Pleomorphic adenoma parotid surgery, how much margin we can reach to be safe?

Abstract

Background: The extent of surgery in cases of parotid gland pleomorphic adenoma (PA) remains
challenging. This study aims to evaluate the importance of surgical margins in ensuring safe surgery
for patients with PA.
Materials and Methods: This prospective study was conducted to evaluate the risk of local
recurrence based on surgical margins in patients with parotid PA who underwent superficial or
total parotidectomy between May 2019 and November 2021 at a tertiary referral hospital in Tehran,
Iran. Patients were followed for at least 2 years. Data were analyzed using SPSS version 23. The
normality of data distribution was assessed using the Kolmogorov–Smirnov test. Quantitative and
qualitative variables were analyzed with the independent t‑test and Chi‑square test, respectively.
A P < 0.05 was considered statistically significant.
Results: Fifty‑seven cases were included in the study. The mean age was 40.7 years, with 37 of
57 (64.9%) patients being female. Of these, 35 of 57 (61.4%) underwent superficial parotidectomy.
All tumors were resected with negative margins, with an average safe margin of 0.58 cm (range:
0–3.7 cm). The greatest margin was found at the anterior side (average: 0.76 cm), whereas the
smallest margin was at the vertical side (average: 0.39 cm). Postoperative radiotherapy was not
administered to patients with close surgical margins. No recurrence was observed after a 2‑year
follow‑up.
Conclusion: In the surgical resection of parotid PA, negative margins are sufficient, and there is no
need to obtain additional safe margins to reduce the risk of recurrence. Therefore, extracapsular
dissection (which carries higher morbidities) can be replaced by superficial parotidectomy with
negative margins (which carries lower morbidities).
Key Words: Adenoma, head and neck neoplasms, parotid gland, salivary gland neoplasms,surgery

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Mosleh KadkhodaMohammadi: Pubmed,Google Scholar