title: Management and prognostic factors of recurrent pleomorphic adenoma of the parotid gland: personal experience and review of the literature.
abstract: The aim of this study was to investigate the management and prognostic determinants of recurrent pleomorphic adenoma (RPA). A retrospective analysis was performed to examine the clinical features, the prevalence of surgical complications, and new recurrences of RPA. Tumor recurrence rate was estimated by the Kaplan-Meier method, and the prognostic value of some of the variables was tested by univariate analysis using the log rank test. The study focused on 33 patients, 18 female (54.5%) and 15 male (45.5%), aged 12-71 years (median 41). A total or extended total parotidectomy was performed in 16 cases (48.5%), a superficial parotidectomy in 10 cases (30.3%), and a local excision in 7 cases (21.2%). In ten patients (30.3%), a branch or the trunk of the facial nerve was deliberately sacrificed. Major complications included one unexpected definitive paralysis of the marginal mandibular branch of the facial nerve and 14 cases of Frey syndrome. Follow-up varied from 2 to 25 years (median 10.5 years), and there were 11 new recurrences (33.3%) within a period varying from 1 to 16 years (median 6 years). The estimated tumor recurrence rates were 14.1+/-6.6% at 5 years, 31.4+/-9.4% at 10 years, 43.0+/-10.8% at 15 years, and 57.2+/-14.8% at 20 years. Presence of a multinodular lesion and the type of intervention performed were significantly associated with a higher probability of recurrence. RPAs are prone to new recurrences, especially when multinodular and treated with a local excision. Surgical treatment should include facial nerve resection in selected cases. Follow-up for the patient's lifetime is warranted.
authors.affiliation: Department of Otorhinolaryngology, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy. redaelli@med.unibs.it
authors.forename: Luca Oscar
authors.initials: LO
authors.lastname: Redaelli de Zinis
authors.forename: Michela
authors.initials: M
authors.lastname: Piccioni
authors.forename: Antonino Roberto
authors.initials: AR
authors.lastname: Antonelli
authors.forename: Piero
authors.initials: P
authors.lastname: Nicolai
mesh_terms: D008949:Adenoma, Pleomorphic / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010307:Parotid Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors