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Surgeons' preferences and practice patterns regarding intraoperative frozen section during partial nephrectomy.

Abhinav Sidana1, James F Donovan1, Krishnanath Gaitonde1

  • 1Division of Urology, University of Cincinnati College of Medicine, Cincinnati, OH.

Urologic Oncology
|May 20, 2014
PubMed
Summary

Most urologists still use intraoperative frozen section (FS) during partial nephrectomy (PN), despite evidence of low clinical utility. Older surgeons are more likely to use FS, but it rarely changes management for positive margins.

Keywords:
Frozen sectionPartial nephrectomyRenal cell cancerSurgical margins

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Area of Science:

  • Urologic Oncology
  • Surgical Pathology

Background:

  • Intraoperative frozen section (FS) evaluation for tumor margin during partial nephrectomy (PN) is controversial.
  • Current literature suggests limited clinical utility of FS in this setting.

Purpose of the Study:

  • To evaluate urologist preferences and practice patterns regarding intraoperative FS during PN.
  • To identify factors influencing the use of FS in PN.

Main Methods:

  • A 17-item questionnaire was distributed to members of the Society of Urologic Oncology and Endourological Society.
  • The survey collected data on surgeons' preferences and practices concerning FS during open PN (OPN) and laparoscopic PN (LPN).

Main Results:

  • 197 urologists responded, with 69% and 58% using FS during OPN and LPN, respectively.
  • Younger surgeons were less likely to use FS during OPN.
  • Surgeons not using FS cited confidence in complete resection (79%) and no change in management (35%) as primary reasons.
  • Most surgeons (95%) would not recommend additional treatment for positive margins on final pathology.

Conclusions:

  • The majority of surgeons continue to utilize FS during PN, contrary to recent literature.
  • Older surgeons demonstrate a higher propensity for using FS.
  • Fellowship training and practice type did not significantly impact FS preferences or practices.