PDF(Sci-hub)
Abstract：
The impact of the extent of parotid surgery on postoperative complications has long been considered a topic of controversy. The aim of the current network meta-analysis (NMA) is to answer the following questions: (1) Does the extent of surgical resection of benign parotid tumors increase the risk of postoperative complications? (2) What is the best surgical intervention for treatment of benign parotid tumors that can provide an acceptable balance between tumor recurrence rate and other postoperative complications? A comprehensive search on PubMed, Embase, Scopus, and Cochrane library was conducted to identify the eligible studies. The outcome was the incidence of tumor recurrence, facial nerve weakness (temporary [TFW] or permanent [PFP]), Frey\'s syndrome (FS), sialocele, and salivary fistula. The Bayesian network meta-analysis (NMA) accompanied by a random effect model and 95% credible intervals (CrI) were calculated using the GeMTC R package. Forty-four studies with a total of 7841 participants were included in the current NMA comparing five surgical interventions, namely enucleation, extracapsular dissection (ECD), partial superficial parotidectomy (PSP), superficial parotidectomy (SP), and total parotidectomy (TP). Enucleation showed the highest recurrence rate compared to ECD, SPS, SP, and TP. No statistical differences were observed concerning the recurrence rate when ECD, PSP, SP, and TP were compared together. There was an increased incidence of TFW and FS with the increase in the extent of parotid resection, while no significant difference was found when comparing enucleation with ECD and PSP. SP showed the highest incidence of PFP, and salivary fistula compared to ECD, PSP, and TP. The tumor recurrence rates in enucleation, ECD, PSP, SP, and TP were 14.3%, 3.6%, 3.7%, 2.8%, and 1.4%, respectively. The current NMA demonstrated that the risk of TFW and FS increases with the increase in the extent of parotid resection and that ECD and PSP can be considered the treatment of choice for benign parotid tumors, as both provide an acceptable balance between the incidence of tumor recurrence and facial nerve dysfunction.
摘要：
腮腺手术程度对术后并发症的影响长期以来一直被认为是有争议的话题。当前网络荟萃分析（NMA）的目的是回答以下问题：（1）腮腺良性肿瘤的手术切除程度是否会增加术后并发症的风险？（2）治疗腮腺良性肿瘤的最佳手术干预措施是什么，可以在肿瘤复发率和其他术后并发症之间提供可接受的平衡？Embase,Scopus,并进行Cochrane图书馆以确定合格的研究。结果是肿瘤复发的发生率，面神经无力（暂时性[TFW]或永久性[PFP]），弗雷综合征（FS），唾液膨出,和唾液瘘.使用GeMTCR软件包计算了贝叶斯网络荟萃分析（NMA）以及随机效应模型和95％可信间隔（CrI）。目前的NMA纳入了44项研究，共7841名参与者，比较了5项手术干预措施。即摘除,囊外夹层（ECD），腮腺部分切除术（PSP），浅表腮腺切除术（SP），和全腮腺切除术（TP）。与ECD相比，摘除术的复发率最高，SPS,SP,和TP。当ECD，PSP,SP,与TP进行比较。随着腮腺切除程度的增加，TFW和FS的发生率增加，而与ECD和PSP相比，没有发现明显差异。SP显示PFP发生率最高，与ECD相比，唾液瘘，PSP,和TP。摘除术中的肿瘤复发率，ECD,PSP,SP,TP为14.3%，3.6%,3.7%,2.8%，和1.4%，分别。目前的NMA表明，TFW和FS的风险随着腮腺切除程度的增加而增加，ECD和PSP可以被认为是腮腺良性肿瘤的首选治疗方法。因为两者在肿瘤复发和面神经功能障碍的发生率之间提供了可接受的平衡。
