Extracapsular Dissection in Pleomorphic Adenomas of the Parotid Gland: Results After 13 Years of Follow‐up

Mantsopoulos, Konstantinos; Koch, Michael; Goncalves, Miguel; Mantsopoulos, Konstantinos; Iro, Heinrich

doi:10.1002/lary.28696

Cited by 22 publications

(35 citation statements)

References 37 publications

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“…Iro demonstrated decreases in both temporary (22.8%‐9.8%) and permanent (9%‐5.9%) facial paresis with the transition to less radical procedures, primarily extracapsular dissection 8 . Further review supported this finding 12 and a recent study from this group noted temporary and permanent facial paresis rates of 5.9% and 2.0%, respectively, in ED procedures done specifically for pleomorphic adenoma 30 . The least invasive subgroup in the current series was the partial/superficial parotidectomy procedure.…”

Section: Discussionmentioning

confidence: 59%

Single‐surgeon parotidectomy outcomes in an academic center experience during a 15‐year period

Deschler

Kozin

Kanumuri

et al. 2020

Laryngoscope Investig Oto

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Objective: As large single-surgeon series in the literature are lacking, we sought to review a single-surgeon's experience with parotidectomy in an academic center, with a focused analysis of pathology, technique, and facial nerve (FN) weakness. Benchmark values for complications and operative times with routine trainee involvement and without continuous FN monitoring are offered. Materials and Methods: All patients who underwent parotidectomy, performed by D. G. D., for benign and malignant disease between January 2004 and December 2018 at an academic center were reviewed. Results: A total of 924 parotidectomies, with adequate evaluatable data were identified. The majority of patients had benign tumors (70.9%). Partial/superficial parotidectomy was the most common approach (65.7%). Selective FN branch sacrifice was rare (12.3%), but significantly more common among patients with malignant pathology (33.8% vs 3.5% for benign, P < .0001). Among patients with intact FN, post-operative short-and long-term FN weaknesses were rare (6.5% and 1.7%, respectively). These rates were lower among patients with benign tumors (5.4% and 1.3%). Partial/superficial parotidectomy for benign tumors was associated with a low rate of short-and long-term FN weaknesses (2.7% and 0.9%). Mean OR time was 185 minutes. Conclusion: This is the largest single-surgeon series on parotidectomy, spanning 15 years. We demonstrate excellent long-and short-term FN paresis rates with acceptable operative times without regular use of continuous FN monitoring and with routine trainee involvement. These findings may provide valuable insight into parotid tumor pathology, FN outcomes, and feasibility and expectations of performing parotidectomy in an academic setting.

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Section: Discussionmentioning

confidence: 59%

Single‐surgeon parotidectomy outcomes in an academic center experience during a 15‐year period

Deschler

Kozin

Kanumuri

et al. 2020

Laryngoscope Investig Oto

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“…In the past, enucleation was a surgical option, but is no longer employed due to an unacceptably high rate of recurrence 9 . Although challenging, outcomes following surgery of pPA are generally excellent, with low recurrence rates and favorable facial nerve outcomes 6,7,10‐12 …”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5] In experienced hands, pPA can be reliably managed with more minimally invasive approaches such as extracapsular dissection or partial parotidectomy, as long as a healthy surrounding rim of tissue can be retained. 6 In instances where there is a larger tumor burden, recurrent PA (rPA), or concern for more malignant disease, a more invasive approach could be employed, such as a superficial parotidectomy (SP) or total parotidectomy (TP). [6][7][8][9] In the past, enucleation was a surgical option, but is no longer employed due to an unacceptably high rate of recurrence.…”

Section: Introductionmentioning

confidence: 99%

“…6 In instances where there is a larger tumor burden, recurrent PA (rPA), or concern for more malignant disease, a more invasive approach could be employed, such as a superficial parotidectomy (SP) or total parotidectomy (TP). [6][7][8][9] In the past, enucleation was a surgical option, but is no longer employed due to an unacceptably high rate of recurrence. 9 Although challenging, outcomes following surgery of pPA are generally excellent, with low recurrence rates and favorable facial nerve outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…9 Although challenging, outcomes following surgery of pPA are generally excellent, with low recurrence rates and favorable facial nerve outcomes. 6,7,[10][11][12] Unlike management of pPA, treatment of rPA can be exceedingly challenging, and there is no uniform consensus regarding standard of care. [7][8][9] Treatment for rPA also predominantly involves surgery, which typically consists of some form of a revision parotidectomy and up to total parotidectomy, but is heavily individualized to address the patient's disease burden.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Risk factors for subsequent recurrence after surgical treatment of recurrent pleomorphic adenoma of the parotid gland

et al. 2020

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Background: Recurrent pleomorphic adenoma (PA) can be a lifelong disease, and rates of subsequent recurrence are high. Methods: Patients between 2000 and 2015 were identified. Primary outcome was subsequent recurrence after surgical salvage. Results: Twenty-seven of 84 patients developed a subsequent recurrence. Risk factors for subsequent recurrence included a higher number of previous recurrences (P < .01), worse preoperative facial nerve function (P < .01), and deep parotid lesion(s) (P < .01). Interval since last surgery was protective (P < .01), specifically >10 years since last surgery (P < .01). For patients with a >10-year interval since their last surgery, the subsequent recurrence-free rate at 10 years follow-up was 80.2% vs 31.8%. Conclusions: For patients presenting with a >10-year interval since their last surgery, subsequent recurrence rates are low, which may allow for as needed surveillance recommendations. For patients presenting with recurrent PA and ≤10 years since their last surgery, a closer surveillance is warranted.

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Surgical interventions for management of benign parotid tumors: Systematic review and network meta‐analysis

et al. 2021

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The impact of the extent of parotid surgery on postoperative complications has long been considered a topic of controversy. The aim of the current network meta-analysis (NMA) is to answer the following questions: (1) Does the extent of surgical resection of benign parotid tumors increase the risk of postoperative complications? (2) What is the best surgical intervention for treatment of benign parotid tumors that can provide an acceptable balance between tumor recurrence rate and other postoperative complications? A comprehensive search on PubMed, Embase, Scopus, and Cochrane library was conducted to identify the eligible studies. The outcome was the incidence of tumor recurrence, facial nerve weakness (temporary [TFW] or permanent [PFP]), Frey's syndrome (FS), sialocele, and salivary fistula. The Bayesian network meta-analysis (NMA) accompanied by a random effect model and 95% credible intervals (CrI) were calculated using the GeMTC R package. Forty-four studies with a total of 7841 participants were included in the current NMA comparing five surgical interventions, namely enucleation, extracapsular dissection (ECD), partial superficial parotidectomy (PSP), superficial parotidectomy (SP), and total parotidectomy (TP). Enucleation showed the highest recurrence rate compared to ECD, SPS, SP, and TP. No statistical differences were observed concerning the recurrence rate when ECD, PSP, SP, and TP were compared together. There was an increased incidence of TFW and FS with the increase in the extent of parotid resection, while no significant difference was found when comparing enucleation with ECD and PSP. SP showed the highest incidence of PFP, and salivary fistula compared to ECD, PSP, and TP. The tumor recurrence rates in enucleation, ECD, PSP, SP, and TP were 14.3%, 3.6%, 3.7%, 2.8%, and 1.4%, respectively. The current NMA demonstrated that the risk of TFW and FS increases with the increase in the extent of parotid resection and that ECD and PSP can be considered the treatment of choice for benign parotid tumors, as both provide an acceptable balance between the incidence of tumor recurrence and facial nerve dysfunction.

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Extracapsular Dissection in Pleomorphic Adenomas of the Parotid Gland: Results After 13 Years of Follow‐up

Cited by 22 publications

References 37 publications

Single‐surgeon parotidectomy outcomes in an academic center experience during a 15‐year period

Single‐surgeon parotidectomy outcomes in an academic center experience during a 15‐year period

Risk factors for subsequent recurrence after surgical treatment of recurrent pleomorphic adenoma of the parotid gland

Surgical interventions for management of benign parotid tumors: Systematic review and network meta‐analysis

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