The status of surgical margins in relation to the type of surgical approach in the management of early-stage cervical cancer: Canadian Cervical Cancer Collaborative (4C) study (533)

Abstract

<b>Objectives:</b> Surgical margin status in women undergoing surgery for early-stage cervical cancer is considered an important prognostic factor. We sought to determine if positive or close surgical margin status (<3mm) is related to the type of surgical approach and associated with worse outcomes. <b>Methods:</b> A national retrospective cohort study of cervical cancer treated with a radical hysterectomy was conducted. Patients with stage IA1 (LVSI positive) to IIIC2 (FIGO 2018) with lesions up to 4cm at ten Canadian institutions from 2007-2019 were included. Surgical approaches for the radical hysterectomy included robotic/laparo- scopic (RLRH), abdominal (ARH), or laparoscopic-assisted vaginal/ vaginal hysterectomy (LVVRH). Recurrence-free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier analysis. Chi-square and log-rank tests were used to compare between cohorts. <b>Results:</b> A total of 960 patients met the inclusion criteria. The majority of patients had squamous histology (470, 49%), while 343 (35.7%) had adenocarcinomas and 113 (11.8%) had adenosquamous. Most were stage IB (681, 70.0%) and 183 (19%) were IA. Mode of surgery included: 495 (51.6%) RLRH, 88 (9.2%) LVVRH and 376 (39.2%) ARH. Surgical margins were negative in 819 (85.3%), positive in 15 (1.6%) or close in 103 (10.7%) patients. Factors predictive of close/positive margins included stage, tumor diameter, vaginal involvement, and parametrial extension; the surgical approach was not a predictor of margin status (p=0.38). Close/positive margins were associated with a higher risk of death on univariate analysis (HR: 2.53; 95% CI: 0.78-8.22) for positive margins and 1.83 (95% CI: 1.04-3.24) for close margins, p=0.05), but margin status was not significant for OS or PFS when adjusting for stage, histology, surgical approach, and adjuvant treatment. Overall, 71% of patients with positive margins and 60% of patients with close margins received adjuvant treatment. One patient (6.7%) with positive margins recurred distantly, despite having received adjuvant chemoradiation; 16 patients (15.3%) with close margins recurred (p=0.023), with 73% having received either adjuvant radiation or chemoradiation. The surgical approach was not statistically associated with either OS (p=0.067) or PFS (p=0.06). <b>Conclusions:</b> Positive or close surgical margins were not found to be associated with the use of the minimally invasive surgical (MIS) approach. MIS approach did not appear to negatively impact outcomes. Positive or close surgical margins were not associated with worse outcomes, possibly due to adjuvant treatment.