PTU - Polskie Towarzystwo Urologiczne
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Intraoperative assessment of surgical margins of the radical prostatectomy specimen – preliminary (pilot) study
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Jakub Dobruch, Andrzej Borówka, Łukasz Nyk, Tomasz Dzik, Piotr Chłosta, Artur A. Antoniewicz
Klinika Urologii CMKP, I Zespół Dydaktyki Urologicznej, Międzyleski Szpital Specjalistyczny w Warszawie
Zakład Patomorfologii Międzyleski Szpital Specjalistyczny w Warszawie
Oddział Urologii, Świętokrzyskie Centrum Onkologii w Kielcach

summary

Introduction.

Positive surgical margins (PSMs) defined as the presence of cancer cells within the surface of the prostate specimen removed during radical prostatectomy (RP) are one of the factors that predict therapeutic efficacy of the procedure. PSMs are usually found within the apex or posterior lateral specimens surface. Nerve-sparring RP is associated with increased risk of PSMs. Their presence is definitely defined not before standard histological evaluation of the specimen.

Objectives.

The aim of the study is to evaluate the possibility of surgical margin status assessment just after the prostate removal.

Materials and methods.

17 prostate specimens removed together with neurovascular bundles due to clinically organ confined cancer were examined so far. The specimen was artificially prepared to create circumstances favoring positive surgical margin by its intersection in the tumor area and division of neurovascular bundle. Cytological analysis of material scratched with cold knife from the surface of the specimen („PS” – prostate surface), from the posterolateral surface of the prostate (P-LS)
after NVBs removal (NVBS – neurovascular bundle surface) and from the surface of the tumor after its intersection („TS” – tumor surface) was performed. Smears were fixed and stained with hematoksylin and eosin and evaluated by experienced pathologist who then assessed the prostate specimen. The specimens were then reconstructed and
subjected to routine histological evaluation. Immediate assessment done by experienced pathologist considered finally 17 PS, 15 P-LS and 17 TS.

Results.

Cytological assessment of the smears revealed the presence of cancer cells in 1 PS, 4 P-LS and all TS. Results consistency (positive or negative) of immediate assessment and routine histological evaluation was found in 1 PS and 4 P-LS. False negative results were found in 2 PS and 3 P-LS.

Conclusions.

Results of the pilot study show that immediate assessment of the smears taken from different parts of the specimen removed during radical prostatectomy are the promising way of intraoperative surgical margin status evaluation. It seems that larger number of the prostates may be helpful in creating the method of intraoperative assessment of surgical margins status in selected patients subjected to radical prostatectomy that would necessitate wider neighboring tissue/neurovascular bundles removal or ablation.