Quer Miquel, Vander Poorten Vincent, Takes Robert P, Silver Carl E, Boedeker Carsten C, de Bree Remco, Rinaldo Alessandra, Sanabria Alvaro, Shaha Ashok R, Pujol Albert, Zbären Peter, Ferlito Alfio
Department of Otolaryngology-Head and Neck Surgery, University Hospital de la Santa Creu i Sant Pau, Universitat Autonòma de Barcelona, Mas Casanovas, 90., 08041, Barcelona, Spain.
European Salivary Gland Society, Geneva, Switzerland.
Eur Arch Otorhinolaryngol. 2017 Nov;274(11):3825-3836. doi: 10.1007/s00405-017-4650-4. Epub 2017 Jun 21.
Different surgical options are currently available for treating benign tumors of the parotid gland, and the discussion on optimal treatment continues despite several meta-analyses. These options include more limited resections (extracapsular dissection, partial lateral parotidectomy) versus more extensive and traditional options (lateral parotid lobectomy, total parotidectomy). Different schools favor one option or another based on their experience, skills and tradition. This review provides a critical analysis of the literature regarding these options. The main limitation of all the studies is the bias of selection for different surgical approaches. For this reason, we propose a staging system that could facilitate clinical decision making and the comparison of results. We propose four categories based on the size of the tumor and its location within the parotid gland. Category I includes tumors up to 3 cm, which are mobile, close to the outer surface and close to the parotid borders. Category II includes deeper tumors up to 3 cm. Category III comprises tumors greater than 3 cm involving two levels of the parotid gland, and category IV tumors are greater than 3 cm and involve more than 2 levels. For each category and for the various pathologic types, a guideline of surgical extent is proposed. The objective of this classification is to facilitate prospective multicentric studies on surgical techniques in the treatment of benign parotid tumors and to enable the comparison of results of different clinical studies.
目前有不同的手术方式可用于治疗腮腺良性肿瘤，尽管已经进行了多项荟萃分析，但关于最佳治疗方案的讨论仍在继续。这些手术方式包括范围更有限的切除（囊外剥离、部分腮腺外侧切除术）与范围更广的传统术式（腮腺外侧叶切除术、全腮腺切除术）。不同的流派基于自身经验、技术和传统而倾向于某种术式。本综述对有关这些术式的文献进行了批判性分析。所有研究的主要局限性在于不同手术方法的选择偏倚。因此，我们提出一种分期系统，该系统有助于临床决策和结果比较。我们根据肿瘤大小及其在腮腺内的位置提出了四类分期。I类包括直径达3 cm、可活动、靠近外表面且靠近腮腺边界的肿瘤。II类包括直径达3 cm的较深部位肿瘤。III类包括直径大于3 cm且累及腮腺两个层面的肿瘤，IV类肿瘤直径大于3 cm且累及两个以上层面。对于每一类分期以及各种病理类型，我们都提出了手术范围指南。这种分类的目的是促进关于腮腺良性肿瘤治疗手术技术的前瞻性多中心研究，并能够比较不同临床研究的结果。
