Intraoperative photodynamic evaluation of surgical margins during endoscopic extraperitoneal radical prostatectomy with the use of 5-aminolevulinic acid.
OBJECTIVE
Today there are no established techniques to image positive surgical margins (PSM) intraoperatively in endoscopic extraperitoneal radical prostatectomy (EERPE). The intention of this study was to describe the specific technique of photodynamic diagnosis (PDD) in patients undergoing EERPE and report on the potential to detect PSM under PDD.


METHODS
Twenty-four patients with clinically organ-confined prostate cancer received 5-aminolevulinic acid 20 mg/kg body weight orally 3 hours prior to nonnerve-sparing EERPE. An endoscopic PDD system (Karl Storz, Tuttlingen, Germany) including a Tricam PDD 3-chip camera head linked with a straight 10-mm telescope and a D-light C system was used. During EERPE, visualization of the surgical margins was performed by means of both white light and PDD at specific steps during standardized prostatectomy in all patients. Positive PDD areas on the prostate specimen were marked with white ink and consequently processed in pathology.


RESULTS
In white light endoscopy, no suspicion of a PSM was raised. Six out of the eight PSM were detected by PDD. In two cases, areas of positive PDD findings were free of prostate cancer and two PSM were not detected by PDD ( one bladder neck, one lateral). The overall sensitivity and specificity were 75% and 88.2%, respectively.


CONCLUSIONS
Laparoscopy offers an appropriate setting for the use of PDD in prostate cancer to visualize possible PSM. Although imaging of PSM by PDD is promising with the technique being feasible and safe, larger series are needed to prove the reproducibility of our results.
Ganzer
Roman
R
Department of Urology, University of Regensburg, Krankenhaus St. Josef, Regensburg, Germany. roman.ganzer@gmx.de
Blana
Andreas
A
Denzinger
Stefan
S
Wieland
Wolf F
WF
Adam
Christoph
C
Becker
Armin
A
Khoder
Wael
W
Walther
Sebastian
S
Stief
Christian G
CG
Zaak
Dirk
D
Salomon
Georg
G
Hartmann
Arndt
A
Knuechel
Ruth
R
Bertz
Simone
S
Popken
Gralf
G
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid / Q000008:administration & dosage*; D001706:Biopsy; D004210:Dissection; D004724:Endoscopy; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery*; D010778:Photochemotherapy; D011467:Prostate / Q000473:pathology / Q000601:surgery*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D055815:Young Adult
D000622:Aminolevulinic Acid