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

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.