Does Total Parotidectomy Improve Survival Over Partial Parotidectomy in Early-Stage Adenoid Cystic Carcinoma of the Parotid Gland?

Abstract

The decision to perform a partial or total parotidectomy in localized high-grade parotid cancer is often a matter of debate in the absence of a deep lobe disease. The purpose of this study was to compare survival between patients submitted to partial and total parotidectomy for early-stage parotid adenoid cystic carcinoma (ACC). This was a retrospective cohort study using data from the Surveillance, Epidemiology, and End Results database from 2004 through 2017. Patients with pT1/2 N0 M0 parotid ACC were included. The primary study predictor was surgical treatment with either total or partial parotidectomy. Other covariates included age, gender, race, T stage, and need for facial nerve resection. Outcomes were disease-specific (DSS) and overall survival (OS). Kaplan-Meier survival probabilities were calculated. Simple and multiple regression models were constructed to identify prognostic varaibles. A total of 300 patients were included in the final sample. Of these 300, 55.7% of tumors were T2, and 59.3% of patients were treated with a total parotidectomy. In the univariate time-to-event analyses, neither total parotidectomy nor facial nerve preservation reduced the risks of disease-specific or overall death. In the multivariate model, after controlling for covariates, only older age (DSS hazard ratio [HR]=2.59; P<.01, OS HR=2.72; P<.01) and T2 stage (DSS HR=2.44; P=.02, OS HR=2.02; P<.01) independently influenced survival. For localized parotid ACC, total parotidectomy did not improve survival compared to partial parotidectomy. It might be acceptable to maintain clinically uninvolved parotid gland when circumstances so permit.