Frozen Sections for Margins During Partial Nephrectomy Do Not Influence Recurrence Rates.
J Endourol
; 32(8): 759-764, 2018 08.
Article
en En
| MEDLINE
| ID: mdl-29943659
ABSTRACT
INTRODUCTION:
Frozen sections (FS) are routinely employed to assess margin status during partial nephrectomy (PN) for clinically localized renal cell carcinoma (CLRCC); however, their oncologic benefit remains unclear. There have been no studies investigating the long-term impact of FS on local or metastatic recurrence. We wished to determine whether the utilization of FS for this purpose during PN influenced recurrence rates. MATERIALS ANDMETHODS:
We performed a retrospective review of 1090 patients with (n = 172) and without (n = 918) FS during open and robotic PN between 2006 and 2016 for CLRCC at a single tertiary care institution. Standard follow-up protocols were employed, with imaging used to guide subsequent biopsy for confirmation. Univariate and multivariate competing-risk regression analysis predicting the association of FS status and clinicodemographic characteristics with recurrence, with adjustment for all-cause mortality, were performed. Administrative data were reviewed to calculate costs of FS.RESULTS:
Forty-five out of 1090 (4.13%) patients had recurrence. There was no difference in the cumulative incidence of recurrence between patients with and without FS (χ2 = 0.001, p = 0.97). On multivariable competing risk analysis, FS was not associated with recurrence (hazard ratio [HR], 1.56; 95% confidence interval [CI], 0.65-3.76). However, tumor grade (g3-4 vs 1-2 HR, 2.45; 95% CI, 1.16-5.14) and stage (>pT2 vs pT1a HR, 2.86; 95% CI, 1.13-7.26) were associated with recurrence. The average direct charge per patient undergoing FS was $902.CONCLUSIONS:
Intraoperative FS for margins during PN did not predict decreased recurrence rates in a single-institution high-volume center. Given the lack of associated benefit, and the added cost, the utilization of FS during PN should be limited.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Márgenes de Escisión
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Secciones por Congelación
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Neoplasias Renales
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Recurrencia Local de Neoplasia
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Nefrectomía
Tipo de estudio:
Guideline
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Endourol
Asunto de la revista:
UROLOGIA
Año:
2018
Tipo del documento:
Article