Extracapsular dissection alone for low-grade malignancies of the parotid gland – oncologically sound?
Reviewed by Christopher Burgess

The general treatment strategy advocated for a primary carcinoma of the parotid gland is surgical resection +/- adjuvant radiotherapy. A selective neck dissection is usually recommended in all cases of parotid malignancies, except for small, low-grade tumours. In this paper, the authors review the long-term functional and oncological outcomes associated with extracapsular dissection alone as the treatment for locally limited, low-grade malignant parotid tumours treated in a tertiary centre in Germany. Sixteen cases were included with a mean age of 50.2 years (range 21-84 years). Mean follow-up was 107 months (60-201 months). The commonest tumour type treated was a mucoepidermoid carcinoma (9) followed by acinic cell carcinoma (6) with one basal cell adenocarcinoma. The tumour stage was predominantly T1 (12) with a small number of T2 tumours (3) and one Tis. An R0 resection was obtained in all cases. The five-year disease-specific survival rate was 100%, as was local disease control. Facial nerve function was House-Brackmann grade I in all cases. The authors conclude that extracapsular dissection seems to be oncologically sufficient for carefully selected T1-T2 low-grade malignancies of the parotid gland. Whilst limited by small numbers and the retrospective nature of the study, the relatively long follow-up period in this study does help to provide a degree of support for this conclusion. Given the potential for very late recurrences of low-grade salivary malignancies however, even longer-term follow-up data would be desirable. The surgical margins obtained would also have been helpful to know.

Limited parotid surgery as sole form of treatment for carefully selected malignant tumours of the parotid gland: Still sufficient on the long-term?
Mantsopoulos K, Thimsen V, Sievert M, et al.
AM J OTOLARYNGOL
2023;44(2):103735.