysterectomy is 10–20%. Traditional therapy is to remove the upper one third or 2 cm of the vagina. Our aim was to determine whether the length of vaginal margin is associated with localized recurrence of cancer. METHODS: A review of patients treated by radical hysterectomy and pelvic lymphadenectomy was conducted ranging from 1987 to 2005. Vaginal length (mm) was defined as the length of vaginal tissue from a normal cervix to the distal vaginal margin. RESULTS: A total of 169 patients with stage IB1 cervical cancer were identified. The mean age was 41 years. There were 108 patients with squamous carcinoma and 46 patients with adenocarcinoma. Forty-seven patients had grade 3 tumors; 66 patients had lymph vascular space invasion. Fifteen patients had metastases to the pelvic lymph nodes at presentation. The median follow-up was 12 years with 19 recurrences: seven vaginal, eight pelvic, and four distant. Twenty-six patients died of disease. The 5-year actuarial survival rate is 89%. Mean vaginal cuff length was 13 mm and did not correlate with vaginal (P=.377) or pelvic (P=.318) recurrence. Cell type and vaginal cuff length were not associated with localized recurrence. CONCLUSION: Vaginal cuff length at time of radical hysterectomy is not associated with recurrent cancer in the vagina or pelvis. Surgeons should tailor therapy according to the individual patient; however, excessive margins are not necessary; vaginal margins are unnecessary to prevent localized recurrence.