Intraoperative frozen section analysis during nerve sparing laparoscopic radical prostatectomy: feasibility study.
OBJECTIVE
Nerve sparing radical prostatectomy may allow preservation of potency but it can increase positive surgical margins. We used intraoperative frozen section (IFS) analysis to monitor the nerve sparing procedure in laparoscopic prostatectomy.


METHODS
A total of 100 patients with localized prostatic carcinoma underwent bilateral intrafascial nerve sparing laparoscopic prostatectomy with IFS. A wedge of tissue was cut from base to apex in the region of the neurovascular bundles (NVBs) and analyzed on frozen section. If carcinoma was detected at the inked margin, the corresponding NVB was resected. Definitive margin status was evaluated after permanent section analysis of IFS prostatectomy specimens and eventually NVB specimens.


RESULTS
IFS analysis was positive in 24 patients, as confirmed in all by permanent section of the wedges. Three of these patients had positive margins in the prostate specimen at another site. Of the 76 tumors with negative IFSs 1 had positive margins on permanent sections of the wedges and 8 had positive margins on the prostate specimen at another site. IFS led to a decrease in the overall positive margin status from 33% to 12% and from 26.1% to 7.9% in pT2 tumors. Tumor was found on NVB resection in 8 cases (33%).


CONCLUSIONS
These results suggest that IFS analysis is a reliable method by which to monitor nerve sparing during laparoscopic prostatectomy. IFS could allow the surgeon to offer a nerve sparing procedure more frequently without compromising cancer control.
Fromont
Gaëlle
G
Department of Pathology, Institut Montsouris, 42 Boulevard Jourdan, 75014 Paris, France. gaelle.fromont@imm.fr
Baumert
Hervé
H
Cathelineau
Xavier
X
Rozet
François
F
Validire
Pierre
P
Vallancien
Guy
G
D007172:Erectile Dysfunction / Q000517:prevention & control*; D005629:Frozen Sections / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000517:prevention & control*; D011379:Prognosis; D011467:Prostate / Q000294:innervation* / Q000473:pathology; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012306:Risk