Results of extracapsular dissection of pleomorphic adenoma of parotid gland

Abstract

Purpose: Current opinion that extracapsular dissection is in fact a euphemism for enucleation prompted us to retrospectively identify all patients in whom the extracapsular dissection technique was used and to critically assess the value of this technique.

Patients and methods: The study includes all patients who underwent extracapsular dissection of parotid pleomorphic adenoma from 1979 to 2002 in our department (Department of Surgical Oncology, Medical University of Lodz, Poland). Ninety-eight cases were evaluated. Mean tumor diameter was 3.6 cm (range, 1.5 to 10 cm; median, 3 cm).

Results: In 8 cases (8/98; 8.2%) local recurrence was observed. For the entire group, the probability of living 10 years without the recurrence of the disease was 0.58. The lowest probability of local recurrence was found in patients with tumors larger than 4 to 6 cm in diameter. In these cases, the extensiveness of resection was similar to superficial parotidectomy, which could explain the result. In 13 cases (13/98; 13.3%) capsular exposure was found and consequently microscopic disease was present at the excision margins. In 7 cases (7/98; 7.1%) capsular rupture took place during surgery. The persistent paresis of facial nerve was observed in 8 cases (8/98; 8.2%).

Conclusion: Extracapsular dissection of pleomorphic adenoma is a very demanding technique. Inevitable eventual clinical errors (eg, incomplete resection) lead to unacceptably high incidences of recurrences and complications. We do not advise this technique for the treatment of pleomorphic adenoma.