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Is There a Role for Limited Parotid Resections for Primary Malignant Parotid Tumors?

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Is There a Role for Limited Parotid Resections for Primary Malignant Parotid Tumors? Opinion Is There A Role for Limited Parotid Resections for Primary Malignant Parotid Tumors? Miquel Quer 1,2,3,* , Kerry D. Olsen 4, Carl E. Silver 5, Marc Hamoir 6 , Antti A. Mäkitie 7,8,9, Juan P. Rodrigo 10,11 , Vincent Vander Poorten 3,12, Robert P. Takes 13, Henrik Hellquist 14, Jacinto García Lorenzo 1,2, Orlando Guntinas-Lichius 3,15,16 , Remco de Bree 17 , Carlos Suárez 18, Luiz P. Kowalski 19, José G. Vartanian 19 , Alvaro Sanabria 20 , Ashok R. Shaha 21, Peter Zbären 22, Alessandra Rinaldo 23 and Alfio Ferlito 24 1 Department of Otolaryngology-Head and Neck Surgery, University Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; [email protected] 2 Department of Surgery, Universitat Autonòma de Barcelona, 08193 Bellaterra, Barcelona, Spain 3 Multidisciplinary Salivary Gland Society, 1204 Genève, Switzerland; [email protected] 4 Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN 55902, USA; [email protected] 5 Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ 85724, USA; [email protected] 6 Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital and King Albert II Cancer Institute, 1200 Brussels, Belgium; [email protected] 7 Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland; Antti.Makitie@hus.fi 8 Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, 00100 Helsinki, Finland 9 Department of Clinical Sciences Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska University Hospital, Stockholm, 171 64 Solna, Sweden 10 Department of Otolaryngology, Hospital Universitario Central de Asturias, 33011 Oviedo, Asturias, Spain; [email protected] 11 Instituto Universitario de Oncología del Principado de Asturias (IUOPA), University of Oviedo, 33006 Oviedo, Asturias, Spain 12 Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium 13 Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; [email protected] 14 Department of Biomedical Sciences and Medicine, University of Algarve, 8005-139 Faro, Portugal; [email protected] 15 Department of Otorhinolaryngology, Institute of Phoniatry/Audiology, Jena University Hospital, 07743 Jena, Germany; [email protected] 16 Facial Nerve Center, Jena University Hospital, 07743 Jena, Germany 17 Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; [email protected] 18 Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Asturias, Spain; [email protected] 19 Department Otorhinolaryngology-Head and Neck Surgery, Centro de Tratamento e Pesquisa Hospital do Cancer A.C. Camargo, 01508-010 São Paulo, Brazil; [email protected] (L.P.K.); [email protected] (J.G.V.) 20 Department of Surgery, School of Medicine, Universidad de Antioquia- Hospital Universitario San Vicente Fundacion, CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellin 1226, Colombia; [email protected] 21 Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; [email protected] 22 Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Universitätsspital Bern, 3010 Bern, Switzerland; [email protected] 23 University of Udine School of Medicine, 33100 Udine UD, Italy; [email protected] 24 International Head and Neck Scientific Group, 35100 Padua, Italy; alfi[email protected] * Correspondence: [email protected] Received: 29 May 2020; Accepted: 11 June 2020; Published: 15 June 2020 Surgeries 2020, 1, 2–9; doi:10.3390/surgeries1010002 www.mdpi.com/journal/surgeries Surgeries 2020, 1 3 Abstract: (1) Background: Lateral or total parotidectomy are the standard surgical treatments for malignant parotid tumors. However, some authors have proposed a more limited procedure. (2) Methods: We performed a review of the literature on this topic. Studies were included that met the following criteria: malignant parotid tumors, information about the extent of surgical resection, treated with less than a complete lateral lobectomy, and information on local control and/or survival. Nine articles fulfilled the inclusion criteria. (3) Results: Eight of the nine series reported favorable results for the more limited approaches. Most used them for small, mobile, low-grade cancers in the lateral parotid lobe. Most authors have used a limited partial lateral lobectomy for a presumed benign lesion. The remaining study analyzed pediatric patients treated with enucleation with poor local control. (4) Conclusions: There is weak evidence for recommending less extensive procedures than a lateral parotid lobectomy. In the unique case of a partial lateral parotidectomy performed for a tumor initially thought to be benign but pathologically proved to be malignant, close follow-up can be recommended for low grade T1 that has been excised with free margins and does not have adverse prognostic factors. Keywords: primary malignant parotid tumors; parotid malignancy; parotid tumors; partial parotid surgery; parotid surgery 1. Introduction Surgery is considered the primary treatment modality for most malignant parotid tumors. The extent of the surgery depends mainly on the local extent of the disease [1–10]. In advanced tumors (T3 and T4), there is consensus that a total parotidectomy is the standard local treatment. In contrast, for early tumors (T1, N0), the extent of resection is still controversial. The standard approach has been total parotidectomy or lateral parotid lobectomy. One debated issue is whether to extirpate the deep lobe of the gland to remove the intraparotid deep lobe nodes [1–10]. This is done when there is evidence of superficial parotid or neck node metastasis from a parotid gland cancer, or if the tumor is of high-grade histology. Controversy regarding the extent of the gland to be removed also occurs as some recommend [11] a more limited resection than complete lateral lobectomy. Limited parotid surgery is becoming more frequent in the management of benign tumors, and as a result, more malignant tumors are incidentally found after partial surgery. When limited parotid surgery is done for a presumably benign tumor, and final histology reveals malignancy, subsequent treatment is often dictated by the final pathologic findings. For most cancers, the standard advice is to complete a total parotidectomy [1–8]. Recently, some advocate “watchful waiting”, for small, low-grade, and free-margin resections [12]. The objective of this article is to review the literature regarding the use of partial parotid surgery for the treatment of malignant parotid tumors and try to define the proper indications for such procedures. 2. Materials and Methods To analyze the role of limited resections for malignant primary parotid tumors, we conducted a systematic review of the current literature. A PubMed internet search was performed for English language publications between the years 1990 and 2019, using the following search criteria in the title or abstract: “parotid gland malignant tumor” or “parotid gland cancer” or “parotid surgery”. The search results were reviewed for potential eligible studies. When any abstract addressed procedures less extensive than lateral parotid lobectomy, the full article was searched. References were cross-checked to ensure inclusion of all relevant publications. Studies were selected if they met the following inclusion criteria: (1) patients treated for malignant parotid tumors, (2) information about the extent of surgical resection, (3) patients treated with less than lateral lobectomy, and (4) information on local control and/or survival. Our search criteria identified 61 papers for data review and 9 articles fulfilled the inclusion criteria. Surgeries 2020, 1 4 3. Results The nine articles (Table1) are presented in the order of publication, but three articles of the same group are analyzed together. Table 1. Publications in partial surgery for parotid malignant tumors. Number of Cases. Histolo-Gical Local Control (LC) Year Authors Complementary Treatment Type and Survival 79% LC (5 recurrences). 24 extracapsular dissection (ECD) No specific 1999 Renehan et al. [13] 68% 10 years overall (13 post-op radiotherapy) information survival. 1 PLL (low-grade, <3 cm) 100% LC 1999 Witt [14] (No information on 1 MEPCA No data on survival complementary treatment) 1 ACC 12 ECD in selected cases (discrete, 1 AdCC 91.7% LC (1 recurrence) mobile, and less than 4 cm 2003 McGurk et al. [15] 7 MEPCA 100% The 10-year in diameter) 3 others (no cancer-specific survival (7 post-op radiotherapy) specified) Low-grade: 11 ACC 9 MEPCA 6 BCC 90.5% LC (4 43 “conservative parotidectomy” 1 AdCC recurrences) 2005 Lim et al. [11] (less than superficial) High-grade: 88% 5 years overall (10 post-op radiotherapy) 5 MEPCA survival 4 AdCC 3 CEPA 2 ADC 2 SCC 11 Enucleation No specific 2016 Cockerill et al. [16] (No information on 36% LC (7 recurrences) information complementary treatment) 2 PLL (II) low-intermediate grade, 100% LC (one T1 and one T2) with close 1 AdCC 2017 Stodulski et al. [17] 100% cancer-specific margins 1MEPCA survival (No post-op radiotherapy) 4 ACC 14 ECD low grade (13 T1 and one 100% LC Mantsopoulos et al. 1 BCC 2019 T2). Free margins 100% cancer-specific
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