對於利用多參數磁振造影與術中冷凍切片的有無判斷其對達文西攝護腺根除術
最終病理結果的影響
周聖峰、謝博帆、張議徽、林維卿、張兆祥
中國醫藥大學附設醫院泌尿部
Analysis the effect of intraoperative Frozen-Section Analysis and multiparametric magnetic resonance imaging in patients of prostate cancer undergoing robotic-assisted radical prostatectomy can Reduce the Rate of Positive Surgical Margins or not
Shen-Feng Chou, Po-Fan Hsieh, Han Chang, Yi-Huei Chang, Wei-Ching Lin, Chao-Hsiang Chang
Department of Urology, China Medical University Hospital, Taichung, Taiwan
Introduction
Multiparametric magnetic resonance imaging (mpMRI) and intraoperative frozen-section analysis (IFS) may play an important role in surgical planning during robotic-assisted radical prostatectomy (RARP) for localized prostate cancer (PCa). Our goal is to compare oncological outcomes in patients with intermediate risk and high risk patients who underwent robot-assisted RP (RARP) at a single institution with or without mpMRI and frozen-section analysis.
Materials and Methods
A retrospective analysis of patients treated as RARP from AUG 2012 to JAN 2017 was conducted. Data were reviewed from patients who underwent preoperative MRI or CT. We excluded low risk, metastatic lesion, and initial PSA>30ng/ml. During robot-assisted radical prostatectomy, IFS analysis was sent according to surgeon’s judgement and mpMRI mapping which may indicate the invasion of bladder neck and distal urethra. Secondary resections were performed when IFS results were positive for cancer. Patients without mpMRI were selected as control group. Rates of positive surgical margins were compared by means of multivariate conditional logistic regression model as two-way ANOVA to estimate the positive rate of surgical margin for patients who underwent MR imaging with or without IFS analysis compared to control subjects.
Results
Total data were reviewed as 149 patients, and 38 patients was excluded. Compared to control patients (n =22), patients who took mpMRI with or without sending IFS revealed lower positive margin rate with significant difference (41.67% vs 52.38%, p = .035 ). Moreover, positive surgical margins were found less frequently in the patients who underwent MR imaging with IFS analysis than in control patients (41.67% vs 52.38%, P = .02). Besides, positive surgical margins were found less frequently in the patients who underwent MR imaging with IFS analysis than MR imaging without IFS(41.67% vs 47.44%, P = .045).
Conclusion
Our experience showed significantly lower rate of positive surgical margins in patient who had mpMRI–directed IFS analysis than patients without mpMRI or with mpMRI but no sending IFS, which provides preliminary evidence of the positive clinical effect of mpMRI and IFS analysis separately for patients who undergo prostatectomy.