Acinic cell carcinoma surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ramyar Ghandriz MD[2]
Overview
Acinic cell carcinoma is usually anatomically accessible tumor and patient do not show far metastasis at the time of diagnosis, the treatment of choice is surgery with resection of all free margins. Since acinic cell carcinoma could be neglected, a high rate of recurrence after first resection have been reported. low grade acinic cell carcinoma will be cured with surgery alone, but the site of origin indicates extension of resection. Superficial parotidectomy often effects complete removal of acinic cell carcinoma, but conservative parotidectomy is indicated if the deep lobe is involved. Initial approach would be more aggressive if the tumor is locally advanced acinic cell carcinoma, the facial nerve cannot be preserved, it must be resected and reconstructed with an autograft from greater auricular or sural nerve. Elective neck dissection is not recommended in acinic cell carcinoma, because of low risk of regional lymph node metastasis. However, studies have revealed additional neck dissection decrease the rate of recurrence.
Indications
- Acinic cell carcinoma is usually anatomically accessible tumor and patient do not show far metastasis at the time of diagnosis, the treatment of choice is surgery with resection of all free margins.[1][2]
- Since acinic cell carcinoma could be neglected, a high rate of recurrence after first resection have been reported.
- Low grade acinic cell carcinoma will be cured with surgery alone, but the site of origin indicates extension of resection.
- Superficial parotidectomy often effects complete removal of acinic cell carcinoma, but conservative parotidectomy is indicated if the deep lobe is involved.
- If there was no margin between the tumor and facial nerve, it can be preserved, and treated by post-operative radiotherapy.
- Initial approach would be more aggressive if the tumor is locally advanced acinic cell carcinoma, the facial nerve cannot be preserved, it must be resected and reconstructed with an autograft from greater auricular or sural nerve.
- Minor salivary gland acinic cell carcinoma, surgery is due to anatomical dictation.
Surgery
- Elective neck dissection is not recommended in acinic cell carcinoma, because of low risk of regional lymph node metastasis. However studies have revealed additional neck dissection decrease the rate of recurrence.[3]
- Patients with large volume or high grade tumor would likely benefit from elective neck dissection at level II, III, IV.
- Positive cervical lymph nodes are adverse prognosticator which indicate a necessary therapeutic neck dissection as a part of surgical approach, and raise suspicions of high grade transformation of acinic cell carcinoma.
References
- ↑ Vander Poorten, V.; Triantafyllou, A.; Thompson, L. D. R.; Bishop, J.; Hauben, E.; Hunt, J.; Skalova, A.; Stenman, G.; Takes, R. P.; Gnepp, D. R.; Hellquist, H.; Wenig, B.; Bell, D.; Rinaldo, A.; Ferlito, A. (2015). "Salivary acinic cell carcinoma: reappraisal and update". European Archives of Oto-Rhino-Laryngology. 273 (11): 3511–3531. doi:10.1007/s00405-015-3855-7. ISSN 0937-4477.
- ↑ Lewis, Jean E.; Olsen, Kerry D.; Weiland, Louis H. (1991). "Acinic cell carcinoma. Clinicopathologic review". Cancer. 67 (1): 172–179. doi:10.1002/1097-0142(19910101)67:1<172::AID-CNCR2820670129>3.0.CO;2-X. ISSN 0008-543X.
- ↑ Neskey, David M.; Klein, Jonah D.; Hicks, Stephanie; Garden, Adam S.; Bell, Diana M.; El-Naggar, Adel K.; Kies, Merrill S.; Weber, Randal S.; Kupferman, Michael E. (2013). "Prognostic Factors Associated With Decreased Survival in Patients With Acinic Cell Carcinoma". JAMA Otolaryngology–Head & Neck Surgery. 139 (11): 1195. doi:10.1001/jamaoto.2013.4728. ISSN 2168-6181.