THE SURGICAL-MANAGEMENT OF RECURRENT OR RESIDUAL PLEOMORPHIC ADENOMASOF THE PAROTID-GLAND - ANALYSIS AND RESULTS IN 40 PATIENTS

From 1974 to 1995, 40 patients were treated surgically at the Universi ty Hospital Vrije, Universiteit Amsterdam for recurrent or residual pl eomorphic adenomas of the parotid gland after previous surgery. The me dian interval between the initial procedure and surgery for the recurr ence was 122 months. Eleven patients had one or more attempts to resec t tumor recurrences prior to referral. During reoperation at this inst itution it was decided to refrain from tumor resection in three patien ts. Tumor control in two of these patients was achieved using radiothe rapy. In the third patient a ''wait-and-see'' policy was adopted. The other 37 patients underwent en bloc surgical excisions of their tumor and/or previously incised tissues. Among the 36 patients operated for histopathologically benign disease, 16 received postoperative radiothe rapy (to 6500 cGy). None developed a further recurrence, the median fo llow-up being 106 months. Only one of these patients experienced perma nent segmental facial nerve paralysis. Malignant transformation of tum or occurred in two patients. One of these patients died of locoregiona l disease after surgery and radiotherapy. Radical tumor resection was deferred in the other patient, with tumor control achieved using radio therapy (7000 cGy). However, since recurrent disease tends to be multi focal in origin, prolonged routine follow-up is required.