Introduction This study arises from the need to clarify the actual benefit, in terms of local disease control and survival, of the surgical technique of en bloc temporo-parotid resection (TPR) for patients presenting with malignant parotid tumors infiltrating surrounding structures such as the external auditory canal (EAC), mastoid, condyle, and mandibular ramus. To date, TPR is one of the best therapeutic options aiming for oncologic radicality with an acceptable functional impact, balancing the need for adequate oncologic resections and the sacrifice of anatomical structures. Aim of the study Temporo-parotid resection (TPR) is a technique designed to treat advanced malignant parotid tumors through an en bloc surgical procedure based on the principles of skull base oncologic surgery. The technique is not new but has been infrequently and inconsistently applied in some sporadic experiences among otologic and skull base microsurgeons. The aim of this study is to analyze the experience of the ENT Clinic at the Padua University Hospital (AOPD) with en bloc temporo-parotid resection in patients with locally advanced primary or secondary parotid gland tumors, in order to evaluate and demonstrate whether this type of technique has a significant impact on local disease control and survival. Materials and Methods The data of 34 patients who underwent en bloc TPR and were treated at the ENT Clinic of the University Hospital of Padua between December 2016 and May 2025 were retrospectively analyzed. Partial lateral temporo-parotid resection en bloc (partial LTBR) was performed in 10 patients (29.4%), lateral (LTBR) in 20 patients (58.8%), and subtotal (STBR) in 4 patients (11.8%). Results Postoperative surgical margins evaluated by the pathologist were as follows: 15 patients (44.1%) underwent R0 resection, while in 12 cases (35.3%) the margins were defined as “close,” meaning they had a distance of less than 5 mm from the tumor margin. In 7 patients (20.6%), the margin was microscopically infiltrated by the tumor (R1), with all positive margins involving soft tissues of the specimen. Overall, 13 out of 34 patients (38.2%) experienced treatment failure, with an incidence of local recurrence in 2/34 (5.9%), loco-regional recurrence in 5/34 (14.7%), and distant recurrence in 8/34 (23.5%). Overall survival (OS) was 75.6% at 1 year and 63.8% at 2 years. Disease-specific survival (DSS) was 83.4% at 1 year and 78.5% at 2 years. Disease-free survival (DFS) was 77.7% at 1 year and 65.7% at 2 years. Local recurrence-free survival (L-RFS) was 93.3% at 1 year and maintained the same value at 2 years, while regional recurrence-free survival (R-RFS) was 90.5% at 1 year and 86.4% at 2 years. The cumulative risk of distant metastases (D-RFS) was 27.4% at two years. Conclusions Temporo-parotid resection (TPR) represents a valid and effective surgical option for advanced malignant parotid tumors with extraglandular extension, ensuring better local control compared to isolated extended parotidectomy. In this study, R0/close margins were associated with better local disease control. Furthermore, the highest treatment failure rate in these patients was correlated with distant metastases, as the disease was often in an advanced stage. Unfavorable histopathological factors (perineural and vascular invasion, facial nerve involvement, pN+, G3, mandibular condyle infiltration) were found to be associated with a worse prognosis. The reconstructive technique also influenced outcomes. Despite methodological limitations, the data confirm the validity of TPR in selected patients within a multidisciplinary management framework.
Introduzione Questo studio nasce dall’esigenza di chiarire l’effettivo vantaggio in termini di controllo locale di malattia e di sopravvivenza della tecnica chirurgica di resezione temporo-parotidea (TPR) en bloc per pazienti che presentano tumori maligni della parotide infiltranti strutture circostanti come condotto uditivo esterno (CUE), mastoide, condilo e ramo della mandibola. Ad oggi la TPR è una delle migliori opzioni terapeutiche con finalità di radicalità oncologica ed impatto accettabile dal punto di vista funzionale, in un bilancio tra necessità di resezioni oncologicamente adeguate e sacrificio di strutture. Scopo dello studio La resezione temporo-parotidea TPR è una tecnica che si prefigge di trattare i tumori maligni avanzati della parotide con una procedura chirurgica en bloc che sfrutta i principi della chirurgia oncologica della base del cranio. La tecnica non è nuova, ma è stata poco applicata, in modo disomogeneo in qualche sporadica esperienza tra oto-chirurghi e microchirurghi della base del cranio. Lo scopo di questo studio è quello di analizzare l’esperienza della Clinica ORL dell’Azienda Ospedaliera di Padova (AOPD) con la resezione temporo-parotidea en bloc nei pazienti con tumori primitivi o secondari localmente avanzati della ghiandola parotide, in modo da valutare e dimostrare se questo tipo di tecnica abbia un impatto significativo sul controllo locale di malattia e sulla sopravvivenza. Materiali e metodi Sono stati analizzati retrospettivamente i dati di 34 pazienti sottoposti a TPR en bloc, trattati presso la Clinica di Otorinolaringoiatria dell’Azienda Ospedaliera dell’Università di Padova tra dicembre 2016 e maggio 2025. La resezione laterale parziale temporo-parotidea en bloc (partial LTBR) è stata eseguita in 10 pazienti (29,4%), la laterale (LTBR) in 20 pazienti (58,8%), la subtotale (STBR) in 4 pazienti (11,8%). Risultati I margini chirurgici valutati nel post-operatorio con l’anatomopatologo sono stati i seguenti: 15 (44,1%) pazienti erano stati sottoposti a resezione R0, mentre in 12 casi (35,3%) i margini erano stati definiti “close”, ovvero presentati una distanza < a 5 mm dal margine tumorale. In 7 pazienti (20,6%) il margine era risultato microscopicamente infiltrato dal tumore (R1), dove i margini positivi erano tutti riferiti ai tessuti molli del campione. Nel complesso, 13 su 34 pazienti (38,2%) hanno mostrato fallimento del trattamento, con una incidenza di recidiva locale di 2/34 (5,9%), recidiva loco-regionale di 5/34 (14,7%) e recidiva a distanza di 8/34 (23,5%). La sopravvivenza globale (OS) è stata del 75,6% ad 1 anno e del 63,8% a 2 anni. La sopravvivenza specifica per malattia (DSS) è stata del 83,4% ad 1 anno e del 78,5% a 2 anni. La sopravvivenza libera da malattia (DFS) è stata del 77,7% ad 1 anno e del 65,7% a 2 anni. La sopravvivenza libera da recidiva locale (L-RFS) è risultata del 93,3% ad 1 anno e del medesimo valore a 2 anni, la sopravvivenza libera da recidiva regionale (R-RFS) del 90,5% ad 1 anno e del 86,4% a 2 anni. Il rischio cumulativo di metastasi a distanza (D-RFS) è risultato del 27,4% a due anni. Conclusioni La resezione temporo-parotidea (TPR) rappresenta un’opzione chirurgica valida ed efficace per tumori maligni avanzati della parotide con estensione extraghiandolare, garantendo un miglior controllo locale rispetto alla parotidectomia estesa isolata. In questo studio, margini R0/close sono stati associati ad un maggior controllo della malattia a livello locale. Inoltre, il più alto tasso di fallimento di questi pazienti è stato correlato alle metastasi a distanza in quanto la malattia spesso è risultata in stadio avanzato. Fattori istopatologici sfavorevoli (metastasi parotidea, invasione perineurale e vascolare, coinvolgimento del nervo facciale, pN+, G3, infiltrazione del condilo mandibolare) sono risultati correlati a una prognosi peggiore. Anche la tecnica ricostruttiva ha influenzato gli outcomes.
Resezioni temporo-parotidee en bloc per tumori maligni della parotide: risultati preliminari di uno studio monocentrico
NEPITALI, DAVIDE
2024/2025
Abstract
Introduction This study arises from the need to clarify the actual benefit, in terms of local disease control and survival, of the surgical technique of en bloc temporo-parotid resection (TPR) for patients presenting with malignant parotid tumors infiltrating surrounding structures such as the external auditory canal (EAC), mastoid, condyle, and mandibular ramus. To date, TPR is one of the best therapeutic options aiming for oncologic radicality with an acceptable functional impact, balancing the need for adequate oncologic resections and the sacrifice of anatomical structures. Aim of the study Temporo-parotid resection (TPR) is a technique designed to treat advanced malignant parotid tumors through an en bloc surgical procedure based on the principles of skull base oncologic surgery. The technique is not new but has been infrequently and inconsistently applied in some sporadic experiences among otologic and skull base microsurgeons. The aim of this study is to analyze the experience of the ENT Clinic at the Padua University Hospital (AOPD) with en bloc temporo-parotid resection in patients with locally advanced primary or secondary parotid gland tumors, in order to evaluate and demonstrate whether this type of technique has a significant impact on local disease control and survival. Materials and Methods The data of 34 patients who underwent en bloc TPR and were treated at the ENT Clinic of the University Hospital of Padua between December 2016 and May 2025 were retrospectively analyzed. Partial lateral temporo-parotid resection en bloc (partial LTBR) was performed in 10 patients (29.4%), lateral (LTBR) in 20 patients (58.8%), and subtotal (STBR) in 4 patients (11.8%). Results Postoperative surgical margins evaluated by the pathologist were as follows: 15 patients (44.1%) underwent R0 resection, while in 12 cases (35.3%) the margins were defined as “close,” meaning they had a distance of less than 5 mm from the tumor margin. In 7 patients (20.6%), the margin was microscopically infiltrated by the tumor (R1), with all positive margins involving soft tissues of the specimen. Overall, 13 out of 34 patients (38.2%) experienced treatment failure, with an incidence of local recurrence in 2/34 (5.9%), loco-regional recurrence in 5/34 (14.7%), and distant recurrence in 8/34 (23.5%). Overall survival (OS) was 75.6% at 1 year and 63.8% at 2 years. Disease-specific survival (DSS) was 83.4% at 1 year and 78.5% at 2 years. Disease-free survival (DFS) was 77.7% at 1 year and 65.7% at 2 years. Local recurrence-free survival (L-RFS) was 93.3% at 1 year and maintained the same value at 2 years, while regional recurrence-free survival (R-RFS) was 90.5% at 1 year and 86.4% at 2 years. The cumulative risk of distant metastases (D-RFS) was 27.4% at two years. Conclusions Temporo-parotid resection (TPR) represents a valid and effective surgical option for advanced malignant parotid tumors with extraglandular extension, ensuring better local control compared to isolated extended parotidectomy. In this study, R0/close margins were associated with better local disease control. Furthermore, the highest treatment failure rate in these patients was correlated with distant metastases, as the disease was often in an advanced stage. Unfavorable histopathological factors (perineural and vascular invasion, facial nerve involvement, pN+, G3, mandibular condyle infiltration) were found to be associated with a worse prognosis. The reconstructive technique also influenced outcomes. Despite methodological limitations, the data confirm the validity of TPR in selected patients within a multidisciplinary management framework.| File | Dimensione | Formato | |
|---|---|---|---|
|
Nepitali_Davide.pdf
accesso aperto
Dimensione
2 MB
Formato
Adobe PDF
|
2 MB | Adobe PDF | Visualizza/Apri |
The text of this website © Università degli studi di Padova. Full Text are published under a non-exclusive license. Metadata are under a CC0 License
https://hdl.handle.net/20.500.12608/87185