The Impact of Routine Frozen Section Analysis during Cystectomy on Surgical Margins and Long-Term Outcomes
Jerome Jean-Gilles, Jr., Jorge L Yao, P Anthony di Sant'Agnese, Hiroshi Miyamoto. University of Rochester, Rochester, NY
Background: Intraoperative frozen sections analysis (FSA) is indicated when the histological findings can alter the surgical procedure. Literature recommends its use in the assessment of surgical margins in partial surgical resections but discourages its systematic use in radical surgical resections. The objective of this study is to investigate the impact of FSA in patients who underwent cystectomy for urothelial carcinoma.
Design: A retrospective review identified consecutive patients (n=247) who underwent a radical (n=240) or partial cystectomy (n=7) from 2004-2010 at our institution. A subset of patients (n=151) had at least 2 months or more follow-up. All patients underwent FSA of any combinations of the ureter, urethra, or perivesical tissue. FSA was correlated with the final surgical margin status and results of parrafin-wax embedded section diagnosis. Disease progression was evaluated using the Kaplan-Meier method.
Results: FSA was performed in 244 patients (99%), while no FSA was done in 3 patients (1%). Positive FSA (non-invasive/invasive carcinoma) in comparison with benign FSA (no malignancy identified) and atypical FSA showed a trend towards positive surgical margin (p<0.09). There was, however, a statistically significant correlation (p<0.03) between positive FSA diagnosis and positive SM in a subgroup of patients with muscle-invasive carcinoma (n=149; pT2 or greater on the final pathology report). The final surgical margin status showed no statistically significant correlation with the number of FSA received (range 0-17) during the procedure. There were thirty-five tumor recurrences during follow-up (mean: 21.8; range 2-54 months); 4 (1.6%) with negative FSA and positive surgical margin and 1 (0.4%) with positive FSA and positive surgical margin. Kaplan-Meier analysis revealed that the number or diagnosis of FSA was not significantly correlated with tumor progression.
Conclusions: Overall the utility of FSA in patients undergoing cystectomy (radical/partial) does not have any significant impact on final surgical margin status nor the long term outcomes. When FSAs are performed, their advantages are limited to malignant diagnoses which in our study have statistically significant correlation with positive surgical margin.
Category: Genitourinary (including renal tumors)
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 161, Wednesday Afternoon