Vanroose R, Scheerlinck J, Coopman R, Nout E
Department of Oral Health Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Oral and Maxillofacial Surgery, Sint-Elisabeth Hospital, Tilburg, the Netherlands.
Department of Oral and Maxillofacial Surgery, Sint-Elisabeth Hospital, Tilburg, the Netherlands.
Int J Oral Maxillofac Surg. 2023 Feb;52(2):191-198. doi: 10.1016/j.ijom.2022.05.001. Epub 2022 May 24.
Improvements in preoperative diagnostics and intraoperative techniques have made the surgical excision of benign parotid gland tumours less invasive. Extracapsular dissection (ECD) has become more popular in comparison to superficial parotidectomy (SP), the gold standard. Although clinical outcomes have been reported, reports on cost-effectiveness are limited. The aim of this retrospective study was to analyse the surgical outcomes and cost-effectiveness of ECD versus SP in benign parotid tumour surgery. A retrospective cohort of 161 patients treated between 2012 and 2020 was collected. Data concerning demographics, clinical outcomes, and cost-efficiency were recorded. Analysis of the 161 unilateral parotidectomy cases (59 SP, 102 ECD) showed a significantly longer operation time, anaesthesia time, and length of stay for SP patients (all P < 0.001). Regarding postoperative complications, transient facial nerve weakness (P < 0.001) and haematoma formation (P = 0.016) were more prevalent in the SP patients. The frequency of positive margins was lower for SP (P = 0.037). No case of recurrence was identified with either technique. ECD showed excellent clinical outcomes as well as a reduction in complications when compared to SP. ECD is a viable alternative for superficial benign parotid gland tumours after thorough preoperative clinical, pathological, and radiological examination. The reduction in operation, anaesthesia, and hospitalization times with ECD is likely to result in a gain in cost-effectiveness.
术前诊断和术中技术的改进使腮腺良性肿瘤的手术切除侵入性降低。与金标准术式浅叶腮腺切除术（SP）相比，包膜外剥离术（ECD）越来越受欢迎。尽管已有临床结果的报道，但关于成本效益的报告却很有限。这项回顾性研究的目的是分析在腮腺良性肿瘤手术中，ECD与SP的手术结果和成本效益。收集了2012年至2020年间接受治疗的161例患者的回顾性队列。记录了有关人口统计学、临床结果和成本效益的数据。对161例单侧腮腺切除术病例（59例SP，102例ECD）的分析显示，SP患者的手术时间、麻醉时间和住院时间明显更长（均P<0.001）。关于术后并发症，SP患者中短暂性面神经麻痹（P<0.001）和血肿形成（P=0.016）更为常见。SP的切缘阳性率较低（P=0.037）。两种技术均未发现复发病例。与SP相比，ECD显示出良好的临床结果以及并发症减少。在进行全面的术前临床、病理和放射学检查后，ECD是浅表性腮腺良性肿瘤的一种可行替代方案。ECD手术、麻醉和住院时间的减少可能会带来成本效益的提高。
