Close surgical margin after conservative parotidectomy in early stage low-/intermediate-grade parotid carcinoma: Outcome of watch and wait policy.

AIM: The aim of the study was to assess the watch&wait strategy for management of patients with close surgical margin after conservative parotidectomy due to early low/intermediate grade parotid carcinoma.

PATIENTS AND METHODS: Out of 78 patients operated on due to primary parotid gland cancer we selected 32 patients with a history of parotidectomy, and preservation of 7th nerve, with negative (≥1mm), but close (≤5mm) surgical margin and who did not receive supplementary radiotherapy due to other indications. Margins ranged from 1 to 3mm (in 27 cases it was 1mm, in 3 cases - 2mm and in 2 cases - 3mm), average 1.2mm. The patients underwent further clinical-histological analysis.

RESULTS: 3 of 32 (9.38%) patients experienced a local recurrence 36, 53 and 56months post-surgery. The 5-year disease-free survival (DFS) was 90.6%. Recurrences were treated surgically, followed by radiotherapy, which resulted in an overall survival of 107, 104 and 104months. One patient died 72months after surgery due to non-oncological causes. The 10-year disease-free survival (DFS) was 96.3%. The 3 patients with recurrence of cancer had histological diagnosis of epithelial-myoepithelial carcinoma LG, with a margin of 2, 1 and 3mm, respectively. There were no other distinctive features.

CONCLUSION: The watch&wait strategy with intensive follow-up seems justified in cases of close margin after excision of I/LG T1/T2 parotid tumors. EMC should be considered as a neoplasm associated with higher risk of recurrence.