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. 2023 Jul:174:21-27.
doi: 10.1016/j.ygyno.2023.03.005. Epub 2023 May 3.

Surgical margin status in relation to surgical approach in the management of early-stage cervical Cancer: A Canadian cervical Cancer collaborative (4C) study

Sabrina Piedimonte  1 , Limor Helpman  2 , Gregory Pond  2 , Gregg Nelson  3 , Janice Kwon  4 , Alon Altman  5 , Tomer Feigenberg  6 , Laurie Elit  2 , Susie Lau  7 , Jeanelle Sabourin  8 , Vanessa Samouelian  9 , Karla Willows  10 , Christa Aubrey  8 , Ji-Hyun Jang  4 , Ly-Ann Teo-Fortin  11 , Norah Cockburn  2 , Nora-Beth Saunders  5 , Sarah Shamiya  8 , Danielle Vicus  12 , Marie Plante  13 ; 4C: Canadian Cervical Cancer Collaborative
Affiliations

Surgical margin status in relation to surgical approach in the management of early-stage cervical Cancer: A Canadian cervical Cancer collaborative (4C) study

Sabrina Piedimonte et al. Gynecol Oncol. 2023 Jul.

Abstract

Objective: Surgical margin status in women undergoing surgery for early-stage cervical cancer is an important prognostic factor. We sought to determine whether close (<3 mm) and positive surgical margins are associated with surgical approach and survival.

Methods: This is a national retrospective cohort study of cervical cancer patients treated with radical hysterectomy. Patients with stage IA1/LVSI-Ib2(FIGO 2018) with lesions up to 4 cm at 11 Canadian institutions from 2007 to 2019 were included. Surgical approach included robotic/laparoscopic (LRH), abdominal (ARH) or combined laparoscopic-assisted vaginal/vaginal (LVRH) radical hysterectomy. Recurrence free survival(RFS) and overall survival (OS) were estimated using Kaplan-Meier analysis. Chi-square and log-rank tests were used to compare groups.

Results: 956 patients met inclusion criteria. Surgical margins were as follows: negative (87.0%), positive (0.4%) or close <3 mm (6.8%), missing (5.8%). Most patients had squamous histology (46.9%); 34.6% had adenocarcinomas and 11.3% adenosquamous. Most were stage IB (75.1%) and 24.9% were IA. Mode of surgery included: LRH(51.8%), ARH (39.2%), LVRH (8.9%). Predictive factors for close/positive margins included stage, tumour diameter, vaginal involvement and parametrial extension. Surgical approach was not associated with margin status (p = 0.27). Close/positive margins were associated with a higher risk of death on univariate analysis (HR = non calculable for positive and HR = 1.83 for close margins, p = 0.017), but not significant for OS when adjusted for stage, histology, surgical approach and adjuvant treatment. There were 7 recurrences in patients with close margins (10.3%, p = 0.25). 71.5% with positive/close margins received adjuvant treatment. In addition, MIS was associated with a higher risk of death (OR = 2.39, p = 0.029).

Conclusion: Surgical approach was not associated to close or positive margins. Close surgical margins were associated with a higher risk of death. MIS was associated with worse survival, suggesting that margin status may not be the driver of worse survival in these cases.

Keywords: Early cervical cancer; MIS; Surgical margin; Survival.

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