METASTASIS TO THE PAROTID-GLAND - IS A RADICAL SURGICAL APPROACH JUSTIFIED

Introduction: At the time of this writing, it is unclear whether metas tasis to the parotid gland necessitates a radical surgical approach, i ncluding removal of the facial nerve, which results in a great loss of the patient's quality of life. Materials and Methods: The clinical co urse of patients who underwent parotid surgery in the ENT clinic of Ha mburg University during the period 1982-1992 as a result of metastasis of a malignant melanoma or squamous cell carcinoma was studied. Eithe r the lateral portion of the gland was removed (laterofacial parotidec tomy) or the whole gland, thereby preserving the facial nerve (total p arotidectomy) or removing it (radical parotidectomy). Results: Metasta sis to the parotid gland occurred in 17 patients (17/347). All 10 pati ents with metastasis of a malignant melanoma developed further metasta sis and 7 of these patients, independent of the radicality of parotid surgery, died within the first postoperative year. Of the 7 patients w ith metastasis of a squamous cell carcinoma, 5 developed further metas tasis and 4, independent of the radicality of parotid surgery, died wi thin 16 months after the operation. Conclusion: Radical parotid surger y, which involves a great loss of quality of life for the patient, doe s not positively influence life expectancy. Moreover, the long-term pr ognosis is influenced by the type of the tumor and the stage at which the disease is first diagnosed. Copyright (C) 1996 by W.B. Saunders Co mpany.