Is the extracapsular dissection in pleomorphic adenomas of the parotid gland "worth its name"? Surgical debate and pathological reality

Background The aim of this study was to compare extracapsular dissection with facial nerve dissecting modalities with respect to the incidence of positive margins and focal capsular exposure in the management of pleomorphic adenoma of the parotid gland.

Materials and Methods The clinical records as well as the histopathological specimens of all patients who underwent parotid surgery for pleomorphic adenoma at a tertiary care hospital between 2006 and 2020 were re-examined.

Results 845 cases made up our study sample. The pleomorphic adenoma was removed by means of extracapsular dissection in 577 cases (68.3%). Focal exposure of the capsule was observed in 551/845 (65.2%) of our study cases. Positive margins were detected in 37/845 cases (4.4%). Our analysis did not reveal a statistically significant difference between the examined surgical modalities regarding the incidence of capsule exposure (p=0.344) or positive margins (p=0.127). Our analysis showed an increase in the performance of extracapsular dissection from 52.8% (2006) to 63.3% (2020) and an increase in histopathology specimens with tumours completely covered by healthy tissue from 27.7% (2006) to 50% (2020).

Conclusion Provided that the surgical rule “do not see the capsule” is adhered to, the choice of surgical method does not seem to have a significant effect on the incidence of positive margins or the capsular exposure of a pleomorphic adenoma. Successful surgery of pleomorphic adenomas depends on a proper indication and careful surgery. How to safeguard the intactness of the capsule is a matter of philosophy and experience.

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Publication History

Article published online:
13 May 2021