Variables related to recurrence of pleomorphic adenomas: Outcome of parotid surgery in 182 cases (original) (raw)

Tumour Recurrence and Facial Nerve Injury Rates After Surgery of Pleomorphic Adenoma Through 5-Year Follow-Up : A Retrospective Single-Centre Study

2019

According to the guidelines for the treatment of pleomorphic adenoma of parotid gland patients should undergo superficial parotidectomy. The aim of our study was to compare facial nerve injury rates and tumour recurrence rates after superficial parotidectomy vs. tumour extirpation as an alternative procedure of treatment. Study was conducted as a retrospective analysis of the data from patients, who underwent different surgeries of pleomorphic adenoma removal in our university centre between 2005 till 2017 and were followed up for 5 years after the procedure. The major independent variables were superficial parotidectomy or extirpation, and the main outcome parameter was diagnosis of facial nerve injury or tumour recurrence. Overall 161 cases of surgical removal of pleomorphic adenomas were analysed. Mean age of patients was 47.9±19.5 years. The male-to-female ratio was 1:1.04 with no significant differences between genders. Adenoma pleomorphe as diagnosis was mostly found at paroti...

Management and prognostic factors of recurrent pleomorphic adenoma of the parotid gland: personal experience and review of the literature

European Archives of …, 2008

The aim of this study was to investigate the management and prognostic determinants of recurrent pleomorphic adenoma (RPA). A retrospective analysis was performed to examine the clinical features, the prevalence of surgical complications, and new recurrences of RPA. Tumor recurrence rate was estimated by the Kaplan-Meier method, and the prognostic value of some of the variables was tested by univariate analysis using the log rank test. The study focused on 33 patients, 18 female (54.5%) and 15 male (45.5%), aged 12-71 years (median 41). A total or extended total parotidectomy was performed in 16 cases (48.5%), a superWcial parotidectomy in 10 cases (30.3%), and a local excision in 7 cases (21.2%). In ten patients (30.3%), a branch or the trunk of the facial nerve was deliberately sacriWced. Major complications included one unexpected deWnitive paralysis of the marginal mandibular branch of the facial nerve and 14 cases of Frey syndrome. Follow-up varied from 2 to 25 years (median 10.5 years), and there were 11 new recurrences (33.3%) within a period varying from 1 to 16 years (median 6 years). The estimated tumor recurrence rates were 14.1 § 6.6% at 5 years, 31.4 § 9.4% at 10 years, 43.0 § 10.8% at 15 years, and 57.2 § 14.8% at 20 years. Presence of a multinodular lesion and the type of intervention performed were signiWcantly associated with a higher probability of recurrence. RPAs are prone to new recurrences, especially when multinodular and treated with a local excision. Surgical treatment should include facial nerve resection in selected cases. Follow-up for the patient's lifetime is warranted.

Pleomorphic adenoma of the parotid gland: is long-term follow-up needed?

Auris Nasus Larynx, 2002

Introduction: Pleomorphic adenoma is a slow-growing benign salivary tumour most commonly arising in the parotid gland. Macroscopically it has a surrounding capsule from which it can be enucleated */often the treatment used in the past. These tumours do not have a true capsule but can press surrounding normal salivary gland, frequently having finger-like extensions into the normal tissues. Recurrence, or more accurately residual disease, is thought to be due to these small islands of tumour which can be left behind at surgery, in particular enucleation which is associated with high recurrence rate. The current, most common practice is the excision of these tumours through superficial parotidectomy and postoperative follow-up. However, is long-term follow-up necessary and does it reduce the morbidity from tumour recurrence? Methods: We reviewed the charts of 182 patients who underwent parotid surgery operated upon by a single surgeon (RKM) between 1973 and 1999. We included only 58 cases of pleomorphic adenomas removed by superficial parotidectomy. We excluded cases that had follow-up of less than 12 months and cases which had previous surgery elsewhere. Adequate tumour excision and the integrity of the capsule were ascertained intraoperatively, and this was confirmed by postoperative histology. Results: In our study we had 34 females, mean age of 58, and 24 males, mean age of 50. The average follow-up was 6 years with a range of 1 Á/23 years. We had no permanent facial nerve dysfunction, and we recorded only one recurrence (1.7%). Conclusion: Provided adequate excision of the tumour with intact capsule and histological confirmation are achieved, long-term follow-up is unnecessary and can be replaced by patient education and selfexamination. #

Recurrent Parotid Pleomorphic Adenomas: Our Clinical Experience

Turk Otolarengoloji Arsivi/Turkish Archives of Otolaryngology, 2016

Objective: The aim of our study was to present our findings in a series of patients who were treated for recurrent parotid pleomorphic adenoma with their clinical, surgical, and follow-up information and to discuss them in light of the recent literature. Methods: Eleven patients who had revision surgery for recurrent pleomorphic adenoma at our institution were retrospectively analyzed for the clinical and radiological features of their lesions, surgery type, facial nerve management, and follow-up period. Results: Seven patients were females and four were males with an average age of 45 years. All patients underwent previous surgeries at other institutions. Revision surgery was performed with superficial parotidectomy in six patients and total conservative parotidectomy with preservation of the facial nerve in five patients. Two patients had lesions involving the facial nerve branches necessitating sacrifice of involved branches. One patient was given adjuvant radiotherapy because of adjacent lymphatic vessel involvement with tumor cells. During the mean follow-up period of 9.1 years, there were no recurrences in any of the patients. Conclusion: Management of patients with recurrent parotid pleomorphic adenomas must be carefully planned according to the size, location, and multicentricity of the tumor and involvement of the facial nerve. Surgery should aim at reaching tumor-free surgical margins. Sacrifice of the facial nerve should be considered only in cases with direct involvement. In the postoperative period, patients must be followed up regularly for early diagnosis of recurrences.

Rupture of the Pleomorphic Adenoma of the Parotid Gland: What to Know before, during and after Surgery

Journal of Clinical Medicine, 2021

Background: We assessed the cases of intraoperative spillage of primary pleomorphic adenomas (PPAs) of the parotid gland in the literature, comparing them with our own cases. We aim to explain how the surgeon should manage a spillage during surgery (i.e., how to avoid spreading the contents that are coming out of the tumor). We also aim to investigate whether or not spillage is linked to a higher rate of PPA recurrence. Methods: We collected surgical and pathological reports, taking data on capsular ruptures and the spillage of tumors. Results: Intraoperative tumor spillage and tumor rupture occurred in 34/202 cases. There were three recurrences after a mean of 3.7 years (mean follow-up duration: 10.3 years). One recurrence happened to a patient who had an intraoperative tumor spillage, and two more recurrences happened to patients who did not have spillage. Conclusion: We believe that the real number of the events of spillage is underestimated and underreported by surgeons. Capsula...

Etiology and management of recurrent parotid pleomorphic adenoma

The Laryngoscope, 2014

The objective of this review study was to encompass the relevant literature and current best practice options for this challenging, sometimes incurable problem. The source of the data was Ovid MEDLINE from 1946 to 2014. Review methods consisted of articles with clinical correlates. The most important cause of recurrence is enucleation with rupture and incomplete tumor excision at operation. Incomplete pseudocapsule, extracapsular extension, pseudopods of pleomorphic adenoma tissue, and satellite pleomorphic beyond the pseudocapsule are also likely linked to recurrent pleomorphic adenoma. Most recurrent pleomorphic adenoma are multinodular. Magnetic resonance imaging is the imaging study of choice for recurrent pleomorphic adenoma. Nerve integrity monitoring may reduce morbidity for recurrent pleomorphic adenoma. Treatment of recurrent pleomorphic adenoma must be individualized. Total parotidectomy, given the multicentricity of recurrent pleomorphic adenoma, is appropriate in many pa...

Clinical Manifestations of Recurrent Parotid Pleomorphic Adenoma

Clinical and Experimental Otorhinolaryngology, 2009

Objectives. This study was undertaken to confirm the clinical characteristics of recurrent pleomorphic adenoma (RPA), and to identify those factors that affect the development of malignant transformation (MT) from RPA. Methods. The medical records of 270 patients, who were operated upon for parotid PA, were retrospectively reviewed. The pathologic specimens of a selected series of 23 patients were reviewed for histologic subtype and microscopic multi-nodularity. Results. Mean age of initial operation in RPA without MT (RPA-MT) group was significantly lower than that of primary PA group. Mean age of the revision operation in RPA with MT (RPA +MT) group was significantly greater than that of RPA-MT group. Mean interval from operation to recurrence shortened after each revision operation. The risk of MT and additional recurrence increased significantly with recurrence. In RPA-MT group tumor recurrence occurred in 21.4% of patients despite a clear resection margin. Conclusion. The risk factors for MT may be an age of over 45 yr and multiple recurrences. However, younger patients are more at risk of recurrence. A clear resection margin cannot guarantee a cure in RPA, and it seems that parotid pleomorphic adenomas slowly gain malignant characteristics after repeated recurrences.

Long-Term Clinical Experience in Patients Following Parotidectomy

2018

Introduction: Neoplasms of the salivary glands comprise 3-12% of head and neck tumors. Type of surgery to be performed varies according to the location, histopathology and facial nerve involvement, while the most commonly applied methods currently are superficial, total and radical parotidectomy. The aim of this study was to retrospectively evaluate the 434 cases that were operated on for parotid mass between January 2008 and December 2016 in a tertiary university hospital. Results: Demographic data, histopathologic type, clinical findings and symptoms, type of surgery, early and late complications, recurrence were retrospectively reviewed and evaluated. Postoperative evaluations revealed a non-neoplastic mass in 40 (9.22%) patients , while 37 (8.52%) had malignant neoplastic mass, 344 (79.26%) patients had benign neoplastic mass. and 13 (2.99%) patients had hematolymphoid mass. Recurrence was found in 2 patients (0.048%) who underwent surgery and histopathological diagnosis in all ...