Bozzini Giorgio, Seveso Mauro, Otero Javier R, Osmolorskij Boris, Garcia Cruz Eduard, Margreiter Markus, Verze Paolo, Besana Umberto, Buizza Carlo
Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy -
Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy.
Minerva Urol Nefrol. 2020 Jun;72(3):332-338. doi: 10.23736/S0393-2249.19.03110-2. Epub 2019 Dec 11.
Frozen 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.
Between January 1995 and December 2005, a series of patients who were treated with open PN for renal cell carcinoma was prospectively analyzed. 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. Recurrence-free survival (RFS) and cost analysis on the FSA performed were analyzed.
A total number of 373 patients were enrolled. FSA was performed in all the patients considered for PN. Fifteen 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 eight patients (2.1%). In that eight cases after a deeper excision the definitive pathological outcome on SM was still positive in two 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.
FSA during PN does not reduce the risk of positive SMs. The use of FSA has also a higher cost related to the procedure.
在部分肾切除术（PN）期间经常进行冰冻切片分析（FSA）。我们通过评估术中FSA对最终手术切缘（SM）状态的影响来研究其效用。
对1995年1月至2005年12月期间接受开放性PN治疗肾细胞癌的一系列患者进行前瞻性分析。在PN期间，每位患者均对肾实质远切缘进行FSA。如果FSA浸润阳性，则进行更深层切除直至FSA阴性。将FSA的SM结果与最终病理报告进行比较。分析无复发生存率（RFS）以及所进行FSA的成本分析。
共纳入373例患者。所有考虑进行PN的患者均进行了FSA。15例患者转为根治性肾切除术。最终病理结果显示切缘阳性的患者有36例（9.6%）。FSA阳性的患者有8例（2.1%）。在这8例中，经过更深层切除后，SM的最终病理结果仍有2例为阳性。FSA仅显示出14.3%的切缘阳性情况。考虑RFS时，切缘阳性的患者随访情况较差（P<0.05）。Kaplan-Meier分析显示FSA对预防复发的作用不大（P=0.35）。PN期间进行FSA的平均成本为1438欧元。
PN期间的FSA不会降低切缘阳性的风险。FSA的使用还与该操作相关的较高成本有关。
