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Intraoperative Frozen Section for Margin Evaluation During Radical Prostatectomy: A Systematic Review
Eoin P Dinneen1, Michelle Van Der Slot2, Kelvin Adasonla3
1Division of Surgery and Interventional Science, University College London, Fitzrovia, London, UK; Department of Urology, University College London Hospital, London, UK.
European Urology Focus
|December 3, 2019
Summary
Intraoperative frozen section (IFS) during radical prostatectomy may reduce positive surgical margins and improve neurovascular bundle preservation. However, limited high-quality evidence necessitates cautious interpretation and further research.
Area of Science:
- Urology
- Surgical Oncology
- Pathology
Background:
- Surgical margin status and neurovascular bundle (NVB) preservation are critical for oncological and functional outcomes after radical prostatectomy (RP).
- Intraoperative frozen section (IFS) is used to assess margins and guide NVB preservation during RP, but its efficacy is debated.
Purpose of the Study:
- To systematically review and synthesize current literature comparing outcomes of RP with IFS versus RP without IFS.
- To evaluate the impact of IFS on surgical margin status, oncological control, NVB preservation, and erectile function.
Main Methods:
- Comprehensive literature searches were conducted in Medline, Embase, and Cochrane Library.
- Included were 10 nonrandomized retrospective comparative studies involving 16,897 patients.
- Data on margin status, oncological outcomes, NVB status, and erectile function were narratively synthesized due to heterogeneity.
Main Results:
- Eight studies indicated reduced positive surgical margin (PSM) rates with IFS (-1.4% to -14.5%), while two showed increased rates.
- No significant differences in long-term oncological outcomes were observed.
- Three studies using the NeuroSAFE technique reported improved NVB preservation or erectile function recovery.
Conclusions:
- IFS may offer a modest reduction in PSM rates during RP.
- Systematic IFS at the posterolateral margin (NeuroSAFE) shows potential for enhanced NVB preservation.
- Lack of prospective, randomized trials with standardized methodology and long-term follow-up limits definitive conclusions.
