title: Intraoperative frozen section in laparoscopic radical prostatectomy: impact on cancer control.
abstract: BACKGROUND
  Intraoperative Frozen Section (IFS) with further tissue resection in case of positive margins has been proposed to decrease positive surgical margins rate during radical prostatectomy. There are a few reports on the benefits of this potential reduction of positive margins (PSM).
  
  
  OBJECTIVE
  The aim of this study is to assess the oncological advantages of PSM rate reduction with the use of IFS and additional tissue excision in case of PSM. DESIGN, SETTING AND PARTECIPANTS: 270 patients undergoing laparoscopic radical prostatectomy were included in a prospective study, to evaluate the results of further tissue excision in case of PSM at IFS. Median age was 65 yrs. Median PSA was 7.0 ng/ml.
  
  
  METHODS
  The prostate was extracted during the operation. IFS was performed in all patients on the prostate surface, at the base, the apex and along the postero-lateral aspect of the gland. In case of PSM additional tissue was excised from the site of the prostatic bed corresponding to the surgical margin.
  
  
  METHODS
  Endpoint was biochemical recurrence-free survival.
  
  
  CONCLUSIONS
  PSM were found in 67 patients (24.8%). With additional tissue resection, PSM rate dropped from 24.8% to 12.6%. Decreased PSM after further resection didn't improve biochemical-free survival. Patients with initial PSM at IFS rendered negative with further resection, had similar results if compared to patients with margins still positive, and worse results if compared to patients with negative margins (NSM). Biochemical recurrence rate was 2.95% at 58 months in 203 patients with NSM, 15.1% at 54 months in 33 patients with PSM at IFS that were rendered negative after further resection, and 11.7% at 67 months in 34 patients with still PSM after additional resection. These results were confirmed also according to: stage, nerve-sparing procedure, Gleason score.
  
  
  CONCLUSIONS
  Our data don't support IFS during radical prostatectomy to improve biochemical-free survival.
authors.affiliation: San Giovanni Hospital, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Emiliozzi
authors.forename: Mostafà
authors.initials: M
authors.lastname: Amini
authors.forename: Alberto
authors.initials: A
authors.lastname: Pansadoro
authors.forename: Marco
authors.initials: M
authors.lastname: Martini
authors.forename: Vito
authors.initials: V
authors.lastname: Pansadoro
mesh_terms: D000368:Aged; D005629:Frozen Sections; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*