Extracapsular dissection vs superficial parotidectomy for pleomorphic adenomas of parotid gland: An updated systematic review and meta-analysis.

Abstract

e18086 Background: The optimal surgical approach for small pleomorphic adenomas of the parotid gland is disputed. Extracapsular dissection (ED) is considered less invasive than superficial parotidectomy, but concerns exist regarding oncologic safety and postoperative complication. Methods: A meta-analysis and systematic review were conducted according to PRISMA guidelines. We searched PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, and Ovid MEDLINE from 1950 until 2025. We reported comparative studies which included ED and SP. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) for recurrence, facial nerve dysfunction, Frey's syndrome, salivary fistula, seroma, and hematoma were calculated using random-effects meta-analyses. Results: Across 8 studies including approximately 1492 patients, no significant difference in recurrence was observed between ED and SP (RR 0.45, 95% CI 0.12–1.72; I² = 35.2%). Extracapsular dissection was associated with a significantly lower risk of transient facial nerve palsy (RR 0.12, 95% CI 0.07–0.20; I² = 0%), while rates of permanent facial nerve palsy were comparable between techniques (RR 0.79, 95% CI 0.40–1.58; I² = 0%). Frey’s syndrome occurred significantly less frequently after ED (RR 0.33, 95% CI 0.15–0.71; I² = 72.2%), as did salivary fistula (RR 0.29, 95% CI 0.10–0.87; I² = 0%). No statistically significant differences were observed for seroma or hematoma. Conclusions: Extracapsular dissection considerably lowers surgical morbidity, especially temporary facial nerve dysfunction and Frey's syndrome, while offering recurrence rates similar to superficial parotidectomy. ED is a safe and efficient surgical substitute for SP in carefully chosen individuals with small, mobile pleomorphic adenomas limited to the superficial lobe. However, the high heterogeneity across studies necessitates more extensive, well-designed trials before definitive conclusions can be drawn.