Background
Retrospective single-institution series (UCLA, City of Hope). N=135, squamous cell carcinoma of the vulva treated with radical vulvectomy 1956–1987. Analyzed relationship between surgical excision margin width and local recurrence to define adequate-resection criteria.
Interventions and follow up
Treatment: Radical vulvectomy (surgical series)
Primary endpoint: Local vulvar recurrence rate by surgical margin width
mFollow up: NR (retrospective)
Primary endpoint: Local vulvar recurrence rate by surgical margin width
mFollow up: NR (retrospective)
Results
Local recurrence, margin <8 mm (fixed tissue): 48%
Local recurrence, margin ≥8 mm: 0%
Additional risk factors: VIN at margins, multifocal disease, older age
Local recurrence, margin ≥8 mm: 0%
Additional risk factors: VIN at margins, multifocal disease, older age
Adverse events
Main adverse events: Retrospective surgical series — toxicity not the focus. Radical vulvectomy morbidity (wound breakdown, sexual dysfunction, psychological sequelae) well documented but not analyzed here.
Conclusions
Surgical margin <8 mm (fixed tissue) is associated with markedly higher local recurrence (48%) vs ≥8 mm (0%), establishing the ≥8 mm fixed-tissue (≈10 mm fresh-tissue) margin standard for radical vulvectomy.
Key Limitations
Retrospective, single-institution series spanning three decades with treatment/staging heterogeneity. Small N. Fixed- vs fresh-tissue margin measurement ambiguity (contraction ~20%). No multivariate control for tumor size, grade, or LVSI. Contemporary data suggest 1–2 mm margins may be acceptable for tumors abutting clitoris/urethra/anus.
Clinical Context
Highly influential; the ≥8 mm rule entered surgical training for decades. Contemporary practice individualizes margins — close margins (1–5 mm) may not warrant re-excision if further surgery compromises function, with adjuvant RT addressing close margins. Reflects balancing functional outcomes against local control.