Predicting Factors for Positive Vaginal Surgical Margin Following Radical Hysterectomy for Stage IB1 Carcinoma of the Cervix


Background: To examine the incidence of positive vaginal surgical margins and determine the predictingfactors following radical hysterectomy for stage IB1 carcinoma of the cervix. Materials and
Methods: The clinicaland histological data of 656 FIGO stage IB1 cervical cancer patients who had radical hysterectomy with bilateralpelvic lymphadenectomy (RHPL) from January 2003 to December 2012 were retrospectively reviewed andwere analyzed for their association with a positive vaginal surgical margin. A p-value of < 0.05 was consideredsignificant.
Results: Thirty-five patients (5.3%) had positive vaginal surgical margins following RHPL; 24(3.7%) for intraepithelial lesions and 11 (1.7%) for carcinoma. On multivariate analysis, microscopic vaginalinvolvement by high-grade squamous intraepithelial lesion and/or carcinoma (adjusted odd ratio (OR) 186.8;95% confidence interval (CI) 48.5-718.5) and squamous histology (OR 8.7; 95% CI 1.7-44.0), were significantlyassociated with positive vaginal surgical margin.
Conclusions: Microscopic vaginal involvement by HSIL and/or carcinoma are strong predictors for positive vaginal surgical margins for stage IB1 cervical cancer patientsundergoing radical hysterectomy. Preoperative ‘mapping’ colposcopy or other strategies should be consideredto ensure optimal vaginal resection.