Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience

Kadletz, Lorenz; Grasl, Stefan; Grasl, Matthäus C.; Perisanidis, Christos; Erovic, Boban M.

doi:10.1002/hed.24598

Cited by 59 publications

(59 citation statements)

References 25 publications

(121 reference statements)

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“…Similar findings were described in breast cancer studies, where preoperative utilization of core needle biopsy was significantly associated with decreased risk of positive margins and need for reoperation . Preoperative diagnosis of a parotid malignancy by biopsy may allow for optimal surgical planning, including preparation for total parotidectomy and/or facial nerve sacrifice if involvement is identified intraoperatively, and avoidance of conservative extracapsular dissection or excisional biopsy, subsequently improving the chances for adequate margin‐free resection and adequate nodal sampling . A recent single center study of 477 patients with surgically treated parotid masses who underwent FNA found that FNA changed the surgical management in 19% of patients, resulting in an added neck dissection when tumors were identified as malignant and downgrading to excisional biopsy in case of a benign entity …”

Section: Discussionsupporting

confidence: 57%

“…However, others argue that preoperative biopsy allows for optimal surgical planning, as well as patient preparation, as some malignant tumors may necessitate the addition of a neck dissection, total parotidectomy, and possibly facial nerve sacrifice to remove the tumor in its entirety . Moreover, partial or less extensive resections employed in clinically benign, but not malignant tumors, such as extracapsular dissection, may increase the risk of positive margins and recurrence …”

Section: Introductionmentioning

confidence: 99%

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Preoperative biopsy in parotid malignancies: Variation in use and impact on surgical margins

et al. 2019

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Objectives Determine rate of preoperative biopsy in parotid malignancies, identify factors associated with its use, and its association with surgical margins. Study Design Retrospective cohort. Setting Commission on Cancer–Accredited Institutions. Subjects and Methods We included 5533 patients treated surgically for a parotid malignancy 2004–2014 in the National Cancer Database. Chi‐squared tests, univariable, and multivariable logistic regressions were used to evaluate predictors of preoperative biopsy (defined as needle, aspiration, or incisional), and associate biopsy with surgical margins. Results Preoperative biopsy was utilized in 26.0% of patients. Biopsy was more likely in patients >60 years (odds ratio [OR]: 1.19, P = .035), advanced clinical T stage (vs. T1,T2 OR: 1.23, P = .009; T3 OR: 1.26, P = .026; T4A OR: 2.05, P < .001), advanced clinical N stage (vs. N0, N1: OR: 1.39, P = .013; N2/3: OR: 1.63, P < .001), in academic centers (OR: 1.18, P < .024), and in higher volume centers (vs. low, medium OR: 1.28, P = .002; high OR: 2.16, P < .001). Biopsy use increased over time (vs. 2004–2006, 2007–2010 OR: 1.20, P = .047; 2011–2014 OR: 1.39, P < .001). Biopsy was associated with a reduced risk of positive margins in patients with clinical T1 stage (OR: 0.70, P = .012), and younger than 61 (OR: 0.79, P = .036). Conclusion The national rate of preoperative biopsy in parotid malignancy is low at 26.0%, but has increased over time. Preoperative biopsy is associated with a reduced risk of positive margins in younger patients and those with early clinical stage, suggesting its increased use may improve surgical outcomes and decrease reoperation or adjuvant therapy in these subgroups of patients. Level of Evidence 3 Laryngoscope, 130:1450–1458, 2020

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Preoperative biopsy in parotid malignancies: Variation in use and impact on surgical margins

et al. 2019

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“…Surgeons defined the operation mostly as a superficial parotidectomy ( Table 2; (70% in Cologne, 72% in Jena, 71% in Giessen). However, all main peripheral facial nerve branches (5) were dissected in 33% of surgeries in Cologne, in 75% in Jena, and in 0% in Giessen. On the other hand, parotidectomy was defined as partial in Cologne and Giessen in 20% and 24%, respectively, and in 0% in Jena.…”

Section: Characteristics Of the Patients And Surgerymentioning

confidence: 99%

“…The appropriate amount of dissection for treatment of benign parotid tumors is an ongoing debate . The goal of limited surgery is to minimize perioperative and postoperative morbidity.…”

Section: Introductionmentioning

confidence: 99%

Impact of extent of parotidectomy on early and long‐term complications: A prospective multicenter cohort trial

et al. 2019

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Background In this prospective nonrandomized multicenter trial, we analyze the incidence of early and late complications after parotidectomy in correlation to the extent of dissection. Methods A total of 148 patients underwent a parotidectomy for a benign lesion in the superficial lobe. The number of intraoperatively dissected main facial nerve branches was photo‐documented and defined the extent of tissue dissection. Early postoperative complications including sialocele were evaluated until 4 weeks after surgery. Late complications as facial nerve palsy, Frey's syndrome (FS) and the outcome of the scar and substance loss were furthermore assessed after 6 and 12 months. Results Early complications occurred in 22 patients (14%) and did not depend on the extent of facial nerve dissection (all P > .05). However, patients with higher number of intraoperatively dissected facial nerve branches showed significantly higher palsy scores on the first postoperative day (P = .026). FS occurred with incidence of 69% and correlated significantly to the extent of dissection (P = .003). Appearance of the scar and substance loss improved significantly during the follow‐up (P < .001 and P < ,005, respectively) without significant correlation to the extent of dissection (P > .05 for both variables after 12 months). Conclusions Less extensive tissue dissection resulted in better postoperative facial nerve function on the first postoperative day and in lower incidence of FS after 12 months. However, incidence of early complications did not depend on the extent of surgery. The study was registered in the German Clinical Trials Register prior to conducting the research. DRKS‐ID: DRKS00008967, URL:http://apps.who.int/trialsearch/.

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“…We read with great interest the article titled "Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience" authored by Kadletz et al, 1 published online in the October 2016 issue of Head & Neck. Over a period of 55 years and after examining 894 cases (514 pleomorphic adenomas together with 380 cystadenolymphomas) the authors detected a significantly higher incidence of tumorinfiltrated resection margins, recurrences, and permanent facial nerve palsies after extracapsular dissection in comparison to superficial parotidectomy.…”

Section: Dear Editormentioning

confidence: 99%

Letter to the Editor‐1 regarding “Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience”

Mantsopoulos

Iro

2017

Head & Neck

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Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience

Abstract: Because extracapsular dissection led to a significantly higher percentage of permanent facial palsy, recurrent disease, and positive resection margins compared to SP, we recommend SP for treating benign parotid gland tumors. © 2016 Wiley Periodicals, Inc. Head Neck 39: 356-360, 2017.

Cited by 59 publications

References 25 publications

Preoperative biopsy in parotid malignancies: Variation in use and impact on surgical margins

Preoperative biopsy in parotid malignancies: Variation in use and impact on surgical margins

Impact of extent of parotidectomy on early and long‐term complications: A prospective multicenter cohort trial

Letter to the Editor‐1 regarding “Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience”

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