[Extemporaneous histological control of margins in prostatectomy for cancer]

A histological study of the margins of radical prostatectomy specimens has been made intraoperatively by frozen section in a series of 66 patients. In 8 of them (12% of all) a positive margin was discovered 10 times at the urethral [3], vesical [2], deferential [1] level, at the level of the Santorini [1] and of the rectoprostatic wall [3]. Further resection was immediately performed until histologically normal tissue was reached in 6 of these patients, for whom positive margins were thus made negative; and the prostatectomy was performed. The prostate was not removed in two patients. Only one positive margin not screened intraoperatively was discovered on definitive specimen examination. The rate of postoperative PSA was lowered in the 6 patients whose margins had been made negative, which is compatible with complete resection. However, 7 of these 8 patients received radiation (45 gray). We made a comparison between the groups with negative (57 patients) and positive margins (9 patients) for preoperative PSA levels, Gleason's scores, and invasion of the capsule, of the seminal vesicles and of the lymph nodes. There was no significant difference between both groups for the PSA levels, Gleason's score and the involvement of the seminal vesicles. Conversely, there was a significant difference between both groups (corrected chi 2 test) for invasion of the capsule (p = 0.02) and of lymph nodes (p = 0.02). Intraoperative histological control allows immediately recognizing and treating some positive margins, in order to choose during the operation whether resection should be widened or abandoned.