Long-term Survey Study to Assess Recurrence and Complications of Surgically Treated Pleomorphic Adenoma

Introduction: Pleomorphic adenomas are the most common tumor that affect the salivary gland and account for upwards of two-thirds of all parotid gland tumors. The current standard of care includes surgical excision, and long-term follow-up is not usually recommended or pursued. In this study, we aim to extend our follow-up length on pleomorphic adenomas operated on in a tertiary care center to evaluate long-term recurrence and post-surgical complications.

Methods: Patients who underwent surgical excision for a pleomorphic adenoma from 1/1/1997 until 12/31/2023 were identified using a departmental registry. Patients with electronic healthcare portal access received an initial message containing 6 questions regarding recurrence and post-operative complications. Patients who did not respond will be sent follow-up messages at 2 and 4 weeks. Patients who do not have a portal will be called to answer the questionnaire.

Results: 784 patients with electronic patient portal were identified and sent the first round of messaging, with 233 responses (30% response rate). The original median follow-up length was 51 days, which extended to a median length of 1954 days (5.3 years) following the survey. The average change in follow-up length was 2326 days (6.4 years). Of the 233 respondents, 5 (2.1%) patients reported recurrences, with 4 of them receiving treatment at an outside institution. 25 patients (10.7%) reported facial asymmetry and 23 (9.8%) reported incisional cosmetic concerns. 71 (30.5%) patients reported experiencing Frey’s syndrome. During their original follow-up, 167 patients were asked about Frey’s syndrome, with only 6 patients endorsing it (3.6%). With the additional follow-up length, the reported experience of Frey’s syndrome increased eightfold.

Conclusions: Even with extended follow-up, the recurrence rate of pleomorphic adenomas remains low. Long-term follow-up for pleomorphic adenomas may not be necessary from a recurrence standpoint. Frey’s syndrome in particular is a common longer-term sequela of parotidectomy, and patients should be counselled appropriately on this complication prior to parotidectomy.