Trends in the Extent of Surgical Management for Low-Grade Parotid Malignancies: A SEER Analysis

Low-grade parotid malignancies have high overall survival rates; however, controversy remains about the appropriate extent of surgery. We aim to explore the trends in the extent of parotidectomy performed over time in low-grade parotid malignancies in the United States, with a hypothesis that there has been a trend towards less aggressive surgery.

Retrospective cohort study of all low-grade (grade I) acinic cell carcinoma (ACC) and mucoepidermoid carcinoma (MEC) in the Surveillance, Epidemiology, and End Results (SEER) from 2004 to 2020.

Geographic areas served by SEER.

Trends were assessed using Cochran-Armitage tests and logistic regression; Kaplan-Meier survival curves were used to analyze overall and cancer-specific survival, and chi-square tests were used to analyze patient characteristics.

In total, 1288 patients were identified (916 MEC; 372 ACC). Most patients (n = 772, 60%) were non-Hispanic white, with an average age of 50.6 years and had a slight female predominance (1.58:1). Most of the cohort presented with tumor stage T1 or T2 (84%), N0 (90.1%), and M0 (96.9%). Treatment with total parotidectomy decreased significantly (34.6 vs 17.7%, P = .02) whereas sacrificing the facial nerve (FN) slightly decreased (20 vs 15.7%, P = .1). A significant increase in N0 patients (71%-94%, P < .0001) was observed, whereas T staging remained stable (61%-64%, P = .3). Overall, both ACC and MEC had excellent cancer-specific survival.

Over the last 17 years, there has been a significant de-escalation in the extent of parotidectomy for low-grade parotid malignancy in the United States.