A Clinical Analysis of 53 Cases of Parotid Gland Carcinomas

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  • Yaguchi Ayaka
    Department of Otolaryngology, Yokohama City University Medical Center
  • Hatakeyama Hiromitsu
    Department of Otolaryngology, Yokohama City University Medical Center
  • Komatsu Masanori
    Department of Otolaryngology, Yokohama City University Medical Center
  • Isono Yasuhiro
    Department of Otolaryngology, Yokohama City University Medical Center
  • Ikemiyagi Hidetaka
    Department of Otolaryngology, Yokohama City University Medical Center
  • Oki Yamato
    Department of Otolaryngology, Yokohama City University Medical Center
  • Oridate Nobuhiko
    Department of Otolaryngology, Head and Neck Surgery, Yokohama City University School of Medicine

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Other Title
  • 当施設における耳下腺癌53例の検討
  • トウ シセツ ニ オケル ジカセンガン 53レイ ノ ケントウ

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Abstract

<p>　The prognosis of parotid gland carcinoma, which presents with a variety of histological types and different grades, is diverse. The purpose of this study was to examine the prognostic factors and to provide protocols for handling the facial nerve and neck dissection, which are important issues in surgery. Fifty-three patients with parotid carcinoma who underwent initial surgery in our department between 2000 and 2020 were included in the study. The histopathological types were classified into 13 types. Salivary duct carcinoma and mucoepidermoid cancer were frequently observed in 13 (25%) and 12 (23%) cases, respectively. The majority of cases (54%) had a high histological grade. A univariate analysis showed that predictors of a poor prognosis included a high grade, T3 or higher, lymph node metastasis, stage IV, and facial nerve palsy, with lymph node metastasis being a particularly strong predictor. In our department, the treatment policy concerning the facial nerve changed during the study period from “in principle, resection of all branches in case of malignancy” to “preservation as much as possible if detachment is possible.” No significant difference in the survival rates for before and after this policy change was seen, and it was possible to save cases of local recurrence among the cases with preservation. Thus, the policy of preserving the facial nerve as much as possible did not seem to pose a problem. As for neck dissection, there was a risk of metastasis to the entire neck region, and a total neck dissection was considered appropriate. In particular, the rate of lymph node metastasis was high among patients with a high grade and a stage of T3 or higher, and a prophylactic neck dissection should be performed in these high-risk patients even if they are preoperatively negative for cervical lymph node metastasis. In addition, a frozen section biopsy of the level II lymph nodes may be useful for determining the extent of dissection.</p>

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