Is there a clinical role for Frozen Section Analysis during partial nephrectomy? A multicenter experience over 10 years.

Abstract

BACKGROUND\nFrozen 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.\n\n\nMETHODS\nBetween January 1995 and December 2005 we prospectively analysed a series of patients who were treated with open PN for Renal Cell Carcinoma. 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. We analyzed the recurrence-free survival (RFS) and cost analysis on the FSA performed.\n\n\nRESULTS\n373 patients were enrolled. FSA was performed in all the patients considered for PN. 15 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 8 patients (2.1%). In that 8 cases after a deeper excision the definitive pathological outcome on SM was still positive in 2 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.\n\n\nCONCLUSIONS\nFSA during PN does not reduce the risk of positive SMs. The use of FSA has also an higher cost related to the procedure.