Selection of the surgical approach for lesions with parapharyngeal space involvement: A single-center experience on 153 cases.

Parapharyngeal imaging Parapharyngeal neoplasm Parapharyngeal space Surgical approach

Journal

Oral oncology
ISSN: 1879-0593
Titre abrégé: Oral Oncol
Pays: England
ID NLM: 9709118

Informations de publication

Date de publication:
11 Jul 2020
Historique:
received: 16 04 2020
revised: 16 06 2020
accepted: 17 06 2020
pubmed: 14 7 2020
medline: 14 7 2020
entrez: 14 7 2020
Statut: aheadofprint

Résumé

The parapharyngeal space (PPS) can harbor a variety of tumors that can be approached through a wide spectrum of surgical routes. A decisional algorithm on the surgical approach to resect PPS lesions was tested in terms of reliability by retrospectively applying it to a large series of patients. Patients treated at the Unit of Otorhinolaryngology - Head and Neck Surgery of the University of Brescia, Italy, for tumor or tumor-like lesions involving the PPS between October 1986 and July 2019 were included in the retrospective analysis. Tumor characteristics, clinical presentation, diagnostic work-up, type of resection, surgical approach, and oncologic and morbidity outcomes were reviewed. Reliability of the algorithm was calculated as the number of cases in which the expected approach was confirmed/total number of cases × 100. The analysis included 153 patients. Most lesions (64.1%) were benign. The most frequent complaint at presentation was unilateral oropharyngeal medialization (47.1%), followed by neck/parotid swelling (41.2%). Ninety-two (61.3%) lesions were excised through an enucleation/extracapsular dissection. Wide-margin resection and compartmental resection were performed in 17 (11.3%) and 41 (27.3%) patients, respectively. A single-corridor approach was employed in 132 (87.4%) cases. Combinations of multiple corridors were adopted in 19 (12.6%) patients. Reliability of the decision-making algorithm was 91.2%. Capsular integrity and margin status affected prognosis of pleomorphic adenomas and PPS malignancies, respectively. The proposed decision-making algorithm can reliably guide approach selection, which should primarily aim at ensuring intact-capsule excision of benign lesions suspicious for pleomorphic adenomas and clear-margins resection of PPS malignancies.

Sections du résumé

BACKGROUND BACKGROUND
The parapharyngeal space (PPS) can harbor a variety of tumors that can be approached through a wide spectrum of surgical routes. A decisional algorithm on the surgical approach to resect PPS lesions was tested in terms of reliability by retrospectively applying it to a large series of patients.
METHODS METHODS
Patients treated at the Unit of Otorhinolaryngology - Head and Neck Surgery of the University of Brescia, Italy, for tumor or tumor-like lesions involving the PPS between October 1986 and July 2019 were included in the retrospective analysis. Tumor characteristics, clinical presentation, diagnostic work-up, type of resection, surgical approach, and oncologic and morbidity outcomes were reviewed. Reliability of the algorithm was calculated as the number of cases in which the expected approach was confirmed/total number of cases × 100.
RESULTS RESULTS
The analysis included 153 patients. Most lesions (64.1%) were benign. The most frequent complaint at presentation was unilateral oropharyngeal medialization (47.1%), followed by neck/parotid swelling (41.2%). Ninety-two (61.3%) lesions were excised through an enucleation/extracapsular dissection. Wide-margin resection and compartmental resection were performed in 17 (11.3%) and 41 (27.3%) patients, respectively. A single-corridor approach was employed in 132 (87.4%) cases. Combinations of multiple corridors were adopted in 19 (12.6%) patients. Reliability of the decision-making algorithm was 91.2%. Capsular integrity and margin status affected prognosis of pleomorphic adenomas and PPS malignancies, respectively.
CONCLUSION CONCLUSIONS
The proposed decision-making algorithm can reliably guide approach selection, which should primarily aim at ensuring intact-capsule excision of benign lesions suspicious for pleomorphic adenomas and clear-margins resection of PPS malignancies.

Identifiants

DOI: 10.1016/j.oraloncology.2020.104872 PMID: 32659725
pubmed: 32659725
pii: S1368-8375(20)30308-0
doi: 10.1016/j.oraloncology.2020.104872
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

104872

Informations de copyright

Copyright © 2020 Elsevier Ltd. All rights reserved.

Auteurs

Davide Lombardi (D)

Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy. Electronic address: davinter@libero.it.

Marco Ferrari (M)

Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy.

Alberto Paderno (A)

Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Stefano Taboni (S)

Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Vittorio Rampinelli (V)

Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Francesco Barbara (F)

Unit of Otolaryngology and Head and Neck, P.O. "Mons. R. Dimiccoli", Barletta, Italy.

Alberto Schreiber (A)

Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Davide Mattavelli (D)

Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Michele Tomasoni (M)

Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Davide Farina (D)

Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Marco Ravanelli (M)

Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Roberto Maroldi (R)

Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.

Piero Nicolai (P)

Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy.

Classifications MeSH