Abstract
Purpose
Enhanced surgical techniques and standardised selection criteria have led to a higher rate of nerve-sparing (NS) radical prostatectomy (RP) procedures. The aim of this study was to evaluate the clinical value of intraoperative frozen sections (IFS) during nerve-sparing radical prostatectomy (NSRP).
Materials and methods
Thousand and eighty-three patients with localised prostatic carcinoma were treated using retropubic RP (from 2004 to 2006). Two hundred and eighty-seven of the 1083 documented cases received NS. One hundred and thirty procedures were carried out with IFS from the area of the neurovascular bundles and 157 without IFS. The decision to use IFS was made intraoperatively and based on clinical suspicion of possible positive resection margins in the area of the bundles.
Results
In the NS group with IFS, the results revealed positive margins in nine (6.9%) out of 130 cases, resulting in subsequent resection of the ipsilateral neurovascular bundle. The final histological report on this group revealed four additional patients (3.1%) with positive margins, but only one (0.7%) in the area of the previous neurovascular bundle. The final histopathologic reports on the 157 NS cases without IFS showed that the positive margin was in the area of the previous neurovascular bundle in only one (0.6%) of the nine cases with positive margins (5.7%).
Conclusion
According to our data, there is no need for routine IFS during NSRP. The negative predictive value for infiltration of the NVB is high, and IFS can be dispensed with. Intraoperative biopsies should be taken in those cases where the surgeon is in doubt about the resection margins in the area of bundles.
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References
Epstein JI, Pizov G, Walsh PC (1993) Correlation of pathologic findings with progression after radical retropubic prostatectomy. Cancer 71:3582–3593
Grossfeld GD, Latini DM, Lubeck DP, Mehta SS, Carroll PR (2003) Predicting recurrence after radical prostatectomy for patients with high risk prostate cancer. J Urol 169:157–163
Catalona WJ, Smith DS (1994) 5-year tumor recurrence rates after anatomical radical retropubic prostatectomy for prostate cancer. J Urol 152:1837–1842
Walsh PC, Partin AW, Epstein JI (1994) Cancer control and quality of life following anatomical radical retropubic prostatectomy: results at 10 years. J Urol 152:1831–1836
Ohori M, Wheeler TM, Kattan MW, Goto Y, Scardino PT (1995) Prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol 154:1818–1824
Graefen M, Haese A, Pichlmeier U, Hammerer PG, Noldus J, Butz K, Erbersdobler A, Henke RP, Michl U, Fernandez S et al (2001) A validated strategy for side specific prediction of organ confined prostate cancer: a tool to select for nerve sparing radical prostatectomy. J Urol 165:857–863
Kattan MW, Stapleton AM, Wheeler TM, Scardino PT (1997) Evaluation of a nomogram used to predict the pathologic stage of clinically localized prostate carcinoma. Cancer 79:528–537
Partin AW, Kattan MW, Subong EN, Walsh PC, Wojno KJ, Oesterling JE, Scardino PT, Pearson JD (1997) Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. JAMA 277:1445–1451
Eichelberg C, Erbersdobler A, Haese A, Schlomm T, Chun FK, Currlin E, Walz J, Steuber T, Graefen M, Huland H (2006) Frozen section for the management of intraoperatively detected palpable tumor lesions during nerve-sparing scheduled radical prostatectomy. Eur Urol 49:1011–1016 discussion 1016–8
Cangiano TG, Litwin MS, Naitoh J, Dorey F, deKernion JB (1999) Intraoperative frozen section monitoring of nerve sparing radical retropubic prostatectomy. J Urol 162:655–658
Goharderakhshan RZ, Sudilovsky D, Carroll LA, Grossfeld GD, Marn R, Carroll PR (2002) Utility of intraoperative frozen section analysis of surgical margins in region of neurovascular bundles at radical prostatectomy. Urology 59:709–714
Graefen M, Walz J, Huland H (2006) Open retropubic nerve-sparing radical prostatectomy. Eur Urol 49:38–48
Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Schmid HP, Zattoni F (2008) EAU guidelines on prostate cancer. Eur Urol 53:68–80
Gontero P, Kirby RS (2005) Nerve-sparing radical retropubic prostatectomy: techniques and clinical considerations. Prostate Cancer Prostatic Dis 8:133–139
Sokoloff MH, Brendler CB (2001) Indications and contraindications for nerve-sparing radical prostatectomy. Urol Clin North Am 28:535–543
Quinlan DM, Epstein JI, Carter BS, Walsh PC (1991) Sexual function following radical prostatectomy: influence of preservation of neurovascular bundles. J Urol 145:998–1002
Catalona WJ, Basler JW (1993) Return of erections and urinary continence following nerve sparing radical retropubic prostatectomy. J Urol 150:905–907
Bolenz C, Gierth M, Grobholz R, Kopke T, Semjonow A, Weiss C, Alken P, Michel MS, Trojan L (2008) Clinical staging error in prostate cancer: localization and relevance of undetected tumour areas. BJU Int 103(9):1184–1189
Partin AW, Borland RN, Epstein JI, Brendler CB (1993) Influence of wide excision of the neurovascular bundle(s) on prognosis in men with clinically localized prostate cancer with established capsular penetration. J Urol 150:142–146 discussion 146–8
Pfitzenmaier J, Pahernik S, Tremmel T, Haferkamp A, Buse S, Hohenfellner M (2008) Positive surgical margins after radical prostatectomy: do they have an impact on biochemical or clinical progression? BJU Int 102:1413–1418
Sofer M, Hamilton-Nelson KL, Civantos F, Soloway MS (2002) Positive surgical margins after radical retropubic prostatectomy: the influence of site and number on progression. J Urol 167:2453–2456
Pettus JA, Weight CJ, Thompson CJ, Middleton RG, Stephenson RA (2004) Biochemical failure in men following radical retropubic prostatectomy: impact of surgical margin status and location. J Urol 172:129–132
Eastham JA, Kuroiwa K, Ohori M, Serio AM, Gorbonos A, Maru N, Vickers AJ, Slawin KM, Wheeler TM, Reuter VE et al (2007) Prognostic significance of location of positive margins in radical prostatectomy specimens. Urology 70:965–969
Godoy G, Tareen BU, Lepor H (2009) Site of positive surgical margins influences biochemical recurrence after radical prostatectomy. BJU Int
Vickers AJ, Bianco FJ, Gonen M, Cronin AM, Eastham JA, Schrag D, Klein EA, Reuther AM, Kattan MW, Pontes JE et al (2008) Effects of pathologic stage on the learning curve for radical prostatectomy: evidence that recurrence in organ-confined cancer is largely related to inadequate surgical technique. Eur Urol 53:960–966
Lepor H, Kaci L (2004) Role of intraoperative biopsies during radical retropubic prostatectomy. Urology 63:499–502
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Heinrich, E., Schön, G., Schiefelbein, F. et al. Clinical impact of intraoperative frozen sections during nerve-sparing radical prostatectomy. World J Urol 28, 709–713 (2010). https://doi.org/10.1007/s00345-010-0529-3
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DOI: https://doi.org/10.1007/s00345-010-0529-3