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Parotid pleomorphic and non-pleomorphic adenomas: a mono-institutional series of 512 patients

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Abstract

Purpose

Pleomorphic adenoma (PA) is the most common benign parotid tumor, with a well-known propensity to recur. Many factors have been advocated as prognostic, but there is no consensus on how they affect local control. We studied how PA recurrence-free survival (RFS) may be affected by the most relevant risk factors in a time-to-event analysis, comparing them with those observed in a population of non-PA (NPA).

Methods

Patients undergoing parotidectomy for benign lesions between 2002 and 2018 in a single academic tertiary referral center were included. A description of patients, tumors, and treatment characteristics was performed, highlighting differences between PA and NPA. Analysis of PA RFS and relative risk factors was also conducted.

Results

Eight hundred fifty patients underwent parotidectomy for benign lesions, 455 (53.5%) for PA and 57 (6.7%) for NPA. Significant differences between PA and NPA were age at surgery, surgical procedure, and resection margins. Recurrence occurred in 3.1% of PA, with a median disease-free interval of 54 months. 2-, 5-, and 10-year RFS were 99.2, 98.5, and 93.9%, respectively. Age < 18 years (HR = 31.31, p < 0.001), intraoperative tumor spillage (HR = 6.57, p = 0.041), extensive pseudo-capsule interruption (HR = 5.85, p = 0.023), and resection margins < 1 mm (HR = 3.16, p = 0.085) were associated with RFS.

Conclusion

Patients affected by NPA were significantly older and treated with more conservative surgical procedures compared to those with PA. In PA, younger age, major pseudo-capsule defects, and surgical margins were the most relevant factors affecting local control. These results confirm the importance of an appropriate surgical management and long-term follow-up in PA.

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Authors and Affiliations

  1. Unit of Otorhinolaryngology–Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy

    Davide Lombardi, Michele Tomasoni, Alessio Nicolai, Alberto Paderno, Alberto Grammatica, Mara Arcuri, Davide Lancini & Cesare Piazza

  2. Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

    Michele Tomasoni, Alberto Paderno, Mara Arcuri & Cesare Piazza

  3. Unit of Pathology, ASST Spedali Civili, University of Brescia, Brescia, Italy

    Simonetta Battocchio, Laura Ardighieri & Anna Bozzola

  4. Unit of Radiology, ASST Spedali Civili, University of Brescia, Brescia, Italy

    Frida Pittiani & Davide Farina

  5. Unit of Pediatric Otolaryngology–Head Neck Surgery, Children Hospital, ASST Spedali Civili, Brescia, Italy

    Luca Oscar Redaelli de Zinis

  6. Section of Otorhinolaryngology–Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy

    Piero Nicolai

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  1. Davide Lombardi
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Correspondence to Davide Lombardi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Davide Lombardi, Davide Farina and Piero Nicolai are members of the Multidisciplinary Salivary Gland Society (MSGS), Geneva, Switzerland.

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Lombardi, D., Tomasoni, M., Nicolai, A. et al. Parotid pleomorphic and non-pleomorphic adenomas: a mono-institutional series of 512 patients. Eur Arch Otorhinolaryngol 279, 2543–2551 (2022). https://doi.org/10.1007/s00405-021-07018-7

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