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Ann Surg Oncol ; 17(12): 3308-13, 2010 Dec.
Article in English | MEDLINE | ID: mdl-20645014

ABSTRACT

BACKGROUND: Recurrent parotid pleomorphic adenoma surgery increases the risk of facial nerve injury, and there is also a risk of ulterior recurrence. METHODS: Postoperative results from 62 consecutive patients operated for recurrent pleomorphic adenoma were analyzed. It was the first recurrence for 49 patients (79%), the second or more for 13 patients (21%). RESULTS: Total parotidectomy was performed in 69.4% of cases. Skin resection was performed in 47 patients (75.8%). Resection of a facial nerve branch was performed in seven patients (11.3%). Pathologic examination findings revealed carcinoma ex pleomorphic adenoma in 10/62 cases (16.1%) and microscopic multinodular disease in 39 patients (62.9%). Nine patients had preoperative facial palsy, 95% had postoperative facial paralysis ≥ grade II (House-Brackmann scale), and 11.3% still had ≥ grade III facial palsy after 1 year. Six patients developed another recurrence after our intervention (9.68%). Moreover, carcinoma was discovered after a new intervention in 40% of these patients. Initial partial parotid surgery [hazard ratio (HR) = 8.477, P = 0.008], microscopic multinodular recurrent disease (HR = 11.717, P = 0.005), and ≥ 1 recurrence number (HR = 10.608, P = 0.01) were associated with increased risk of ulterior recurrence. CONCLUSION: Surgery is recommended in pleomorphic adenoma recurrence because of the high rate of carcinoma ex pleomorphic adenoma (16.1%). Nevertheless, a definitive facial paralysis ≥ grade III rate of 11.3% is reported after multiple nerve dissection. New recurrence after surgery is less frequent if the initial treatment for pleomorphic adenoma is total parotidectomy.


Subject(s)
Adenoma, Pleomorphic/complications , Facial Nerve Injuries/etiology , Neoplasm Recurrence, Local/etiology , Parotid Neoplasms/complications , Adenoma, Pleomorphic/pathology , Adenoma, Pleomorphic/surgery , Adolescent , Adult , Aged , Facial Nerve Injuries/pathology , Facial Nerve Injuries/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Neoplasm Staging , Parotid Neoplasms/pathology , Parotid Neoplasms/surgery , Retrospective Studies , Survival Rate , Treatment Outcome , Young Adult
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