手术切缘阳性 (PSM) 是对前列腺癌 (PCa) 进行根治性前列腺切除术的外科医生经常关注的问题。 PSM 被认为是早期生化复发的危险因素，并使患者接受辅助或挽救治疗，例如外部放射治疗和激素治疗。已经制定了多种策略来降低 PSM 率，同时仍然允许安全的神经保留手术。建议通过多参数磁共振成像 (mpMRI) 和融合活检进行精确的术前分期，以识别在解剖过程中需要特别注意的可疑囊外延伸 (ECE) 区域。然而，即使采用最佳成像，ECE 也可能会被遗漏，一些癌症的定义不明确或不可见，并且手术期间的包膜切口仍然是一个问题。因此，术中冰冻切片技术，例如神经血管结构邻近冰冻切片检查（NeuroSAFE）已经被开发出来，并在最近得到了广泛传播。 NeuroSAFE 技术降低了 PSM 率，同时允许更高的神经保留手术率。然而，由于其在物流、人力资源、专业知识以及成本方面的进入壁垒较高，其使用仅限于大容量或专家中心。此外，即使在专家手中，NeuroSAFE 也是一个耗时的过程。为了解决这些问题，已经开发了几种用于离体和体内使用的技术。荧光共焦显微镜和术中 PET-CT 等离体技术需要提取标本进行准备和数字图像采集。体内技术，例如基于 mpMRI 图像的增强现实和 PSMA 荧光引导手术，具有提供切除完整性的体内分析的优势。当前的手稿对已建立的技术进行了叙述性回顾，并详细介绍了几种用于术中 PSM 评估的新的和有前景的技术。© 2024。作者。

Positive surgical margin (PSM) is a frequent concern for surgeons performing radical prostatectomy for prostate cancer (PCa). PSM are recognized as risk factors for earlier biochemical recurrence and expose patients to adjuvant or salvage treatments such as external radiotherapy and hormonotherapy. Several strategies have been established to reduce PSM rate, while still allowing safe nerve-sparing surgery. Precise preoperative staging by multiparametric magnetic resonance imaging (mpMRI) and fusion biopsy is recommended to identify suspicious areas of extracapsular extension (ECE) that warrant special attention during dissection. However, even with optimal imaging, ECE can be missed, some cancers are not well defined or visible, and capsular incision during surgery remains an issue. Hence, intraoperative frozen section techniques, such as the neurovascular structure-adjacent frozen section examination (NeuroSAFE) have been developed and lately widely disseminated. The NeuroSAFE technique reduces PSM rate while allowing higher rate of nerve-sparing surgery. However, its use is limited to high volume or expert center because of its high barrier-to-entry in terms of logistics, human resources and expertise, as well as cost. Also, NeuroSAFE is a time-consuming process, even in expert hands. To address these issues, several technologies have been developed for an ex vivo and in vivo use. Ex vivo technology such as fluorescent confocal microscopy and intraoperative PET-CT require the extraction of the specimen for preparation, and digital images acquisition. In vivo technology, such as augmented reality based on mpMRI images and PSMA-fluorescent guided surgery have the advantage to provide an intracorporeal analysis of the completeness of the resection. The current manuscript provides a narrative review of established techniques, and details several new and promising techniques for intraoperative PSM assessment.© 2024. The Author(s).