Systematic Review and Case Report on the Surgical Management of Pleomorphic Adenomas: Lessons on Recurrence and Error...

Area of Science:

• Otorhinolaryngology
• Surgical Oncology
• Head and Neck Surgery

Background:

• Pleomorphic adenomas (PAs) are the most common salivary gland tumors.
• Inadequate surgical excision is linked to a significant risk of PA recurrence.
• Optimizing surgical strategies is crucial for improving patient outcomes and reducing recurrence rates.

Purpose of the Study:

• To systematically review and synthesize recurrence rates of pleomorphic adenomas (PAs) based on various surgical techniques.
• To analyze the impact of different surgical approaches on PA recurrence.
• To illustrate the challenges of recurrent PA (RPA) management with a complex case study.

Main Methods:

• A systematic review adhering to PRISMA 2020 guidelines was performed.
• Searched PubMed, Cochrane, and Google Scholar for studies within the last ten years.
• Extracted data on recurrence rates, complications, and tumor characteristics; included a case report of recurrent deep lobe PA (DLPA).

Main Results:

• Fifteen studies involving 2095 patients were analyzed.
• Recurrence rates: 3.27% for extracapsular dissection (ED), 0.73% for partial superficial parotidectomy (PSP), and 2.41% for superficial parotidectomy (SP).
• Recurrent PAs (RPAs) are often multifocal, increasing risks of facial nerve palsy and positive margins.

Conclusions:

• ED and PSP demonstrate efficacy and safety, but require careful consideration of tumor size and location.
• Recurrent pleomorphic adenoma (RPA) presents significant treatment challenges.
• Evidence-based decision-making and avoidance of outdated techniques are essential for improved long-term PA management outcomes.