From 1965 to 1995, at the University of Miami/Jackson Memorial Medical
Center, 1223 patients with stage IA2, IB, or IIA cervical cancer have
undergone a radical hysterectomy. The charts of these patients were r
eviewed retrospectively for pathology reports showing positive or clos
e surgical margins. Fifty-one of these cases had final pathology resul
ts interpreted as close vaginal margins (CVM), which we define as tumo
r less than or equal to 0.5 cm from the vaginal margins of resection.
All slides of blocks with close vaginal margins were found and reviewe
d by a single pathologist. Twenty-eight (54.9%) had parametrial involv
ement or positive lymph nodes and received adjuvant radiation therapy
(RT). Of the remaining 23 cases, only 6 had other high risk factors, t
umor greater than 4 cm, poorly differentiated, greater than 50% invasi
on, or lymphovascular space involvement. Sixteen of 23 received radiat
ion. The 5-year survival was significantly greater with RT, 81.3%, tha
n without RT, 28.6% (P < 0.05). The recurrence rate was also decreased
from 85.7 to 12.5% (P < 0.01). Although present in less than 2% of ra
dical hysterectomy specimens, CVM without other high risk factors may
be an important prognostic variable that should be considered when mak
ing adjuvant therapy decisions. (C) 1998 Academic Press.