The application value of intraoperative frozen section examination in determining the residual margin during robot-assisted laparoscopic radical prostatectomy
10.3760/cma.j.cn112330-20241224-00567
- VernacularTitle:术中冰冻病理检查在机器人辅助腹腔镜根治性前列腺切除术中判断切缘残留的应用价值
- Author:
Yang LUAN
1
;
Shengming LU
1
;
Shang WU
1
;
Liangyong ZHU
1
;
Xuefei DING
1
Author Information
1. 扬州大学附属苏北人民医院泌尿外科，扬州 225001
- Publication Type:Journal Article
- Keywords:
Intraoperative frozen section examination;
Robot-assisted;
Radical prostatectomy;
Margin
- From:
Chinese Journal of Urology
2025;46(4):262-266
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical application value of intraoperative frozen section (IFS) pathology in assessing the status of residual tissue margins during robot-assisted laparoscopic radical prostatectomy (RARP).Methods:A retrospective analysis was conducted on the clinical data of 26 patients from January 2024 to October 2024. The average age was (69.3±7.9) years, with an average BMI of (24.7±2.5) kg/m 2. The average preoperative PSA level was (22.7±23.0) ng/ml, and the average prostate volume was (37.4±16.1) ml. The PI-RADS scores were as follows: 15.4% (4/26) of the patients scored 3, 42.3% (11/26) scored 4, and 42.3% (11/26) scored 5, with an average PI-RADS score of (4.2±0.7). Preoperative clinical staging included 1 case of cT 1, 21 cases of cT 2, and 4 cases of cT 3. Biopsy pathology revealed Gleason scores of 6 in 19.2% (5/26) of the patients, 7 in 26.9% (7/26), 8 in 26.9% (7/26), 9 in 23.1% (6/26), and 10 in 3.9% (1/26). The overall positive biopsy core rate was 38.4% (184/479). All patients underwent RARP at our institution, and IFS was performed on residual margins at suspicious lesion sites identified by multiparametric MRI (mpMRI) during surgery. If the IFS result was positive, extended resection was performed, followed by a second IFS, until the maximum anatomical limit was reached or a negative margin was achieved. Finally, the resected prostate was examined using large-section histopathology, and the accuracy of IFS in assessing margin status was analyzed by comparing it with the large-section histopathology results. Results:Among the 26 patients, 11 had positive margins indicated by IFS or postoperative large-section histopathology. Of these, 6 patients showed positive surgical margins (PSM) on IFS, and after further extended resection, subsequent IFS results were negative. In 63.6% (7/11) of the patients, the margin results from IFS were consistent with those from postoperative large-section histopathology. Two patients had positive margins on IFS, which turned negative after further extended resection. Although postoperative large-section histopathology indicated positive margins at the posterior prostate, secondary IFS showed no residual tumor tissue, and postoperative PSA levels were all below 0.2 ng/ml. Another two patients had negative margins on IFS, but postoperative large-section histopathology revealed positive margins at some corresponding sites, with subsequent PSA levels also below 0.2 ng/ml.Conclusions:IFS can rapidly and accurately assess the margin status of residual tissue, to some extent avoiding the occurrence of positive margins.
