355 INTRAOPERATIVE SURFACE FROZEN SECTION OF THE PROSTATE TO MINIMIZE POSITIVE MARGIN RATE AND ENSURE PRESERVATION OF NEUROVASCULAR BUNDLES

Abstract

You have accessJournal of UrologyProstate Cancer: Localized (I)1 Apr 2013355 INTRAOPERATIVE SURFACE FROZEN SECTION OF THE PROSTATE TO MINIMIZE POSITIVE MARGIN RATE AND ENSURE PRESERVATION OF NEUROVASCULAR BUNDLES Christian von Bodman, Marko Brock, Björn Löppenberg, Florian Roghmann, Anne Byers, Katharina Braun, Jobst Pastor, Florian Sommerer, Joachim Noldus, and Jüri Palisaar Christian von BodmanChristian von Bodman Herne, Germany More articles by this author , Marko BrockMarko Brock Herne, Germany More articles by this author , Björn LöppenbergBjörn Löppenberg Herne, Germany More articles by this author , Florian RoghmannFlorian Roghmann Herne, Germany More articles by this author , Anne ByersAnne Byers Washington, DC More articles by this author , Katharina BraunKatharina Braun Herne, Germany More articles by this author , Jobst PastorJobst Pastor Herne, Germany More articles by this author , Florian SommererFlorian Sommerer Bochum, Germany More articles by this author , Joachim NoldusJoachim Noldus Herne, Germany More articles by this author , and Jüri PalisaarJüri Palisaar Herne, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1742AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Preoperative variables used to plan radical prostatectomy are associated with a significant risk of misclassification. To evaluate whether intraoperative frozen section analysis of the relevant prostate surface might provide significant information ensuring nerve-sparing and minimizing positive margin rates. METHODS Between June 2011 and September 2012, 236 patients treated with radical prostatectomy (RP) (n=176 open retropubic RP; n=60 robot assisted laparoscopic RP) received intraoperative whole surface frozen section analysis of the removed prostate. Median patient age was 64 years (IQR: 60 - 70) and median pre-operative PSA 6.75 ng/ml (IQR: 5.1 - 10.0). The apex and base were circumferencially dissected as well as the whole posterolateral tissue corresponding to the neurovascular bundles (NVB). The dissected specimens were perpendicularly cut for frozen section analysis resulting in 22-24 surface sections to navigate the procedure. Pre-, intra- and postoperative parameters were prospectively collected. RESULTS Intraoperative frozen section analysis identified positive surgical margins in 22% (NVB: 56.9%, apex 34.5%, base: 8.6%). Nerve-sparing in pT2, pT3a and pT3b patients was performed in 96.5%, 84.1% and 81.8%, respectively. Of men with a positive surgical margin detected at frozen section analysis, 92.3% could be converted to a negative status, while 7.7% remained positive. Final positive margin status of the total cohort was 3% including a false negative frozen section rate of 1.6%. In 14.8% the initial nerve sparing plan was intraoperatively changed due to positive frozen section results. In secondary resected specimen cancer was histopathologically detected in 25%. Final pathology showed Gleason upgrading (≤6 to 7 or 7 to ≥ 8) or upstaging (cT1c + cT2 to T3) in 40.7% compared to preoperative variables. Comparing the group of patients with positive versus negative margins on frozen section, preoperative variables were not significantly different while postoperatively pathologic stage, tumor volume, length of surgery and final margin status were. 13% of patients who had exclusively unilateral positive biopsies showed an intraoperative positive surgical margin on the opposite, biopsy negative, site. CONCLUSIONS Frozen section analysis might help to keep the positive surgical margin rate as low as possible but allow safer preservation of functional anatomic structures in misclassified patients or even patients at higher preoperative risk. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e144 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian von Bodman Herne, Germany More articles by this author Marko Brock Herne, Germany More articles by this author Björn Löppenberg Herne, Germany More articles by this author Florian Roghmann Herne, Germany More articles by this author Anne Byers Washington, DC More articles by this author Katharina Braun Herne, Germany More articles by this author Jobst Pastor Herne, Germany More articles by this author Florian Sommerer Bochum, Germany More articles by this author Joachim Noldus Herne, Germany More articles by this author Jüri Palisaar Herne, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...