Is There An Indication For Frozen Section Examination Of The Ureteral Margins During Cystectomy For Transitional Cell Carcinoma Of The Bladder?
- Thursday, January 11, 2007, 19:22
- Urology / Nephrology
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UroToday.com- While ureteral frozen sections are routinely performed at the time of radical cystectomy, data from Memorial Sloan-Kettering, Johns Hopkins, and Penn have previously suggested that they may not be necessary in all patients. Perhaps most physicians continue to perform them because guidelines for patient selection have not been established.
In the December issue of the Journal of Urology, Schumacher, Studer, and colleagues report their experience with this very issue after reviewing their extensive database of 805 cystectomy procedures performed over a 20-year period.
Of 805 cystectomies performed, 4.8% of patients showed a positive ureteral frozen section and 3.6% exhibited a positive margin on the ureteral permanent section. Eighty percent of patients with positive frozen sections had a history of bladder carcinoma in situ.
If the ureters were divided proximal to the common iliac vessels, the risk of transitional cell carcinoma or CIS in the most proximally resected segment was 1.2%, regardless of the frozen section. This was the most important finding of the study. Of the entire cohort, only 0.3% (2/805) developed recurrence at the ureteroileal anastomosis.
In conclusion, the authors recommend that ureteral frozen sections be performed at the time of cystectomy only if the patient has a history of bladder CIS. Routine frozen sections are not recommended as long as the ureters are divided proximal to the iliac vessels.
Schumacher MC, Scholz M, Weise ES, Fleischmann A, Thalmann GN, Studer UE
J Urol 176(6):2409-2413, 2006.
Reviewed by Contributing Editor Ricardo F. Sánchez-Ortiz, MD
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