Laparoscopic Radical Prostatectomy: The Value of Intraoperative Frozen Sections

Dillenburg, Wolfgang; Poulakis, Vasileios; Witzsch, U.; Vries, Rachelle de; Skriapas, Konstantinos; Altmansberger, Hans-Michael; Becht, E.

doi:10.1016/j.eururo.2005.06.015

Cited by 39 publications

(24 citation statements)

References 29 publications

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“…However, a short follow‐up period of 3 months in this study does not allow any prognostic conclusions. In one study, apical FS helped to decrease the overall PSM status by 5.1%[16]. However, sensitivity of FS from the apical margin to detect prostate cancer is limited in comparison with permanent section examination [14].…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative peripheral frozen sections do not significantly affect prognosis after nerve‐sparing radical prostatectomy for prostate cancer

et al. 2010

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RESULTS• Of all 188 prostatectomy specimens, 49 (26.1%) had positive surgical margins (PSM); these were found posterolaterally in 15 (30.6%), apically in 13 (26.5%), basally in 10 (20.4%) and at multiple sites in 11 (22.4%) specimens.• Intraoperative peripheral FS were positive in 19 (10.7%) patients, including 6.2% at urethral stump, 3.3% at lateral pedicles and 1.1% at bladder neck.• In organ-confined disease, BCR-free survival was 93.3% (111/119) for patients with negative surgical margins (NSM) and 72% (18/25) for patients with PSM (inked specimen), but negative peripheral FS ( P < 0.001).• Five-and 10-year BCR-free survival for NSM was 94.9% and 92.8%, for PSM with negative peripheral FS it was 75.3% and 70.6%, and for PSM with positive peripheral FS it was 62.5% and 62.5%, respectively. CONCLUSIONS• Frozen section biopsies of peripheral resection margins during nerve-sparing radical prostatectomy are not reliable in predicting PSM.• Intraoperative achievement of a locally disease-free status, as monitored by negative circumferential intraoperative FS of peripheral margins, is not associated with a statistically significant BCR-free survival benefit compared with patients with negative surgical margins on the prostatectomy specimen.• Based on these findings, we do not recommend a routine of systematically taking intraoperative FS biopsies during nerve-sparing radical prostatectomy. KEYWORDSfrozen sections, prostate cancer, prostate neoplasms, prostate-specific antigen, retropubic prostatectomy What's known on the subject? and What does the study add? We hypothesized that taking intraoperative frozen section (FS) biopsies of the peripheral margins of resection during radical prostatectomy would allow an intraoperative systematic scan of resection margins. In the case of positive FS, extended resection could be performed with the aim of completely excising residual tumour, improving biochemical recurrence-free survival of patients with positive surgical margins at the inked specimen. To our knowledge, the prognostic value of achieving a negative resection status by systematically taking intraoperative FS of the peripheral margins of resection during radical prostatectomy has not been established to date.Study Type -Therapy (outcomes research) Level of Evidence 2b OBJECTIVE• To determine the value of systematic intraoperative peripheral frozen sections (FS) with or without extended resection during nerve-sparing radical prostatectomy for prediction of biochemical recurrence (BCR) compared with inked surgical margins. Between 1999 and 2003, in a prospective study, multiple peripheral FS (median 14; range 5-20) were taken from the urethral stump, circumferentially from the bladder neck, and from the lateral pedicles in 200 consecutive bilateral nerve-sparing radical prostatectomies for clinically localized prostate cancer by a single surgeon. PATIENTS AND METHODS •• Patients with stage pT3b or more and/or positive lymph nodes were excluded.• Of the 188 patients, 178 (94.7%) were followed over a median of 82 m...

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Section: Discussionmentioning

confidence: 99%

“…The efficacy of intraoperative FS to monitor surgical margin status has been evaluated before [7,14–18]. Shah et al .…”

Section: Discussionmentioning

confidence: 99%

Intraoperative peripheral frozen sections do not significantly affect prognosis after nerve‐sparing radical prostatectomy for prostate cancer

et al. 2010

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“…The only approach currently in use to rapidly evaluate margin status during surgery is through microscopic assessment of intraoperative frozen sections (IFS) [33], [34]. In these cases, the tissue is removed from the body, flash frozen, histochemically stained, and microscopically evaluated by a pathologist.…”

Section: Discussionmentioning

confidence: 99%

Toward Microendoscopic Electrical Impedance Tomography for Intraoperative Surgical Margin Assessment

Halter

Kim

2014

IEEE Trans. Biomed. Eng.

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No clinical protocols are routinely used to intraoperatively assess surgical margin status during prostate surgery. Instead, margins are evaluated through pathological assessment of the prostate following radical prostatectomy, when it is too late to provide additional surgical intervention. An intraoperative device potentially capable of assessing surgical margin status based on the electrical property contrast between benign and malignant prostate tissue has been developed. Specifically, a microendoscopic electrical impedance tomography (EIT) probe has been constructed to sense and image, at near millimeter resolution, the conductivity contrast within heterogeneous biological tissues with the goal of providing surgeons with real-time assessment of margin pathologies. This device consists of a ring of eight 0.6-mm diameter electrodes embedded in a 5-mm diameter probe tip to enable access through a 12-mm laparoscopic port. Experiments were performed to evaluate the volume of tissue sensed by the probe. The probe was also tested with inclusions in gelatin, as well as on a sample of porcine tissue with clearly defined regions of adipose and muscle. The probe's area of sensitivity consists of a circular area of 9.1 mm2 and the maximum depth of sensitivity is approximately 1.5 mm. The probe is able to distinguish between high contrast muscle and adipose tissue on a sub-mm scale (~500 μm). These preliminary results suggest that EIT is possible in a probe designed to fit within a 12-mm laparoscopic access port.

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“…In a series of 500 prostatectomy cases, 21 (4.5%) of 468 FSAs at the apex were positive for carcinoma, and additional tissue resection in some of these cases resulted in a decrease in the rate of positive surgical margins to 3.8% . Similarly, initial positive FSA at the apex (6.1% of 198 apical biopsies) and subsequent resection in all these cases reduced the positive margin rate from 8.6% to 3.5% ( P = 0.01) . Meanwhile, additional excision of the urethral stump has been associated with increased risks of postoperative incontinence .…”

Section: Fsa Of Surgical Margins During Prostatectomymentioning

confidence: 99%

Clinical benefits of frozen section assessment during urological surgery: Does it contribute to improving surgical margin status and patient outcomes as previously thought?

Miyamoto

2016

Int J of Urology

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Abbreviations & Acronyms CIS = carcinoma in situ FSA = frozen section assessment MRI = magnetic resonance imaging NA = not available NVB = neurovascular bundle PSA = prostate-specific antigen RCC = renal cell carcinoma RP = radical prostatectomy SM = surgical margin Abstract: Despite significant advances in patient selection as well as surgical technique over the past few decades, it is still not uncommon for patients with urological malignancy and positive surgical margins to be observed. Meanwhile, intraoperative pathology consultation with frozen section assessment, which generally provides useful information for the optimal procedure, has been widely utilized for the assessment of surgical margins during urological surgeries. Thus, it remains unanswered whether intraoperative frozen section assessment has an impact on final surgical margin status as well as long-term oncological outcomes. The present review summarizes and discusses available data assessing the utility of frozen section assessment of the surgical margins during urological surgeries, such as radical prostatectomy, partial nephrectomy and radical cystectomy. The current findings suggest that select patients might benefit from the routine frozen section assessment.

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Laparoscopic Radical Prostatectomy: The Value of Intraoperative Frozen Sections

Cited by 39 publications

References 29 publications

Intraoperative peripheral frozen sections do not significantly affect prognosis after nerve‐sparing radical prostatectomy for prostate cancer

Intraoperative peripheral frozen sections do not significantly affect prognosis after nerve‐sparing radical prostatectomy for prostate cancer

Toward Microendoscopic Electrical Impedance Tomography for Intraoperative Surgical Margin Assessment

Clinical benefits of frozen section assessment during urological surgery: Does it contribute to improving surgical margin status and patient outcomes as previously thought?

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