FROZEN-SECTIONS FOR CONTROL OF TUMORAL MA RGINS IN RADICAL PROSTATECTOMY FOR CANCER

A histological study of the margins of radical prostatectomy specimens has been made intraoperatively by frozen section in a serie of 66 pat ients. In 8 of them (12 % of all) a positive margin was discovered 10 times at the urethral [3], vesical [2], deferential [1] level, at the level of the Santorini [1] and of the recto-prostatic wall [3]. Furthe r resection was immediately performed until histologically normal tiss ue was reached in 6 of these patients, for whom positive margins were thus made negative; and the prostatectomy was performed. The prostate was not removed in two patients. Only one positive margin not screened intraoperatively was discovered on definitive specimen examination. T he rate of postoperative PSA was lowered in the 6 patients whose margi ns had been made negative, which is compatible with complete resection . However, 7 of these 8 patients received radiation (45 gray). We made a comparison between the groups with negative (57 patients) and posit ive margins (9 patients) for preoperative PSA levels, Gleason's scores , and invasion of the capsule, of the seminal vesicles and of the lymp h nodes. There was no significant difference between both groups for t he PSA levels, Gleason's score and the involvement of the seminal vesi cles. Conversely, there was a significant difference between both grou ps (corrected chi2 test) for invasion of the capsule (p = 0.02) and of lymph nodes (p = 0.02). Intraoperative histological control allows im mediately recognizing and treating some positive margins, in order to choose during the operation whether resection should be widened or aba ndoned.