Intraoperative Frozen Section Monitoring of Nerve Sparing Radical Retropubic Prostatectomy
Published in: The Journal of Urology, v. 162, no. 3, pt. 1, Sep. 1999, p. 655-658
Posted on RAND.org on December 31, 1998
PURPOSE: The authors describe the clinical and pathological outcomes of intraoperative frozen sections performed on the posterolateral prostate margins during nerve sparing radical prostatectomy. MATERIALS AND METHODS: The authors developed a technique of bilateral nerve sparing, inking the posterolateral prostate margins and obtaining frozen sections. When tumor was seen on frozen section, the fascia and neurovascular bundle were widely excised before completing the vesicourethral anastomosis. The authors reviewed 142 radical retropubic prostatectomies performed by a single surgeon between 1992 and 1997. Patients were divided into group 1--nerve sparing procedure using our technique (48 patients), 2--planned unilateral nerve sparing without frozen sections (46) and 3--planned bilateral nerve sparing without frozen sections (48). Potency was measured implicitly by physician assessment and explicitly with the UCLA Prostate Cancer Index. Group comparisons were made for positive margins, biochemical recurrence and potency. Mean followup was 24.5, 43.8 and 39.4 months for groups 1, 2 and 3, respectively. RESULTS: Of the 48 group 1 patients, 9 (18%) had adenocarcinoma in the frozen section specimen, prompting wide excision of the bundles. None of these patients had biochemical recurrence during a mean followup of 20.5 months. Both bundles were spared in the remaining 39 patients (82%). There was no difference in survival or time to biochemical recurrence between groups 1 and 2. Potency was significantly different between groups 1 and 2 (36 versus 13%, p = 0.001), even after age adjustment (p = 0.05). In contrast, potency did not differ between groups 1 and 3 (38 versus 40%). Preoperative stage, grade and prostate specific antigen level were similar among the 3 groups. CONCLUSIONS: The authors found a significant difference in potency rates adjusted for age between patients with and without frozen sections. The results indicate that this technique can enhance the ability of the surgeon to monitor the nerve sparing procedure without compromising cancer control.