Refinement of the surgical indication and increasing expertise are associated with a better quality of pathology specimen in pleomorphic adenomas

Abstract

Background

Traditional surgical philosophy condemns extracapsular dissection for pleomorphic adenoma as a euphemism for the enucleation of this lesion.

Objectives

The aims of the study were to trace the development of surgical treatment by pleomorphic adenomas of the parotid gland over the last 15 years and explore its effects on the histopathology specimen.

Materials and Methods

The medical records of all cases with pleomorphic adenomas of the parotid gland between 2006 and 2020 were examined for information on age, gender, and type of surgery. An experienced head and neck pathologist re-evaluated the histology slides from all the cases.

Results

The study included 844 patients. Our analysis showed an increase in the performance of extracapsular dissection from 52.8% (2006) to 63.3% (2020), and an increase in histopathology specimens with tumours completely covered by healthy tissue from 27.7% (2006) to 50% (2020).

Conclusions

Our decision-making process reached its peak in the last study years, in terms of reduced surgical invasiveness and quality of the pathology specimen.

Significance

Extracapsular dissection has gained a firm hold as an indispensable tool for the experienced parotid surgeon. Proper indication is based on careful selection of cases and the correct interpretation of preoperative features on palpation and imaging.

Chinese abstract

背景：传统的外科手术理念将多形性腺瘤的囊外剥离术斥之为该种病灶摘除的委婉说法。

目的：本研究的目的是追踪过去15年间腮腺多形性腺瘤的外科治疗进展, 并探讨其对组织病理学标本的影响。

材料与方法：检查了2006年至2020年间所有腮腺多形性腺瘤病例的病历, 以了解年龄、性别和手术类型的信息。一位经验丰富的头颈部病理学家对所有病例的组织学切片进行了重新评估。

结果：该研究包括844名患者。我们的分析显示, 囊外剥离手术从52.8％（2006年）增加到63.3％（2020年）, 并且被健康组织完全覆盖的肿瘤的组织病理学标本从27.7％（2006年）增加到50％（2020年）。

结论：在外科手术侵袭性的减少和病理标本质量方面, 我们的决策过程在近期研究中达到了顶峰。

意义：囊外剥离术已成为有经验的腮腺外科医生必不可少的方法。正确的标示是基于对病例的仔细选择以及根据触诊和影像学对术前特征的正确解读。

Keywords:

• Parotid gland
• pleomorphic adenoma
• extracapsular dissection
• facial nerve
• pathology
• pleomorphic adenoma
• capsule

Acknowledgments

The authors thank Mrs. Petra Güthlein and Mr. Philipp Grundtner for their valuable assistance in the collection of the data.

Disclosure statement

We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no financial support for this work that could have influenced its outcome.