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Intraoperative frozen section monitoring during nerve-sparing radical prostatectomy: evaluation of partial secondary resection of neurovascular bundles and its effect on oncologic and functional outcome

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Abstract

Purpose

Intraoperative frozen sections (IFS) of the prostate have demonstrated to be effective in reducing positive surgical margins (PSM) and biochemical recurrence (BCR). The aim of this study was to assess partial secondary resection of neurovascular bundles (NVB) and report for the first time corresponding functional results.

Methods

A total of 500 consecutive patients were included in this prospective series. All patients underwent open nerve-sparing radical prostatectomy. Intraoperatively, both posterolateral aspects of the prostate were sent for IFS. In case of PSM, additional tissue was partly resected from the prostatic bed along the NVB. BCR was the oncologic endpoint (PSA ≥ 0.2 ng/ml). The impact of IFS on PSM and BCR-free survival, and the effect of secondary partial resection of NVB on continence and erectile function (EF) recovery were analyzed by Kaplan–Meier analyses.

Results

Twenty-nine patients were excluded because of neoadjuvant treatment/lymph node positive disease. PSM were detected in 137/471 patients (29.1 %). After secondary resection, 127/137 patients (92.7 %) converted to definitive negative surgical margins (NSM). Out of 137 patients, ten (7.3 %) showed persistent PSM. False-negative rate was 3.3 % (11/334). Out of 471 patients, two (0.4 %) showed PSM outside the IFS area. Overall, final PSM rate was 4.9 % (23/471). Five-year BCR-free survival did not differ significantly in patients with primarily and converted NSM. Continence and EF recovery after 12 months were 95.8 versus 94.3 %, and 65.7 versus 56.1 %, respectively (all p > 0.05).

Conclusion

IFS are highly effective in reducing PSM and avoiding compromised oncologic outcome. Partial secondary resection of the NVB ensures ns status and consequently preserves continence and EF.

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Author notes

    Authors and Affiliations

    1. Department of Urology, University Hospital Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

      Georgios Hatzichristodoulou, Michael Autenrieth, Tobias Maurer, Mark Thalgott, Thomas Horn, Matthias Heck, Kathleen Herkommer, Jürgen E. Gschwend & Hubert Kübler

    2. Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Hospital, Homburg/Saar, Germany

      Stefan Wagenpfeil

    3. Institute for Pathology and Pathological Anatomy, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany

      Gregor Weirich

    Authors
    1. Georgios Hatzichristodoulou
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    2. Stefan Wagenpfeil
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    Corresponding author

    Correspondence to Georgios Hatzichristodoulou.

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    The authors declare that they have no conflict of interest.

    Ethical standard

    All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

    Additional information

    Jürgen E. Gschwend and Hubert Kübler have contributed equally to this work.

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    Hatzichristodoulou, G., Wagenpfeil, S., Weirich, G. et al. Intraoperative frozen section monitoring during nerve-sparing radical prostatectomy: evaluation of partial secondary resection of neurovascular bundles and its effect on oncologic and functional outcome. World J Urol 34, 229–236 (2016). https://doi.org/10.1007/s00345-015-1623-3

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    • DOI: https://doi.org/10.1007/s00345-015-1623-3

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