Surgical options in benign parotid tumors: a proposal for classification

• Published in: European archives of oto-rhino-laryngology Vol. 274; no. 11; pp. 3825 - 3836
• Main Authors: Quer, Miquel, Vander Poorten, Vincent, Takes, Robert P., Silver, Carl E., Boedeker, Carsten C., de Bree, Remco, Rinaldo, Alessandra, Sanabria, Alvaro, Shaha, Ashok R., Pujol, Albert, Zbären, Peter, Ferlito, Alfio
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2017
• Subjects: Clinical Decision-Making; Dissection; Head and Neck Surgery; Humans; Medicine; Medicine & Public Health; Neurosurgery; Otorhinolaryngology; Parotid Gland - pathology; Parotid Gland - surgery; Parotid Neoplasms - pathology; Parotid Neoplasms - surgery; Review Article; Extracapsular dissection; Partial parotidectomy; Superficial parotidectomy; Warthin’s tumor; Parotidectomy; Benign parotid tumors; Pleomorphic adenoma
• ISSN: 0937-4477; 1434-4726; 1434-4726
• DOI: 10.1007/s00405-017-4650-4

Different surgical options are currently available for treating benign tumors of the parotid gland, and the discussion on optimal treatment continues despite several meta-analyses. These options include more limited resections (extracapsular dissection, partial lateral parotidectomy) versus more extensive and traditional options (lateral parotid lobectomy, total parotidectomy). Different schools favor one option or another based on their experience, skills and tradition. This review provides a critical analysis of the literature regarding these options. The main limitation of all the studies is the bias of selection for different surgical approaches. For this reason, we propose a staging system that could facilitate clinical decision making and the comparison of results. We propose four categories based on the size of the tumor and its location within the parotid gland. Category I includes tumors up to 3 cm, which are mobile, close to the outer surface and close to the parotid borders. Category II includes deeper tumors up to 3 cm. Category III comprises tumors greater than 3 cm involving two levels of the parotid gland, and category IV tumors are greater than 3 cm and involve more than 2 levels. For each category and for the various pathologic types, a guideline of surgical extent is proposed. The objective of this classification is to facilitate prospective multicentric studies on surgical techniques in the treatment of benign parotid tumors and to enable the comparison of results of different clinical studies.