Real-Time Assessment of Surgical Margins During Radical Prostatectomy: A Comprehensive Review

Area of Science:

• Urology
• Surgical Oncology
• Medical Technology

Background:

• Radical prostatectomy (RP) for localized prostate cancer requires negative surgical margins to prevent recurrence.
• Positive surgical margins (PSMs) increase recurrence risk, costs, and patient anxiety.
• Intraoperative margin assessment is crucial for surgical decision-making.

Purpose of the Study:

• To review real-time technologies for surgical margin assessment during RP.
• To evaluate their clinical utility, advancements, and impact on intraoperative decisions.

Main Methods:

• A non-systematic review of PubMed/MEDLINE and Google Scholar.
• Included studies on traditional and emerging intraoperative margin assessment technologies for RP.
• Assessed technologies like frozen section analysis, CLE, FCM, optical spectroscopy, and AR based on sensitivity, specificity, and feasibility.

Main Results:

• Frozen section analysis is the gold standard but is time-consuming.
• Emerging technologies (CLE, FCM, AR, optical spectroscopy) offer real-time feedback for improved precision.
• High costs and technical complexity are barriers to adoption; further validation is required.

Conclusions:

• Real-time assessment technologies show potential to reduce PSMs and improve oncological and functional outcomes in RP.
• While frozen section analysis is standard, novel technologies offer enhanced surgical precision.
• Continued innovation and clinical trials are vital for integrating these tools into practice.