Paradigm shift in surgery for benign parotid tumors: 19 years of experience with almost 3000 cases

Bär, B; Mantsopoulos, Konstantinos; Iro, Heinrich

doi:10.1002/lary.28454

Cited by 28 publications

(17 citation statements)

References 30 publications

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“…22,76 Therefore, based on the results of the current study and previous reports, enucleation should not be considered in the management of benign parotid tumors. 5 The higher recurrence rate associated with enucleation could be attributed to that some benign parotid tumors, particularly pleomorphic adenoma, can produce pseudopods extending outside the tumor capsule which might be left behind in the surgical bed during tumor resection. 75 It is also important to note that long follow-up is required for an optimum evaluation of tumor recurrence.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…Nonetheless, tumor recurrence, facial nerve paralysis, and other complications (Frey's syndrome [FS], sialocele, and salivary fistula) continue to be reported following all the above‐mentioned surgical interventions 5,19–20 …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…In ECD, the facial nerve is not identified intentionally, and unlike enucleation, the lesion is removed outside of the capsule. Bär et al 20 examined approximately 3,000 surgeries performed in 2000 to 2018 and reported a rapid increase in ECD in this decade. Furthermore, many reports consistently demonstrate that the rate of postoperative facial nerve palsy and Frey syndrome is lower for ECD than for PSP 21 because ECD is indicated for small tumors located superficially.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors of Postoperative Facial Palsy for Benign Parotid Tumors: Outcome of 1,018 Patients

et al. 2021

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The aim of this study was to evaluate the rate of postoperative facial palsy in benign parotid tumors, as well as its risk factors, pathology, and clinical results.Study Design: Retrospective analysis.Methods: We performed a retrospective analysis of data from patients whose initial operation for a benign parotid tumor had been performed in our department between 1999 and 2020.Results: We included 1,018 patients in this study. The most common tumor observed was pleomorphic adenoma (614 patients), followed by Warthin tumor (234 patients). Fine-needle aspiration cytology and frozen section biopsy were used to identify the tumor histopathology. The overall rate of postoperative facial nerve palsy was 19.5%; the rate was significantly higher in patients with large-diameter tumors or deep lobe tumors. Postoperative facial palsy improved within 24 months of surgery in all cases. There were no cases with permanent facial palsy.Conclusions: Postoperative facial nerve palsy developed regularly after surgery to remove benign parotid tumors despite preservation of the nerve. Palsy rate was high in patients with large tumors or deep lobe tumors. Despite the high risk of facial palsy in these patients and the benign nature of the tumor, we recommend surgery rather than follow-up observation, as the risk of postoperative facial palsy may increase as the tumor grows. It is important to provide an accurate explanation on the risks of postoperative complications to all patients to obtain appropriate informed consent for surgery.

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“…tomischen Kapseldefektes stellt auch die Grundlage der Philosophie der sogenannten extrakapsulären Dissektion dar. Bei dieser Operationsmethode besteht die Aufgabe des Operateurs darin, in der Präparation möglichst außerhalb der Tumorkapsel ("extrakapsuläre Dissektion") des PA zu bleiben, um die Abdeckung eines potenziellen anatomischen Defektes von gesundem Gewebe sicherzustellen und den Tumor "im Gesunden" zu entfernen [17].…”

Section: Diskussionunclassified

“…Ebenso fiel die Rate der mikroskopischen fokalen Kapseldefekte (2,9 %) im Vergleich zur Literatur (14,3 [8] -20,1 % [5]) niedriger aus. Dies ist insofern von Relevanz, als dass die vermehrte Durchführung der "kapselnäheren Dissektion" (in Form der extrakapsulären Dissektion) im Vergleich zur konventionellen Parotischirurgie [17,20] nicht mit einer signifikant höheren Gefährdung der Adenomkapsel verbunden war. Die homogene Verteilung der 37 Fälle über die 16 Jahre der Studie (▶ Abb.…”

Section: Diskussionunclassified

Der Einfluss des Kapseldefektes als Risikofaktor für die Rezidivbildung beim pleomorphen Adenom der Glandula parotidea

Buchta

Thimsen

Iro

et al. 2021

Laryngorhinootologie

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Zusammenfassung Hintergrund Ziel diese Arbeit war es, verschiedene Aspekte des Kapseldefekts eines pleomorphen Adenoms zu beleuchten und den Einfluss dieses Faktors mithilfe der vorliegenden Daten und der relevanten Literatur auf das Rezidivrisiko zu analysieren. Material und Methoden Es handelt sich um eine retrospektive Analyse aller Patienten, welche zwischen 2005 und 2020 bei einem pleomorphen Adenom der Glandula parotidea behandelt wurden. Es erfolgte eine erneute histopathologische Untersuchung der Paraffinblöcke aller Fälle sowie eine Analyse der patientenbezogenen Daten, des Ausmaßes des primären operativen Eingriffs und des Rezidivrisikos. Die Nachsorgeuntersuchung erfolgte im Sinne einer klinischen und sonografischen Untersuchung. Ergebnisse Insgesamt wurden 845 Patienten in einer Datenbank erfasst. Hierunter fanden sich 7 (0,8 %) Rezidive, jedoch alle bei „in sano“ resezierten Tumoren. Positive Ränder zeigten sich in 37 Fällen (4,4 %). Bei 13 der 37 Fälle war dies intraoperativ festgestellt worden, wohingegen der Defekt bei 24 der 37 Fälle erst histopathologisch identifiziert wurde. Bei den 13 Fällen der makroskopischen Tumoreröffnung wurde in 2 Fällen bei der sonografischen Untersuchung der Verdacht auf ein unilokuläres Rezidiv des pleomorphen Adenoms gestellt, welches zunächst sonografisch kontrolliert wurde. Schlussfolgerung Die positiven Ränder beim parotidealen pleomorphen Adenom scheinen nicht zwangsläufig zum vorprogrammierten Rezidiv zu führen.

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Paradigm shift in surgery for benign parotid tumors: 19 years of experience with almost 3000 cases

Cited by 28 publications

References 30 publications

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

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

Risk Factors of Postoperative Facial Palsy for Benign Parotid Tumors: Outcome of 1,018 Patients

Der Einfluss des Kapseldefektes als Risikofaktor für die Rezidivbildung beim pleomorphen Adenom der Glandula parotidea

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