Elsevier

Oral Oncology

Volume 41, Issue 10, November 2005, Pages 1021-1027
Oral Oncology

Conservative parotidectomy for the treatment of parotid cancers

https://doi.org/10.1016/j.oraloncology.2005.06.004Get rights and content

Summary

A conservative parotidectomy is defined as any procedure that is less than a classic superficial parotidectomy, and where less than a full facial nerve is dissected. The aim of this study was to evaluate the oncologic effects of a conservative parotidectomy in a series of patients with malignant tumors of the parotid gland.

The medical records of 43 patients treated at Severance Hospital from 1992 to 2002 who had been diagnosed with parotid cancers confined to the superficial lobe, and had also undergone conservative parotidectomies were reviewed. There were 16 males and 27 females, ranging in age from 8 to 84 years. Sixteen tumors (37%) were high-grade and 27 tumors (63%) were low-grade cancers. Twenty-four patients underwent neck dissection simultaneously with the primary lesion. Surgical treatment was followed by radiotherapy in 10 patients. The follow-up period ranged from 8 to 130 months, with a mean duration of time at 57.7 months.

The overall survival rate and the disease-free rate at five years were 88% and 79%, respectively. Univariate analyses showed histologic tumor grade (p = 0.003) and pathologic neck node metastasis (p < 0.001) to be significant variables. Based on multivariate analysis, only the presence of pathologically positive lymph nodes proved to be significant (p = 0.001). Occult metastases rates was 25% (3 of 12 cases) for high-grade tumors and none of the low-grade tumors had microscopic metastases. Recurrences developed in eight cases (19%). Four cases (9%) had a local or locoregional failure. Of these cases, two cases were high-grade tumors (13%, 2 of 16) and the other two cases were low-grade tumors (7%, 2 of 27). The six cases (14%) of which four cases were high-grade (25%) and two cases were low-grade (7%) had positive surgical margin but showed no evidence of local recurrence after additional postoperative radiotherapy. The incidence of postoperative facial nerve paralysis (HB > 1) was 12% (5 outof 43) for a temporary deficit, but there was no permanent paralysis.

Conservative parotidectomy with appropriate postoperative radiotherapy may be an acceptable procedure without potential morbidity, such as postoperative facial palsy, in the treatment of low-grade parotid cancers confined to the superficial lobe if the facial nerve is sufficiently distant from the tumor.

Introduction

Malignant tumors of the parotid gland represent 1–3% of all tumors of the head and neck.1 Because of their relative rarity and varied biological behaviors, the optimal treatment of parotid malignancies is still in debate.2, 3 Surgical resection has been the standard treatment for primary parotid cancers.

A parotidectomy can be classified in terms of the extent of resection as conservative, superficial, or total. A conservative parotidectomy is defined as any procedure that is less than a superficial parotidectomy, and where less than a full facial nerve is dissected.4, 5

The determination of the resection margin depends on the facial nerve position and the obtainment of a clear safety margin. Generally, the surgical treatment for most malignant parotid tumors confined to the superficial lobe is the classic superficial parotidectomy, where the entire superficial lobe is resected. One exception is the histologically proven high-grade tumor, for which a total parotidectomy is usually performed.6, 7

Nonetheless, we would like to suggest a different approach. We believe that if the tumor is confined to the superficial lobe and is sufficiently distant from the facial nerve, it is not always necessary to resect the entire superficial lobe. The reason for this belief is that while the deep surgical margin is fixed at the facial plane of the facial nerve, the resection margin that the surgeon must select is associated with the horizontal extent of the tumor, not with its depth.

With these considerations, the goal of this study was to evaluate the oncologic efficacy of conservative parotidectomies in a series of patients with malignant tumors of the parotid gland.

Section snippets

Patients and methods

A retrospective analysis of 112 previously untreated consecutive patients with malignant tumors of the parotid gland was performed. All patients were seen from 1992 through 2002 at Severance Hospital, Yonsei University, Seoul, Korea. Thirty-nine patients who underwent total or radical parotidectomy due to tumor extension to the deep lobe, intraoperative facial nerve invasion, or presence of preoperative facial nerve palsy, were excluded. In addition, 13 patients who underwent superficial

Histopathology

Table 2 shows the number of patients in our series with each histologic tumor type and grade. Sixteen tumors (37%) were high-grade and 27 tumors (63%) were low-grade cancers.

Surgical margin

Six patients (14%) had cancer involvement in a margin of the parotidectomy specimen. These tumors were classified as follows: mucoepidermoid carcinoma (two cases), adenoid cystic carcinoma (one case), squamous cell carcinoma (one case), adenocarcinoma (one case), and carcinoma ex pleomorphic adenoma (one case). Four cases

Discussion

The aim of parotid surgery is to eradicate the pathologic process while preserving the facial nerve. The malignant parotid tumors can be resected without sacrificing the facial nerve, especially if nerve function is normal before surgery. However, facial nerve preservation does not always correlate with normal postoperative function. Even when the nerve is carefully dissected, significant facial weakness can occur. The extent of the surgery, one of the previously described risk factors, is

Acknowledgements

This study was presented at the 10th International Congress on Oral Cancer, Island of Crete, Greece, 19–24 April 2005, and supported by Konkuk University Grant 2004.

References (28)

  • C.J. O’Brien

    Current management of benign parotid tumors the role of limited superficial parotidectomy

    Head Neck

    (2003)
  • C. Godballe et al.

    Parotid carcinoma: impact of clinical factors on prognosis in a histologically revised series

    Laryngoscope

    (2003)
  • L.P. Bron et al.

    Facial nerve function after parotidectomy

    Arch Otolaryngol Head Neck Surg

    (1997)
  • D. Pederson et al.

    Malignant parotid tumors in 110 consecutive patients: treatment results and prognosis

    Laryngoscope

    (1992)
  • Cited by (65)

    • Clinical-pathological prognostic factors and treatment failure patterns in T1-2 high-grade parotid gland cancer

      2020, Oral Oncology
      Citation Excerpt :

      Partial parotidectomies have less surgical extent compared to superficial parotidectomies, as they do not involve a complete dissection along the facial nerve. In this study, partial or superficial procedures were defined as less-than-total parotidectomies [8]. Pre-operative facial paralysis was analyzed based on medical records.

    • Surgical extent and role of adjuvant radiotherapy of surgically resectable, low-grade parotid cancer

      2020, Oral Oncology
      Citation Excerpt :

      Surgical extent of parotidectomy was divided into total parotidectomy or less-than-total parotidectomy. In this study, partial or complete superficial parotidectomy except extracapsular dissection and enucleation were defined as less-than-total parotidectomy, as these two procedures showed similar oncological results in the treatment of low-grade parotid gland cancers. [12] Histological diagnosis of salivary gland cancer was made after an experienced pathologist reviewed the pathology slides.

    • Recurrent pleomorphic adenoma of the parotid gland: A comparison of radiographic and pathologic tumor burden

      2020, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
      Citation Excerpt :

      Surgical excision is the standard of care, which historically has ranged from enucleation to radical total parotidectomy, but now most often involves a superficial parotidectomy with facial nerve preservation [3–5]. Tumor control after adequate surgical excision of pPAs are excellent, with recurrence rates less than 3% in patients treated with at least a partial superficial parotidectomy, but up to 20–45% following enucleation procedures [2,3,6–8]. Facial nerve outcomes following initial surgical management of pPAs are excellent, one study (N = 79) showed 100% of patients achieving a House Brackman (HB) score of I/VI 12 months after undergoing a superficial parotidectomy [9].

    View all citing articles on Scopus
    View full text