Dominik Stodulski1, Bogusław Mikaszewski2, Hanna Majewska3, Piotr Wiśniewski4, Czesław Stankiewicz2. 1. Department of Otolaryngology, Medical University of Gdańsk, Poland. Electronic address: dstodulski@gumed.edu.pl. 2. Department of Otolaryngology, Medical University of Gdańsk, Poland. 3. Department of Pathomorphology, Medical University of Gdańsk, Poland. 4. Department of Endocrinology and Internal Medicine, Medical University of Gdańsk, Poland.
Abstract
AIM: The aim of the study was to assess the watch&wait strategy for management of patients with close surgical margin after conservative parotidectomy due to early low/intermediate grade parotid carcinoma. PATIENTS AND METHODS: Out of 78 patients operated on due to primary parotid gland cancer we selected 32 patients with a history of parotidectomy, and preservation of 7th nerve, with negative (≥1mm), but close (≤5mm) surgical margin and who did not receive supplementary radiotherapy due to other indications. Margins ranged from 1 to 3mm (in 27 cases it was 1mm, in 3 cases - 2mm and in 2 cases - 3mm), average 1.2mm. The patients underwent further clinical-histological analysis. RESULTS: 3 of 32 (9.38%) patients experienced a local recurrence 36, 53 and 56months post-surgery. The 5-year disease-free survival (DFS) was 90.6%. Recurrences were treated surgically, followed by radiotherapy, which resulted in an overall survival of 107, 104 and 104months. One patient died 72months after surgery due to non-oncological causes. The 10-year disease-free survival (DFS) was 96.3%. The 3 patients with recurrence of cancer had histological diagnosis of epithelial-myoepithelial carcinoma LG, with a margin of 2, 1 and 3mm, respectively. There were no other distinctive features. CONCLUSION: The watch&wait strategy with intensive follow-up seems justified in cases of close margin after excision of I/LG T1/T2 parotid tumors. EMC should be considered as a neoplasm associated with higher risk of recurrence.
AIM: The aim of the study was to assess the watch&wait strategy for management of patients with close surgical margin after conservative parotidectomy due to early low/intermediate grade parotid carcinoma. PATIENTS AND METHODS: Out of 78 patients operated on due to primary parotid gland cancer we selected 32 patients with a history of parotidectomy, and preservation of 7th nerve, with negative (≥1mm), but close (≤5mm) surgical margin and who did not receive supplementary radiotherapy due to other indications. Margins ranged from 1 to 3mm (in 27 cases it was 1mm, in 3 cases - 2mm and in 2 cases - 3mm), average 1.2mm. The patients underwent further clinical-histological analysis. RESULTS: 3 of 32 (9.38%) patients experienced a local recurrence 36, 53 and 56months post-surgery. The 5-year disease-free survival (DFS) was 90.6%. Recurrences were treated surgically, followed by radiotherapy, which resulted in an overall survival of 107, 104 and 104months. One patient died 72months after surgery due to non-oncological causes. The 10-year disease-free survival (DFS) was 96.3%. The 3 patients with recurrence of cancer had histological diagnosis of epithelial-myoepithelial carcinoma LG, with a margin of 2, 1 and 3mm, respectively. There were no other distinctive features. CONCLUSION: The watch&wait strategy with intensive follow-up seems justified in cases of close margin after excision of I/LG T1/T2 parotid tumors. EMC should be considered as a neoplasm associated with higher risk of recurrence.
Authors: Joseph Zenga; Anuurag S Parikh; Kevin S Emerick; Derrick T Lin; William C Faquin; Daniel G Deschler Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-11-01 Impact factor: 6.223