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Is there a clinical role for frozen section analysis during partial nephrectomy? A multicenter experience over 10
Giorgio Bozzini1, Mauro Seveso2, Javier R Otero3
1Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy - gioboz@yahoo.it.
Summary
Intraoperative frozen section analysis (FSA) during partial nephrectomy (PN) for renal cell carcinoma does not reliably improve surgical margin status. This analysis found FSA to be costly and ineffective in preventing positive margins or recurrence.
Area of Science:
- Urology
- Surgical Pathology
- Oncology
Background:
- Frozen section analysis (FSA) is a common intraoperative technique during partial nephrectomy (PN).
- Its utility in improving final surgical margin (SM) status requires thorough investigation.
Purpose of the Study:
- To evaluate the impact of intraoperative FSA on the final surgical margin (SM) status in patients undergoing PN.
- To assess the effect of FSA on recurrence-free survival (RFS) and its associated costs.
Main Methods:
- A prospective analysis of 373 patients undergoing open PN for renal cell carcinoma from January 1995 to December 2005.
- Intraoperative FSA of the renal parenchyma distal margin was performed, with deeper excision if positive.
- Comparison of FSA SM outcome with final pathology, RFS, and cost analysis.
Main Results:
- FSA identified positive margins in only 14.3% of cases with definitive positive SMs.
- FSA did not significantly reduce positive SMs or prevent recurrence (P=0.35).
- The mean cost of performing FSA during PN was 1438 euros.
Conclusions:
- Intraoperative FSA during PN does not effectively reduce the risk of positive surgical margins.
- The procedure incurs significant costs without a demonstrable benefit in preventing recurrence.
