Outcome of Patients with Cervical and Vaginal Stump Carcinomas Treated with More Conservative Surgical Approaches: a 9-Year Experience of a Tertiary Oncology Center

Abstract

The surgical management of stump carcinoma includes the gold standard pelvic exenteration and more conservative approaches. This study aimed to investigate the outcome among a cohort of vaginal and cervical stump carcinomas that were treated with an intent of organ preservation. This is a prospective study of 60 patients with a biopsy confirmed stump carcinomas at a tertiary care oncology center in Egypt. The demographic, surgical, and pathological data were collected and patients underwent radical surgery with an intent of organ preservation guided by margin negativity. The pathologic data were correlated with the postoperative mortality. Correlation coefficients were calculated for simple correlation and regression analysis was used to investigate the independent predictors of survival. Pelvic exenteration was conducted in 30/60 (50%), while wide local excision with safety margins was possible in 26/60 (43%) and in two cases, resection was precluded. Mean hospital stay in days was 19 ± 9 (range 4-61). Overall operative morbidity was 83.3% (50/60). Perioperative mortality was 6.7% (4/60). Five-year diseasefree survival was 40% (24/60). Five-year overall survival was 50% (30/60). The resection margin status and the perioperative therapy were independent prognostic factors of DFS (p = 0.003 and 0.02, respectively. Only the resection margin status was significantly associated with overall survival (p = 0.009). There was no increased mortality with introduction of more conservative surgical approaches. The resection margin status is the most important determinant of recurrence free and overall survivals.

R0 resection of vaginal stump recurrence of gynecologic malignancy by bi‐directional endoscopic approach: A case series of four patients

“…1 Regarding localized recurrence, local excision has been the primary treatment option, in which precise surgical margin is critical. 2 Hegazy et al reported no increase in mortality after local tumor resection with disease-free resection margins. This indicates that strict margins for resecting vaginal stump recurrence could improve outcomes.…”

“…Hegazy et al reported no increase in mortality after local tumor resection with disease‐free resection margins. This indicates that strict margins for resecting vaginal stump recurrence could improve outcomes 2 . Laparoscopic approaches for treating vaginal stump recurrences have been reported 1 .…”

“…Vaginal stump recurrence occurs after hysterectomies for gynecological malignancies in 2%–3% of cases 1 . Currently known treatment strategies include total pelvic exenteration, local excision (conservative approaches), 2 and radiation therapy. Although radiotherapy has been reported to be effective, there is a known risk of late complications 3,4 .…”

“…There is no consensus on a treatment strategy for this recurrence 1 . Regarding localized recurrence, local excision has been the primary treatment option, in which precise surgical margin is critical 2 . Hegazy et al reported no increase in mortality after local tumor resection with disease‐free resection margins.…”

“…This indicates that strict margins for resecting vaginal stump recurrence could improve outcomes. 2 Laparoscopic approaches for treating vaginal stump recurrences have been reported. 1 However, vaginal margins are set and incised using conventional transvaginal approaches.…”