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

BACKGROUND: 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. METHODS: Between 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. RESULTS: 373 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. CONCLUSIONS: FSA during PN does not reduce the risk of positive SMs. The use of FSA has also an higher cost related to the procedure.