The Impact of Routine Frozen Section Assessment During Penectomy on Surgical Margin Status and Long-Term Oncologic Outcomes

No recent studies have focused on assessing the role of intraoperative frozen section assessment (FSA) in the status of surgical margins (SMs) relating to the outcomes of penectomy cases. In this study, we investigated the utility of routine FSA of the SMs in men undergoing penectomy. A retrospective review identified consecutive patients who underwent partial (n=26) or total (n=12) penectomy for penile squamous cell carcinoma at our institution from 2004 to 2015. FSA of the SMs was performed in 21 (80.8%) partial and 10 (83.3%) total penectomies. FSAs were reported as positive (n=3, 9.7%), atypical (n=3, 9.7%), and negative (n=25, 80.6%). All of the positive or negative FSA diagnoses were confirmed accurate on the frozen section controls, whereas the 3 cases with atypical FSA had non-malignant, atypical, and carcinoma cells, respectively, on the controls. Final SMs were positive in 6 (15.8%) penectomies, including 4 (12.9%) FSA cases versus 2 (28.6%) non-FSA cases (P=0.569). Furthermore, initial positive (1 of 3) and atypical (3 of 3) FSA cases achieved negative conversion by excision of additional tissue sent for FSA. Kaplan-Meier analysis revealed that performing FSA or its number/diagnosis was not significantly associated with disease progression. Thus, performing FSA during penectomy does not appear to have any significant impact on final SM status nor long-term oncologic outcomes. However, as seen in at least 4 cases, select patients may benefit from the routine FSA.