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ORIGINAL ARTICLE   Free accessfree

Minerva Urologica e Nefrologica 2020 June;72(3):332-8

DOI: 10.23736/S0393-2249.19.03110-2


language: English

Is there a clinical role for frozen section analysis during partial nephrectomy? A multicenter experience over 10 years

Giorgio BOZZINI 1 , Mauro SEVESO 1, Javier R. OTERO 2, Boris OSMOLORSKIJ 3, Eduard GARCIA CRUZ 4, Markus MARGREITER 5, Paolo VERZE 6, Umberto BESANA 1, Carlo BUIZZA 1

1 Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy; 2 Department of Urology, 12 De Octubre University Hospital, Madrid, Spain; 3 Department of Urology, Lomonosov Hospital, Moscow, Russia; 4 Department of Urology, Hospital Clínic, Barcelona, Spain; 5 Department of Urology, Vienna General Hospital, Vienna, Austria; 6 Department of Urology, Federico II University, Naples, Italy

BACKGROUND: Frozen section analysis (FSA) is frequently performed during partial nephrectomy (PN). We investigate the utility of intraoperative FSA by evaluating its impact on final surgical margin (SM) status.
METHODS: Between January 1995 and December 2005, a series of patients who were treated with open PN for renal cell carcinoma was prospectively analyzed. During PN, each patient underwent a FSA on renal parenchyma distal margin. If FSA was positive for infiltration a deeper excision was performed till obtaining a negative FSA. SM outcome of the FSA was compared with the final pathology report. Recurrence-free survival (RFS) and cost analysis on the FSA performed were analyzed.
RESULTS: A total number of 373 patients were enrolled. FSA was performed in all the patients considered for PN. Fifteen patients had a conversion to radical nephrectomy. Positive SMs at the definitive pathological outcome were found in 36 patients (9.6%). FSA was positive in eight patients (2.1%). In that eight cases after a deeper excision the definitive pathological outcome on SM was still positive in two cases. FSA revealed just 14.3% of the positive SM. Patients with positive SM had a worse follow up considering RFS (P<0.05). Kaplan-Meier analysis revealed that FSA did not considerably contribute to prevent recurrence (P=0.35). 1438 euros was the mean cost of performing a FSA during PN.
CONCLUSIONS: FSA during PN does not reduce the risk of positive SMs. The use of FSA has also a higher cost related to the procedure.

KEY WORDS: Frozen sections; Nephrectomy; Renal cell carcinoma; Margins of excision; Local neoplasm recurrence

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