Gland-preserving surgery versus total gland excision for benign submandibular tumors: A systematic review and...

Preservation of gland function is gaining importance in the surgical management of benign submandibular gland (SMG) tumors, yet comparative evidence between gland-preserving and total excision approaches remains limited. This study aimed to compare functional, oncologic and cosmetic outcomes between submandibular gland-preserving surgery (SGPS) and total submandibular gland excision (SGTE) for benign SMG tumors.

A systematic review and meta-analysis were conducted using studies retrieved from PubMed, Embase, and the Cochrane Library. The primary outcome was postoperative salivary gland function. Secondary outcomes included operative duration, intraoperative blood loss, tumor recurrence, postoperative complications, and facial contour outcomes.

Four studies involving a total of 318 patients were included. SGPS demonstrated better preservation of unstimulated saliva flow at six months (MD, 0.32 mL/min; 95% CI, 0.23 to 0.41) and twelve months (MD, 0.24 mL/min; 95% CI, 0.10 to 0.38). Compared with SGTE, SGPS was also associated with shorter operative duration (mean difference [MD], -10.58 min; 95% confidence interval [CI], -14.61 to -6.56), reduced intraoperative blood loss (MD, -15.43 mL; 95% CI, -30.82 to -0.04), and lower risk of marginal mandibular nerve injury (risk difference [RD], -0.09; 95% CI, -0.16 to -0.03). No significant differences were observed in stimulated saliva flow, recurrence, or other complications. Facial contour outcomes significantly favored SGPS (standardized mean difference [SMD], 1.95; 95% CI, 0.20 to 3.70).

SGPS offers functional and cosmetic advantages over SGTE without compromising oncologic safety, supporting its role as a safe and effective alternative for appropriately selected patients with benign SMG tumors.