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Vedula S, Shah YS, Barinsky GL, Baredes S, Park RCW. Utility of Elective Neck Dissection in Clinically Node-Negative Parotid Malignancy. Otolaryngol Head Neck Surg 2023; 169:917-927. [PMID: 36807904 DOI: 10.1002/ohn.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 12/20/2022] [Accepted: 12/24/2022] [Indexed: 02/19/2023]
Abstract
OBJECTIVE We sought to investigate the utility of elective neck dissection (END) in clinically node-negative parotid malignancy through the evaluation of factors that are associated with receiving END and survival analysis of patients who received END. STUDY DESIGN Retrospective cohort database study. SETTING The National Cancer Database (NCDB). METHODS The NCDB was used to extract patients with clinically node-negative parotid malignancy. END was defined as having 5 or more lymph nodes examined pathologically, as previously defined in the literature. Univariate and multivariate analyses were used to compare predictors of receiving END, rates of occult metastasis, and survival. RESULTS Of the 9405 included patients, 3396 (36.1%) underwent an END. END was most frequently performed for squamous cell carcinoma (SCC) and salivary duct histology. All other histologies were significantly less likely to undergo END compared to SCC (p < .05). Salivary ductal carcinoma and adenocarcinoma had the greatest rates of occult node disease (39.8% and 30.0%, respectively), followed by SCC (29.8%). Kaplan-Meier survival analysis showed a statistically significant increase in 5-year overall survival in patients who received END with poorly differentiated mucoepidermoid (56.2% vs 48.5%, p = .004) along with moderately and poorly differentiated SCC (43.2% vs 34.9%, p = .002; 48.9% vs 36.2%, p < .001, respectively). CONCLUSION Histological classification is a benchmark for determining which patients should receive an END. We demonstrated an increase in overall survival in patients who undergo END with poorly differentiated tumors of mucoepidermoid and SCC histology. As such, histology should be considered along with clinical T-stage and rate of occult nodal metastasis to determine eligibility for END.
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Affiliation(s)
- Sudeepti Vedula
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Yash S Shah
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Gregory L Barinsky
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Newark, New Jersey, USA
| | - Richard C W Park
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Kazemian E, Solinski M, Adams W, Moore M, Thorpe EJ. The role of perineural invasion in parotid malignancy outcomes: A systematic review and meta-analysis. Oral Oncol 2022; 130:105937. [PMID: 35662029 DOI: 10.1016/j.oraloncology.2022.105937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/04/2022] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE At present, perineural invasion is used as a histologic indicator of aggressive salivary gland disease. In other head and neck malignancies, perineural invasion impacts staging of cancer lesions and therefore affects treatment options. OBJECTIVE To compare survival outcomes in primary parotid malignancies with and without perineural invasion.A systematic review pooled data from the scientific literature in patients with any primary parotid malignancy to investigate the prognosis of those with perineural invasion. DATA SOURCES PubMed (Medline), Scopus and Cochrane databases were queried from inception to July 2020 without any initial search constraints. Additional publications were included from review of pertinent articles. STUDY SELECTION Our inclusion criteria included primary parotid cancers with reported perineural invasion on survival outcomes. Exclusion criteria were non-English language text, non-human studies, reviews, textbooks, abstracts, case reports and case series. Two authors independently reviewed articles for inclusion. Of the initial 465 records, 83 articles were reviewed in full to yield a final collection of 14 studies. DATA EXTRACTION AND SYNTHESIS PRISMA-p guidelines were used in the reporting of our studies. A MOOSE Checklist was also used. MINORS criteria were applied to assess risk of bias. Random-effects models were used to estimate pooled effect sizes. No institutional review board review was needed for our study. MAIN OUTCOMES AND MEASURES Primary study outcomes were set prior to data collection and included overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS) and distant-metastasis-free survival (DMFS) in patients with and without perineural invasion. RESULTS Fourteen studies contributed to this meta-analysis. Compared to patients without perineural invasion, the pooled rate of mortality (HR = 3.64), time to recurrence (HR = 3.56), disease-specific mortality (HR = 2.77) and distant metastasis (HR = 3.84) was significantly higher for patients with PNI (all p <.001). Controlling for perineural invasion status, no moderator was associated with these survival outcomes (all p >.05). Given the clinical severity of perineural invasion, few studies were null as shown in a panel of publication bias plots. CONCLUSION Perineural invasion portends a poor survival outcome in patients with parotid malignancies. LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Elycia Kazemian
- Loyola University Medical Center, Department of Otolaryngology, Maywood, IL, USA.
| | - Mark Solinski
- Loyola University Medical Center Stritch School of Medicine, Maywood, IL, USA
| | - William Adams
- Loyola University Medical Center Stritch School of Medicine, Maywood, IL, USA
| | - Mary Moore
- Loyola University Medical Center Stritch School of Medicine, Maywood, IL, USA
| | - Eric J Thorpe
- Loyola University Medical Center, Department of Otolaryngology, Maywood, IL, USA
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Fussey J, Tomasoni M, Tirelli G, Giordano L, Galli A, Colangeli R, Cazzador D, Tofanelli M, Da Mosto MC, Bianchini C, Pelucchi S, Ubayasiri K, Elsayed M, Long P, Saratziotis A, Hajiioannou J, Piazza C, Deganello A, Lombardi D, Nicolai P, Pracy P, Sharma N, Nankivell P, Borsetto D, Boscolo-Rizzo P. Prognostic indicators in clinically node-negative malignant primary salivary tumours of the parotid: A multicentre experience. Oral Oncol 2021; 123:105577. [PMID: 34742011 DOI: 10.1016/j.oraloncology.2021.105577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/27/2021] [Accepted: 10/13/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Nodal metastasis is an important prognosticator in primary parotid cancers. The management of the clinically node-negative neck is an area lacking consensus. This study investigates the occult nodal metastasis rate, and prognostic indicators in primary parotid cancers. MATERIALS AND METHODS We performed a multicentre retrospective case note review of patients diagnosed and treated surgically with curative intent between 1997 and 2020. Demographic, clinic-pathological and follow-up data was recorded. RESULTS After exclusions, 334 patients were included for analysis, with a median follow-up of 48 months. The overall rate of occult lymph node metastasis amongst patients undergoing elective neck dissection was 22.4%, with older age, high-grade and more advanced primary tumours being associated with higher rates. On multivariable analysis, age ≥ 60 years (HR = 2.69, p = 0.004), high-grade tumours (HR = 2.70, p = 0.005) and advanced primary tumours (pT3-4, HR = 2.06, p = 0.038) were associated with worse overall survival. Occult nodal metastasis on final pathology was associated with a close-to-significant reduction in regional recurrence free survival (HR = 3.18, p = 0.076). CONCLUSION This large series confirms the significant occult lymph node metastasis rate in primary parotid cancer, and demonstrates the importance of primary histology, tumour grade and stage in predicting survival outcome. This data supports the use of elective neck dissection in patients with high-risk tumours.
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Affiliation(s)
- Jonathan Fussey
- Department of ENT Head & Neck Surgery, University Hospitals Birmingham, UK
| | - Michele Tomasoni
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Italy.
| | - Giancarlo Tirelli
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Leone Giordano
- Otorhinolaryngology - Head & Neck Surgery Department, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
| | - Andrea Galli
- Otorhinolaryngology - Head & Neck Surgery Department, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
| | - Roberta Colangeli
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Veneto, Italy
| | - Diego Cazzador
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Veneto, Italy
| | - Margherita Tofanelli
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Maria Cristina Da Mosto
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy
| | | | | | - Kishan Ubayasiri
- Department of ENT Head & Neck Surgery, University Hospitals Nottingham, UK
| | - Mahmoud Elsayed
- Department of ENT Head & Neck Surgery, University Hospitals Nottingham, UK
| | - Patrick Long
- Department of ENT Head & Neck Surgery, University Hospitals Nottingham, UK
| | - Athanasios Saratziotis
- ENT Department of Otolaryngology, General University Hospital of Larissa, Larissa, Thessaly, Greece
| | - Jiannis Hajiioannou
- ENT Department of Otolaryngology, General University Hospital of Larissa, Larissa, Thessaly, Greece
| | - Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Italy
| | - Alberto Deganello
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Italy
| | - Davide Lombardi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Italy
| | - Paul Pracy
- Department of ENT Head & Neck Surgery, University Hospitals Birmingham, UK
| | - Neil Sharma
- Department of ENT Head & Neck Surgery, University Hospitals Birmingham, UK
| | - Paul Nankivell
- Department of ENT Head & Neck Surgery, University Hospitals Birmingham, UK
| | | | - Paolo Boscolo-Rizzo
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy
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Roch M, Mauvais O, Vergez S, Brenet E, Lindas P, Toussaint B, Nguyen DT, Gauchotte G, Rumeau C, Gallet P. Is Revision Surgery Necessary for Patients With High Risk of Recurrence After Parotidectomy? A Multicenter Retrospective Study. Ann Otol Rhinol Laryngol 2021; 131:782-790. [PMID: 34496666 DOI: 10.1177/00034894211045269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Close margin is a frequent situation after parotidectomy. The need for systematic prophylactic revision surgery is a question that arises regularly for malignant tumors, as it exposes to a high risk of facial palsy, while oncological benefits are unclear. STUDY DESIGN retrospective study. SETTING Multicentric. SUBJECTS AND METHODS We included all patients operated for systematic revision surgery in case of close margins after parotidectomy for a malignant tumor and analyzed the rate of tumor residue and its risk factors. RESULTS A tumor residue was identified in 43.5% of 23 cases, but none in case of initial complete excision with supra-millimetric margins. Invaded lymph nodes were identified in 6 cases, but none in case of low-grade tumors. CONCLUSIONS Systematic revision seems mandatory in case of infra-millimetric margins and high-grade tumors or positive lymph node; further studies are needed to confirm whether it can be spared for T1-T2/N0 low-grade tumors, with close margins but complete initial excision.
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Affiliation(s)
- Médarine Roch
- ENT Department, Regional University Hospital of Nancy, Nancy, France
| | - Olivier Mauvais
- ENT Department, Regional University Hospital of Besancon, Besancon, France
| | - Sebastien Vergez
- ENT Department, Regional University Hospital of Toulouse, Toulouse, France
| | - Esteban Brenet
- ENT Department, Regional University Hospital of Reims, Reims, France
| | - Pierre Lindas
- ENT Department, Robert Schuman Hospital, Metz, France
| | - Bruno Toussaint
- ENT Department, Regional University Hospital of Nancy, Nancy, France
| | - Duc Trung Nguyen
- ENT Department, Regional University Hospital of Nancy, Nancy, France
| | | | - Cécile Rumeau
- ENT Department, Regional University Hospital of Nancy, Nancy, France
| | - Patrice Gallet
- ENT Department, Regional University Hospital of Nancy, Nancy, France
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Yamamoto H, Kojima T, Okanoue Y, Otsuki S, Hasebe K, Yuki R, Hori R. Impact of Changing Surgical Strategies on Clinical Outcomes in Patients with Parotid Carcinoma: A 53-Year Single-Institution Experience. MEDICINA-LITHUANIA 2021; 57:medicina57080745. [PMID: 34440951 PMCID: PMC8399018 DOI: 10.3390/medicina57080745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: We investigated the clinical outcomes of patients who underwent surgery for parotid carcinoma in a single institution during a 53-year period. This study aimed to estimate the impact of changing the surgical approach to parotid carcinoma on clinical outcomes including the incidence rate of the facial nerve palsy. Materials and Methods: Sixty-seven patients with parotid carcinoma who underwent surgery between 1966 and 2018 were retrospectively reviewed. Group A consisted of 29 patients who underwent surgery from 1966 to 2002, and Group B consisted of 38 patients from 2002 to 2018. Treatment outcomes were estimated. Additionally, candidate prognostic factors of Group B, the current surgical approach group, were evaluated. Results: Partial parotidectomy and total parotidectomy were performed in 35 and 32 patients, respectively. Partial parotidectomy was performed in 4 patients in Group A and 31 patients in Group B, with a predominant increase in Group B. The facial nerve was preserved in 43 patients, among whom 8 in Group A (8/17; 47.1%) and 7 in Group B (7/26; 26.9%) had temporary postoperative facial nerve palsy. Postoperative radiotherapy was performed on 35 patients. The 5-year OS, DSS, and DFS rates for Group A were 77.1%, 79.9%, and 71.5%, respectively. The 5-year OS, DSS, and DFS rates for Group B were 77.1%, 77.1%, and 72.4%, respectively. Clinical T4 stage, clinical N+ stage, stage IV disease, and tumor invasion of the facial nerve were independent prognostic factors in Group B. Conclusions: The incidence of facial nerve palsy in the current surgical approach group decreased compared with that in the previous surgical approach group. The current surgical management and treatment policies for parotid carcinoma have led to improved outcomes.
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Affiliation(s)
- Hirotaka Yamamoto
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
- Department of Otolaryngology, Shizuoka City Hospital, 10-93 Otte-cho, Aoi-ku, Shizuoka 420-8630, Japan
| | - Tsuyoshi Kojima
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Yusuke Okanoue
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Shuya Otsuki
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Koki Hasebe
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Ryohei Yuki
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Ryusuke Hori
- Department of Otolaryngology—Head and Neck Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Aichi, Japan
- Correspondence: ; Tel.: +81-562-93-9291
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