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Original Investigation
November 2017

Extracapsular Dissection vs Superficial Parotidectomy of Benign Parotid LesionsSurgical Outcomes and Cost-effectiveness Analysis

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
  • 2Stony Brook University School of Medicine, Stony Brook, New York
  • 3Department of Otolaryngology–Head and Neck Surgery, University of Tennessee Health Science Center, Memphis
JAMA Otolaryngol Head Neck Surg. 2017;143(11):1092-1097. doi:10.1001/jamaoto.2017.1618
Key Points

Question  How do health services and clinical outcomes of extracapsular dissection (ECD) compare with superficial parotidectomy when treating benign parotid neoplasms?

Findings  In this medical record review comparing 26 cases of ECD and 20 cases of superficial parotidectomy, operating room, anesthesia, and total hospital charges were significantly lower in the ECD group, and procedure time, anesthesia time, and length of stay for ECD cases were significantly shorter. Postoperative complication rates showed no difference between groups.

Meaning  Extracapsular dissection is a more favorable approach when considering health services outcomes in the treatment of select benign parotid lesions.

Abstract

Importance  The clinical implications of extracapsular dissection over superficial parotidectomy are controversial and limited in data on cost-effectiveness.

Objective  To compare extracapsular dissection with superficial parotidectomy for benign parotid tumors with respect to surgical outcomes and cost-effectiveness.

Design, Setting, and Participants  This was a retrospective medical record review and cost-effectiveness analysis performed from August 2012 to November 2015 at a tertiary care institution. Adult patients (age ≥18 years) who underwent parotidectomy for benign parotid lesions were included.

Exposures  Treatment by extracapsular dissection or superficial parotidectomy.

Main Outcomes and Measures  Differences in postoperative complication rates and health services outcomes, including procedure time, anesthesia time, length of stay, and charges for surgeon, anesthesia, operating room, and hospital.

Results  A total of 46 parotidectomies consisting of 26 extracapsular dissections and 20 superficial parotidectomies met criteria. Of the 46 patients, 33 were women. Patient ages ranged from 18 to 83 years. Lesion features were similar between groups with most being pleomorphic adenoma. Procedure time (effect size, −1.31; 95% CI, −1.93 to −0.65), anesthesia time (effect size, −1.37; 95% CI, −1.99 to −0.70), and length of stay (effect size, −0.66; 95% CI, −1.25 to −0.05) were significantly shorter for extracapsular dissection compared with superficial parotidectomy. Moreover, anesthesia (effect size, −1.55; 95% CI, −2.19 to −0.86), operating room (effect size, −1.09; 95% CI, −1.69 to −0.45), and total hospital charges (effect size, −1.13; 95% CI, −1.74 to −0.49) were significantly less for extracapsular dissection while remaining charges, including surgeon, showed no difference. Finally, facial nerve weakness, great auricular nerve dysesthesia, and other relevant postoperative complications were comparable between groups.

Conclusions and Relevance  In the hands of an experienced surgeon, extracapsular dissection is a shorter, less costly, and equally safe alternative to traditional superficial parotidectomy when treating benign parotid lesions. Further follow-up is needed to ensure these perceived advantages are maintained over time.

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