Primäre Parotiskarzinome: Einfluss einer zweizeitigen Operation auf das onkologisches Outcome

Zusammenfassung

Hintergrund: Parotiskarzinome stellen eine seltene Form der Kopf-Hals-Malignome dar. Fortgeschrittene Malignome werden meist als solche erkannt, wohingegen frühe Tumorstadien aufgrund fehlender Malignitätszeichen teils erst nach erfolgter Parotidektomie diagnostiziert werden. In der vorliegenden Studie wird untersucht, ob dieses ungeplante 2-zeitige Vorgehen einen negativen Einfluss auf das Outcome hat.

Material und Methoden: Die Studie umfasst klinische und histologische Daten von Patienten mit Parotiskarzinomen, die sich von 2004 bis 2014 an der Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie des Universitätsklinikums Ulm, in Behandlung befanden.

Ergebnisse: In die Studie wurden 42 Patienten mit einer medianen Nachbeobachtungszeit von 38 Monaten eingeschlossen. Das RFS lag bei 68,6%, das OS bei 80,1%, was der aktuellen Literatur entspricht. 24/42 der Patienten wurden einzeitig radikal operiert. Bei 18/42 Patienten wurde zunächst eine Parotidektomie und nach Erhalt der Histologie eine onkologische Operation durchgeführt. In der 2-zeitigen Gruppe lagen weniger fortgeschrittene Tumorstadien und Entitäten mit besserer Prognose vor. Diese Patienten wiesen mit einer RFS von 84,4% im Vergleich zu 56,5% (p=0,16) in der primär onkologisch-operierten Gruppe eine, den Tumorstadien und Entitäten und der aktuellen Literatur entsprechende, exzellente Prognose auf.

Schlussfolgerungen: Nach den vorliegenden Daten und im Vergleich mit der Literatur scheint ein ungeplantes 2-zeitiges Vorgehen bei klinisch inapparenten Parotiskarzinomen nicht zwingend einen negativen Einfluss auf das Outcome zu haben. Dennoch sollte die präoperative Diagnostik dahingehend verbessert werden, Parotismalignome auch in frühen Stadien sicher präoperativ zu detektieren.

Abstract

Background: Malignancies of the parotid gland represent a rare form of head and neck cancer. Advanced stages are usually recognized as such, whereas early tumor stages are sometimes diagnosed only after parotidectomy due to lack of signs of malignancy. The present study investigates whether this unplanned 2-stage approach has a negative impact on the outcome.

Material and methods: The study includes clinical and histological data of patients with parotid cancer which were treated in the Department of Oto-Rhino-Laryngology and Head and Neck Surgery of the University Medical Center Ulm between 2004 and 2014.

Results: 42 patients were included into the study with a median follow-up of 38 months. The RFS and OS at 5 years was 68.6 and 80.1%, respectively, which corresponds to the current literature. 24/42 patients received one-step radical surgery. In 18/42 patients a parotidectomy was performed initially followed by oncologic surgery after receiving histology. The patient group with 2-stage surgery included less advanced tumor stages and more entities with better prognosis. Interestingly, these patients presented with an excellent RFS of 84.4% compared to 56,5% (p=0,16) in the patient group with one-step procedure, correspondent to the tumor stages, entities and the current literature.

Conclusions: According to the available data and compared to the literature, an unplanned 2-stage procedure in clinically silent parotid cancer seems not necessarily to have a negative impact on the outcome. Nevertheless, the preoperative diagnosis should be improved to detect these malignancies more sensitive in early stages.

Schlüsselwörter

Parotiskarzinom - 2-zeitige Operation - Fazialisparese - präoperative Diagnostik - Feinnadelaspirationszytologie - Outcome - Überleben

Key words

parotid cancer - 2-step procedure - facial paralysis - preoperative diagnostic - outcome - survival

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