Parotidectomy and neck dissection in locally advanced and relapsed cutaneous squamous cell carcinoma of the head and neck region,,

Melo, Giulianno Molina de; Guilherme, Luiz Henrique; Palumbo, Marcel das Neves; Rosano, Marcello; Neves, Murilo Catafesta das; Callegari, Fabiano Mesquita; Abrahao, Marcio; Cervantes, Onivaldo

doi:10.1016/j.bjorl.2021.11.007

Giulianno Molina de Melo ^**Corresponding author at: Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil. E-mail: giuliannomolina@gmail.com (G.M. Melo).

Study concept

study design

data acquisition

data analysis and interpretation

manuscript preparation

manuscript editing and review

final approval of the version to be published and accountable for all aspects of the work

Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil

Hospital Beneficência Portuguesa de São Paulo, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil

Luiz Henrique Guilherme

Data acquisition

manuscript editing

final approval of the version to be published and accountable for all aspects of the work

Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil

https://orcid.org/0000-0003-3440-6407

Marcel das Neves Palumbo

Data acquisition

manuscript preparation

final approval of the version to be published and accountable for all aspects of the work

Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil

https://orcid.org/0000-0002-5957-0265

Marcello Rosano

Data acquisition

manuscript preparation

final approval of the version to be published and accountable for all aspects of the work

Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil

https://orcid.org/0000-0002-3026-466X

Murilo Catafesta das Neves

Data acquisition

manuscript preparation

final approval of the version to be published and accountable for all aspects of the work

Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil

Hospital Beneficência Portuguesa de São Paulo, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil

https://orcid.org/0000-0002-8094-6298

Fabiano Mesquita Callegari

Study design

data analysis and interpretation

manuscript preparation

manuscript editing and review

final approval of the version to be published and accountable for all aspects of the work

Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Patologia, São Paulo, SP, Brazil

https://orcid.org/0000-0002-5547-599X

Marcio Abrahao

Study design

data analysis and interpretation

manuscript preparation

manuscript editing and review

final approval of the version to be published and accountable for all aspects of the work

Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil

Hospital Beneficência Portuguesa de São Paulo, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil

Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Patologia, São Paulo, SP, Brazil

https://orcid.org/0000-0003-0184-1437

Onivaldo Cervantes

Study design

data analysis and interpretation

manuscript preparation

manuscript editing and review

final approval of the version to be published and accountable for all aspects of the work

Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil

https://orcid.org/0000-0001-8651-2207

*Corresponding author at: Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil. E-mail: giuliannomolina@gmail.com (G.M. Melo).

☆
Peer Review under the responsibility of Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial.

Conflicts of interest

The authors declare no conflicts of interest.

Characteristics	Variable	With parotid metastasis – PM (%)	Without parotid metastasis – WPM (%)
Sex	Male	30 (81.1)	24 (64.9)
	Female	7 (18.9)	13 (35.1)
Age (years)	Mean	67.3	66.6
	Median	71	65
Comorbidites	Yes	31 (83.8)	36 (97.3)
	No	6 (16.2)	1 (2.7)
Primary skin location	Auricular	12 (32.4)	5 (13.5)
	Scalp	7 (18.9)	4 (10.8)
	Frontal	4 (10.8)	4 (10.8)
	Around lip	2 (5.4)	2 (5.4)
	Eyelid	7 (18.9)	10 (27.0)
	Malar	4 (10.8)	6 (16.2.)
	Nose	1 (2.7)	6 (16.2)
Clinical T primary	RT1 (<2cm)	2 (5.4)	9 (24.3)
	RT2 (≥2cm <4cm)	3 (8.1)	23 (62.1)
	T3(≥4cm)	21 (56.7)	3 (8.1)
	T4	11 (29.7)	2 (5.4)
Type surgery primary	No	4 (11.1)	0 (0)
	Total resection with flap reconstruction	20 (55.6)	16 (43.2)
	Maxilectomy	0 (0)	4 (10.8)
	Temporalectomy	6 (16.7)	4 (10.8)
	Exenteration	5 (13.9)	5 (13.5)
	Rinectomy	0 (0)	4 (10.8)
	Other	1 (2.8)	4 (10.8)
Type parotid surgery	No parotid surgery	1 (2.7)	22 (59.5)
	Partial	16 (43.2)	11 (29.7)
	Total	20 (54.1)	4 (10.8)
Type neck dissection	No	1 (2.8)	22 (59.5)
	Selective	17 (45.9)	7 (18.9)
	Modified radical	14 (37.8)	7 (18.9)
	Radical	5 (13.5)	1 (2.7)
Pathological stage	I	1 (2.7)	1 (2.7)
	II	3 (8.1)	18 (48.6)
	III	15 (40.5)	13 (35.1)
	IV	18 (48.6)	5 (13.5)
Adjuvant treatment	Yes	33 (89.2)	21 (56.8)
	No	4 (10.8)	16 (43.2)
Adjuvant treatment type	Irradiation alone	25 (67.6)	21 (56.8)
	Chemotherapy alone	0 (0)	0 (0)
	Chemoradiotherapy	8 (21.6)	6 (16.2)
Recurrence	Yes	8 (21.6)	9 (24.3)
	No	29 (78.4)	28 (75.7)
Distant metastasis	Yes	3 (8.1)	5 (13.5)
	No	34 (91.9)	32 (86.4)
Follow-up period (months)	Mean	35.8	30.1
	Median	19	14

	PM		WPM		Total		p-Value
	n	%	n	%	n	%
Comorbidities	No	16	43.2%	11	29.7%	27	36.5%	0.227
Comorbidities	Yes	21	56.8%	26	70.3%	47	63.5%	0.227
Lymph node extracapsular spread	No	23	62.2%	34	91.9%	57	77.0%	0.002
Lymph node extracapsular spread	Yes	14	37.8%	3	8.1%	17	23.0%	0.002
Parotid extracapsular spread	No	14	38.9%	36	97.3%	50	68.5%	<0.001
Parotid extracapsular spread	Yes	23	62.1%	1	2.7%	23	31.5%	<0.001
Angiolinfatics invasion	No	25	67.6%	30	81.1%	55	74.3%	0.183
Angiolinfatics invasion	Yes	12	32.4%	7	18.9%	19	25.7%	0.183
Perineural invasion	No	23	62.2%	30	81.1%	53	71.6%	0.071
Perineural invasion	Yes	14	37.8%	7	18.9%	21	28.4%	0.071
Compromised margins	No	17	45.9%	26	70.3%	43	58.1%	0.034
Compromised margins	Yes	20	54.1%	11	29.7%	31	41.9%	0.034
Exiguous margins	No	33	89.2%	32	86.5%	65	87.8%	0.722
Exiguous margins	Yes	4	10.8%	5	13.5%	9	12.2%	0.722
Degree of differentiation	Well	17	45.9%	9	24.3%	26	35.1%	0.107
	Moderately	12	32.4%	20	54.1%	32	43.2%
	Poor	8	21.6%	8	21.6%	16	21.6%
Primary tumor margins	Compromised	14	37.8%	15	41.7%	29	39.7%	0.933
	Exiguous	5	13.5%	5	13.9%	10	13.7%
	Free	18	48.6%	16	44.4%	34	46.6%

Pathological characteristics	Variable	With parotid metastasis – PM (%)	Without parotid metastasis – WPM (%)
Cutaneous primary	Auricular	12 (32.4)	5 (13.5)
	Scalp	7 (18.9)	4 (10.8)
	Frontal	4 (10.8)	4 (10.8)
	Around lip	2 (5.4)	2 (5.4)
	Eyelid	7 (18.9)	10 (27.0)
	Malar	4 (10.8)	6 (16.2)
	Nose	1 (2.7)	6 (16.2)
Histological differentiation degree	Well	17 (45.0)	9 (24.3)
	Moderately	11 (29.7)	21 (56.8)
	Poor	9 (24.3)	7 (18.9)
Parotid metastasis	Yes	36 (97.3)	1 (2.7)
Parotid metastasis	No	1 (2.7))	36 (97.3)
Size of parotid metastasis (cm)	0	1 (2.7)	36 (97.3)
	<1	2 (5.4)	0 (0)
	-3	12 (32.4)	0 (0)
	>3	22 (59.5)	1 (2.7)
Neck metastasis	Yes	19 (51.4)	5 (13.5)
Neck metastasis	No	18 (48.6)	32 (86.5)
P stage (cm)	P1 (1–3)	20 (54.1)	0 (0)
	P2 (3–6)	16 (43.2)	1 (2.7)
	P3 (larger than 6)	1 (2.7)	0 (0)
N stage	N0	13 (35.2)	32 (86.5)
	N1	12 (32.4)	2 (5.4)
	N2	12 (32.4)	3 (8.1)
	N3	0 (0)	0 (0)
Lymph node extracapsular spread	Yes	14 (37.8)	3 (8.1)
Lymph node extracapsular spread	No	23 (62.2)	34 (91.9)
Perineural invasion	Yes	14 (37.8)	30 (81.1)
Perineural invasion	No	23 (62.2)	7 (18.9)
Angiolymphatic invasion	Yes	12 (32.4)	7 (18.9)
Angiolymphatic invasion	No	25 (67.6)	30 (81.1)
Parotid metastasis extracapsular spread	Ye s	23 (62.1)	1 (2.7)
Parotid metastasis extracapsular spread	No	14 (37.8)	36 (91.9)
Margins	Free	17 (45.9)	26 (70.1)
	Exiguous	4 (10.8)	5 (13.5)
	Compromised	16 (43.3)	6 (16.2)
Pathological stage	I	1 (2.7)	1 (2.7)
	II	3 (8.1)	18 (48.6)
	III	15 (40.5)	13 (35.1)
	IV	18 (48.6)	5 (13.5)

	Coef. (B)	p-Value	Odds ratio
	Coef. (B)	p-Value	OR	Inferior limit	Superior limit
Constant	−1.230	0.003
Lymph node extracapsular spread	0.422	0,667	1.53	0.22	10.43
Parotid metastasis extracapsular spread	3.627	0.001	37.61	4.30	329.40
Compromised margins	0.140	0.838	1.15	0.30	4.37

Authors	Study (year)	Patients (n)	Parotid metastasis (%)	Neck metastasis (%)	Adjuvant Rtx (%)	Survival at 5 years (%)
O’Brien CJ et al.	2001	123	59.3	26	Not mentioned	58
O’Brien CJ et al.	2002	87	75.8	42.1	86	63
Teymoortash A et al.	2002	19	31.5	31	100	52
Chua MS et al.	2002	52	31	Not mentioned	100	65
O’Brien CJ et al.	2002	87	All included	24	86	63
Bron LP et al.	2003	232	43.5	23.7	85.1	75
Jol JA et al.	2003	41	24	39	100	46
Palme CE et al.	2003	126	64.2	35.7	89	68
Dona E et al.	2003	74	50	25	100	72
Veness MJ et al.	2003	167	Not mentioned	All included	87	73
Audet N et al.	2004	56	All included	100	66.1	53
Moore BA et al.	2005	193	42	20.7	100	95
Veness MJ et al.	2005	167	59	41	87	73
Ch’ng S et al.	2006	67	55.2	35.8	67	54
Andruchow JL et al.	2006	322	80.7	19.2	82.9	69
Hinerman RW et al.	2008	117	81.2	18	72	47
Ch’ng S et al.	2008	170	46	29	77	69
Goh RYH et al.	2012	67	61	39	100	72
Ebrahimi A et al.	2012	168	100	19.6	80	89
Kosec A et al.	2013	103	24.2	23.3	90	55.7
Makki FM et al.	2013	54	All included	30	87	81
Thom JJ et al.	2014	42	26	31	100	93
Shao A et al.	2014	160	93.7	28.1	80	48
Chen MM et al.	2015	2014	All included	41.3	48.6	71
Bachar G et al.	2016	71	11.3	36.6	100	63.3
Hirshoren N et al.	2017	149	61	79	84	50
Czerwonka L et al.	2017	136	All included	70	79	79
Coombs AC et al.	2018	63	All included	Not mentioned	81	53
Bobin C et al.	2018	35	All included	46.9	85.7	59
Creighton F et al.	2018	62	93.5	37.9	73.8	56
Varra V et al.	2018	76	All included	All included	100	60
Coombs AC et al.	2018	63	All included	Not mentioned	81	78
Present study	2020	74	50	32.4	82.4	67.6
Hasmat S et al.	2020	535	43.9	56.0	65.6	55.1

[1] *Corresponding author at: Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil. E-mail: giuliannomolina@gmail.com (G.M. Melo).

Brasil

Brasil

Abstract

Objective:

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HIGHLIGHTS