Frozen Sections for Margins During Partial Nephrectomy Do Not Influence Recurrence Rates.

Area of Science:

• Urology
• Oncology
• Surgical Pathology

Background:

• Frozen sections (FS) are used to assess surgical margins during partial nephrectomy (PN) for clinically localized renal cell carcinoma (CLRCC).
• The oncologic benefit and long-term impact of FS on recurrence rates after PN are not well-established.

Purpose of the Study:

• To determine if the use of FS during PN for CLRCC influences local or metastatic recurrence rates.
• To evaluate the association between FS utilization and recurrence-free survival.

Main Methods:

• Retrospective review of 1090 patients undergoing open or robotic PN for CLRCC between 2006 and 2016.
• Comparison of recurrence rates between patients with and without intraoperative FS.
• Multivariate competing-risk regression analysis adjusting for all-cause mortality.
• Cost analysis of FS utilization.

Main Results:

• No significant difference in recurrence rates was observed between patients who had FS and those who did not (4.13% overall recurrence).
• Intraoperative FS was not associated with a reduced risk of recurrence (HR, 1.56; 95% CI, 0.65-3.76).
• Higher tumor grade and advanced tumor stage were significantly associated with increased recurrence risk.
• The average direct cost per patient for FS was $902.

Conclusions:

• Intraoperative FS for margin assessment during PN for CLRCC does not improve oncologic outcomes.
• The routine use of FS in this setting lacks demonstrated benefit and incurs additional costs.
• Consideration should be given to limiting the use of FS during PN to optimize resource allocation and patient care.