title: Meta-analysis of surgical approaches to the treatment of parotid pleomorphic adenomas and recurrence rates.
abstract: BACKGROUND
  Different types of surgical management of pleomorphic adenoma of the parotid gland are associated with different recurrence rates.
  
  
  METHODS
  A systematic review of literature until 2014 with meta-analysis was conducted. Inclusion criteria were original studies of patients with surgical management for pleomorphic adenoma of the parotid gland and recurrence rates, with a median follow-up period of 5 years. The Newcastle-Ottawa Quality Assessment Scale (NOQAS) was used to assess the quality.
  
  
  RESULTS
  Sixteen studies were included. Four studies show a low recurrence rate (0.01, 95% confidence interval [CI] = 0.00-0.02) after total parotidectomy. Twelve studies show a low recurrence rate (0.02, 95% CI = 0.01-0.03) after superficial parotidectomy. Six studies show a low recurrence rate (0.02, 95% CI = 0.01-0.04) after limited parotidectomy. Six studies demonstrate a low recurrence rate (0.01, 95% CI = 0.00-0.04) after extracapsular dissection. Five studies report a low-to-medium recurrence rate (0.08, 95% CI = 0.03-0.14) after extracapsular enucleation.
  
  
  CONCLUSIONS
  Information about recurrence rates, times of recurrence in relation to type of surgical treatment, and significance of capsule rupture is very poor. With regard to recurrence rates and surgical approaches, the types of operations that show the lowest recurrence rate are total parotidectomy and extracapsular dissection. Controversies over surgical treatment of PA of parotid gland remain, and the safest surgical method for the removal of this tumors has not been identified.
authors.affiliation: Department of Head and Neck Surgery, Second University of Naples, Naples, Italy. Electronic address: giuseppe.colella@unina2.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Colella
authors.affiliation: Department of Head and Neck Surgery, Second University of Naples, Naples, Italy.
authors.forename: Rosangela
authors.initials: R
authors.lastname: Cannavale
authors.affiliation: Medical Statistics Unit, Second University of Naples, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
mesh_terms: D008949:Adenoma, Pleomorphic / Q000601:surgery*; D004210:Dissection / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D010306:Parotid Gland / Q000601:surgery; D010307:Parotid Neoplasms / Q000601:surgery*
keywords: Pleomorphic adenoma; Recurrence rates; Surgical management