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‘Mohs surgery of the prostate’: the utility of in situ frozen section analysis during robotic prostatectomy
Author(s) -
Lavery Hugh J.,
Xiao Guang–Qian,
NabizadaPace Fatima,
Mikulasovich Michael,
Unger Pamela,
Samadi David B.
Publication year - 2011
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09595.x
Subject(s) - medicine , neurovascular bundle , prostatectomy , urology , tolerability , prostate cancer , adverse effect , surgery , surgical margin , frozen section procedure , renal cell carcinoma , cancer , oncology , resection
Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Interim result of this study had shown promising efficacy, with response rate of 14.7% and median PFS of 7.4 months, and good tolerability in previously‐treated Japanese metastatic RCC patients. The final result of the study adds:1 The median overall survival in Japanese metastatic RCC patients was 25.3 months, which is longer than that in the Treatment Approaches in Renal Cancer Global Evaluation Trial (TARGET). 2 The response rate elevated from 14.7% to 19.4% because of 6 late responders achieved after 9.2 months or longer of SD period. 3 Neither unknown adverse events nor cumulative toxicity was observed in the long‐term use of sorafenib.OBJECTIVE • To evaluate a novel technique to lower positive surgical margin rates while preserving as much of the neurovascular bundles as possible during nerve‐sparing robotic prostatectomy. MATERIALS AND METHODS • In situ intraoperative frozen section (IFS) was performed during robotic‐assisted laparoscopic prostatectomy (RALP) when there was macroscopic concern for a positive margin or residual prostate tissue. • When IFS was positive, additional sections were taken from the same area until the IFS was negative, similar to the procedure of Mohs micrographic surgery. • Positive surgical margin and biochemical recurrence rates were compared between the patients who underwent IFS and those who did not. RESULTS • Of 970 patients consecutively undergoing RALP at a single institution, IFS was performed on 177 (18%). • Eleven patients (6%) had IFS positive for carcinoma, whereas another 25 (14%) had benign prostatic tissue in the IFS specimen. • IFS and non‐IFS patients had similar pathological and nerve‐sparing characteristics. • The IFS group had significantly lower rates of positive surgical margins, 7% vs 18% ( P = 0.001) but similar rates of biochemical recurrence (5%) at a median follow‐up of 11 months. CONCLUSIONS • In situ IFS is an effective way of reducing positive margins during RALP. • Twenty percent of patients who underwent IFS, representing 4% of the overall RALP population, had either malignant or benign prostate tissue removed from their prostatic fossa. • Although a reduction of biochemical recurrence was not demonstrated, the follow‐up is short and a difference may become apparent as the data mature.