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. 2025 Jun 6;20(1):286.
doi: 10.1186/s13023-025-03760-x.

The clinical practice and outcomes of minimally invasive surgery in primary malignant melanoma of the vagina and cervix patients: a retrospective cohort study

Bin Liu #  1 , Yan Liu #  2 , Haixin He  1 , Wei Chen  1 , Haizhou Ji  1 , Ling Lin  1 , Quping Tan  1 , Yang Sun  3 , Cuibo Lin  4
Affiliations

The clinical practice and outcomes of minimally invasive surgery in primary malignant melanoma of the vagina and cervix patients: a retrospective cohort study

Bin Liu et al. Orphanet J Rare Dis. .

Abstract

Background: Primary malignant melanoma of the vagina (PMMV) and cervix (PMMC) are extremely rare tumors with a poor prognosis, lacking well-defined protocols or standardized treatment guidelines. While the preferred management for early-stage PMMV and PMMC is surgery, comprehensive reports on the impact of various surgical techniques on cancer outcomes are scarce.

Objective: This study aimed to compare outcomes between open and minimally invasive surgery (MIS) in PMMV and PMMC, and concurrently evaluated prognostic risk factors for these conditions.

Methods: We conducted a single-center retrospective cohort study of PMMV and PMMC patients treated surgically from January 2000 to July 2021. Clinicopathological features and surgical outcomes were assessed retrospectively. Patients underwent either open surgery or MIS. Disease-Free Survival (DFS) rates were compared.

Results: Of 45 eligible patients, the MIS group showed a higher rate of total vaginectomy (P = 0.022), reduced median intraoperative blood loss (P = 0.031), shorter median hospital stay (P = 0.042), and no significant increase in perioperative complications (P = 0.867). The incidence of negative margins < 1 cm was significantly lower in the MIS group (P = 0.032). Cox proportional hazards regression identified microsatellites (HR = 2.893 [1.042-8.029]; P = 0.042), surgical negative margin distance (HR = 0.042 [0.008-0.217]; P < 0.001), and total vaginectomy (HR = 0.042 [0.008-0.217]; P < 0.001) as independent prognostic factors for DFS. MIS was linked to a significant difference in 2-year DFS (P = 0.030), but there was no notable difference in overall survival (OS) compared to open surgery (P = 0.078). The outcomes are validated through sensitivity analysis and hierarchical assessment, leading to the development of a novel nomogram simultaneously.

Conclusions: Total vaginectomy may improve DFS in PMMV and PMMC patients. A combination of MIS and radical vaginal resection can effectively manage PMMV and PMMC as an initial surgical strategy.

Keywords: Minimally invasive surgery; Outcomes; Primary malignant melanoma of the cervix; Primary malignant melanoma of the vagina; Rare diseases.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Fujian Cancer Hospital’s ethics committee on September 10, 2023. Approval number: K2023-246–01. Consent for publication: Not applicable. Competing interests: The authors have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Flow chart of patients selection
Fig. 2
Fig. 2
The Kaplan–Meier survival curve demonstrates the 2-year disease-free survival rates of patients with primary malignant melanoma of the vagina and cervix who underwent minimally invasive surgery
Fig. 3
Fig. 3
The Kaplan–Meier survival curve demonstrates the 2-year overall survival rates of patients with primary malignant melanoma of the vagina and cervix who underwent minimally invasive surgery
Fig. 4
Fig. 4
The Kaplan–Meier survival curve demonstrates the 2-year disease-free survival rates of patients with primary malignant melanoma of the vagina and cervix who underwent total vaginectomy
Fig. 5
Fig. 5
The Kaplan–Meier survival curve demonstrates the 2-year overall survival rates of patients with primary malignant melanoma of the vagina and cervix who underwent partial vaginectomy
Fig. 6
Fig. 6
A nomogram to predict the risk of recurrence in primary malignant melanoma of the vagina and cervix
Fig. 7
Fig. 7
Receiver operating characteristics (ROC) curve and calibration plot. A Receiver operating characteristics (ROC) curve, B calibration plot
See this image and copyright information in PMC

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