Metastasis to the parotid gland: is a radical surgical approach justified?
BACKGROUND
At the time of this writing, it is unclear whether metastasis to the parotid gland necessitates a radical surgical approach, including removal of the facial nerve, which results in a great loss of the patient's quality of life.


METHODS
The clinical course of patients who underwent parotid surgery in the ENT clinic of Hamburg University during the period 1982-1992 as a result of metastasis of a malignant melanoma or squamous cell carcinoma was studied. Either the lateral portion of the gland was removed (laterofacial parotidectomy) or the whole gland, thereby preserving the facial nerve (total parotidectomy) or removing it (radical parotidectomy).


RESULTS
Metastasis to the parotid gland occurred in 17 patients (17/347). All 10 patients with metastasis of a malignant melanoma developed further metastasis and 7 of these patients, independent of the radicality of parotid surgery, died within the first postoperative year. Of the 7 patients with metastasis of a squamous cell carcinoma, 5 developed further metastasis and 4, independent of the radicality of parotid surgery, died within 16 months after the operation.


CONCLUSIONS
Radical parotid surgery, which involves a great loss of quality of life for the patient, does not positively influence life expectancy. Moreover, the long-term prognosis is influenced by the type of the tumor and the stage at which the disease is first diagnosed.
Jecker
P
P
ENT Clinic Eppendorf, University of Hamburg, Federal Republic of Germany.
Hartwein
J
J
D002277:Carcinoma / Q000556:secondary* / Q000601:surgery*; D008545:Melanoma / Q000473:pathology*; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010306:Parotid Gland / Q000473:pathology* / Q000601:surgery*; D010307:Parotid Neoplasms / Q000556:secondary* / Q000601:surgery*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*