Hussein Osama, Abdel Wahab Khaled, Hamdy Omar, Arafa Mohammad, Hamed Emad-Eldeen, Awny Shady, Roshdy Sameh, Denewer Adel, Mosbah Mahmoud
Surgical Oncology Department, Mansoura University Faculty of Medicine, Mansoura University Cancer Center, Mansoura, Egypt.
Pathology Department, Mansoura University Faculty of Medicine, Mansoura, Egypt.
Front Surg. 2018 Feb 5;5:3. doi: 10.3389/fsurg.2018.00003. eCollection 2018.
Pleomorphic adenoma is the most common benign tumor of the parotid gland and is classically treated with superficial or total parotidectomy. Less radical surgeries have been proposed to minimize the risk of facial nerve injury. The oncological safety of these procedures remains controversial. We conducted this study to evaluate the safety of superficial hemi-lobectomy (quadrantectomy).
Retrospective analysis was conducted on the paraffin sections of archived superficial parotidectomy specimens from 11 male and 6 female patients (median age 33 years). The microscopic extent of extra-capsular extension was determined on pathological revision. In addition, prospective evaluation of 12 quadrantectomy procedures (M/F = 7/5, median age = 36 years) compared to 24 radical surgeries (M = F, median age = 40 years) regarding temporary and persistent facial nerve dysfunction on routine clinical assessment and recurrence rate.
On retrospective pathological revision, pleomorphic adenomata had a median microscopic spread of 3 mm beyond capsule in paraffin sections (SD = 3.6). On prospective analysis with a median follow-up of 33 months (range = 18-54 months), quadrantectomy had similar relative risk of temporary facial nerve dysfunction evaluated at the immediate postoperative period as well as persistent nerve dysfunction assessed at 3 months ( = 0.701 and = 0.902, respectively). Of the whole study population, one case of recurrence after total parotidectomy was observed at mid-term follow-up ( = 1.000).
Parotid quadrantectomy is a safe management for smaller pleomorphic adenomata localized close to one of the two divisions of the facial nerve.
多形性腺瘤是腮腺最常见的良性肿瘤，传统上采用腮腺浅叶切除术或全腮腺切除术治疗。有人提出采用创伤较小的手术以降低面神经损伤风险。这些手术的肿瘤学安全性仍存在争议。我们开展本研究以评估腮腺浅叶半切除术（象限切除术）的安全性。
对11例男性和6例女性患者（中位年龄33岁）存档的腮腺浅叶切除术标本石蜡切片进行回顾性分析。通过病理复查确定包膜外扩展的显微镜下范围。此外，对12例象限切除术（男/女 = 7/5，中位年龄 = 36岁）与24例根治性手术（男 = 女，中位年龄 = 40岁）进行前瞻性评估，比较常规临床评估中的暂时性和持续性面神经功能障碍及复发率。
回顾性病理复查显示，多形性腺瘤在石蜡切片中的显微镜下包膜外扩散中位值为3 mm（标准差 = 3.6）。前瞻性分析中，中位随访33个月（范围 = 18 - 54个月），象限切除术在术后即刻评估的暂时性面神经功能障碍相对风险以及3个月时评估的持续性神经功能障碍相对风险相似（分别为 = 0.701和 = 0.902）。在整个研究人群中，中期随访时观察到1例全腮腺切除术后复发（ = 1.000）。
腮腺象限切除术对于位于面神经两个分支之一附近的较小多形性腺瘤是一种安全的治疗方法。
