From the Guidelines
A lumpectomy is not the preferred treatment option for pleomorphic adenoma, instead, a partial superficial parotidectomy is recommended for appropriately located superficial tumors. This approach is based on the clinical behavior of these tumors, which is similar to low-grade salivary gland cancers, as noted in the ASCO guideline 1. The goal of treatment is complete excision of the tumor, and a partial superficial parotidectomy allows for this while minimizing the risk to the facial nerve.
Some key points to consider when treating pleomorphic adenoma include:
- The tumor's location and size, which can impact the surgical approach
- The need for complete excision to reduce recurrence risk, as noted in the study by Zenga et al, which demonstrated excellent disease control with complete surgical resection, even with narrow surgical margins 1
- The potential complications of surgery, including facial nerve damage, Frey's syndrome, and numbness around the surgical site
- The importance of proper surgical techniques to minimize recurrence rates, which are estimated to be around 1-5% when proper techniques are employed
In terms of specific treatment recommendations, a partial superficial parotidectomy is the preferred approach for pleomorphic adenoma, as it allows for complete excision of the tumor while minimizing the risk to the facial nerve, as recommended in the ASCO guideline 1. This approach is supported by studies demonstrating excellent disease control with complete surgical resection, even with narrow surgical margins, in the absence of adverse features such as perineural or lymphovascular invasion or pathologic nodal disease.
From the Research
Lumpectomy for Pleomorphic Adenoma
- A lumpectomy, or the removal of a tumor with a minimal amount of surrounding tissue, may not be the most effective treatment for pleomorphic adenoma, as it can result in higher rates of recurrence 2, 3, 4.
- Studies have shown that formal parotidectomy, or the removal of the entire parotid gland, is not always necessary, but a more extensive removal of tissue, such as partial superficial parotidectomy, may be beneficial in reducing recurrence rates 2, 3.
- The use of extracapsular dissection, a minimal margin surgery, is not recommended due to the high risk of recurrence, especially in the hands of inexperienced surgeons 2, 3, 5.
- The risk of recurrence is higher with enucleation, or the simple removal of the tumor, and with positive resection margins 4.
- A study on pleomorphic adenoma of the breast recommends complete excision of the lesion with a cuff of normal tissue to reduce the risk of recurrence and malignant transformation 6.
Surgical Approaches
- Superficial parotidectomy and partial superficial parotidectomy are commonly practiced surgical approaches for the treatment of pleomorphic adenoma 2, 3.
- Extracapsular dissection is also used, but its effectiveness is debated due to the high risk of recurrence 2, 3, 5.
- Total parotidectomy is not always necessary, but may be considered in certain cases, such as large tumors or tumors with high-risk features 3, 4.
Complications and Outcomes
- Postoperative complications, such as hematoma, hypoaesthesia, transient facial nerve injury, Frey syndrome, and facial paralysis, are more common after superficial parotidectomy than after extracapsular dissection 5.
- The risk of recurrence is higher with younger age, enucleation, and positive resection margins 4.
- Long-term follow-up is necessary to monitor for recurrence and other complications 5.