[Clinical study of parotid tumors: a 20 year statistical analysis of 633 cases]

Resection of liver metastasis from submandibular gland carcinoma five years after the primary operation: A case

Introduction

Liver metastasis of submandibular gland carcinoma is not uncommon, yet its optimal management is still unclear. We report a case of resection of liver metastasis from submandibular gland carcinoma five years after the primary operation.

Case presentation

The patient was a 76-year-old male who had undergone resection of primary adenoid cystic carcinoma of the submandibular gland in 2012. On follow-up computed tomography (CT) five years after the initial operation, a tumor was found incidentally in hepatic segment 6. Magnetic resonance imaging (MRI) confirmed the lesion's presence. Based on imaging findings and medical history, the lesion was suspected to be a liver metastasis of the previous submandibular gland carcinoma. The patient underwent hepatic posterior sectionectomy. His postoperative course was uneventful except for minor bile leakage that subsided without surgical intervention, and he was discharged on postoperative day 25. Postoperative pathological examinations of the hepatic tumor showed exactly the same features seen in the primary submandibular gland carcinoma, and the diagnosis as metastasis from this carcinoma was confirmed.

Discussion

Liver resection may be a reasonable choice of treatment for liver metastasis of submandibular gland carcinoma. Further evidence from studies with larger patient populations must be accumulated to confirm this.

Conclusion

We report our experience with a case of liver metastasis from submandibular gland carcinoma, which was resected five years after the primary operation.

[Significant factors affecting the operation time for benign parotid tumor]

Tumors of the parotid gland are fairly frequent among head and neck tumors. Parotidectomy for benign tumors is necessary for diagnosis and therapy. Furthermore, acquiring the skill for this operation is a significant step in the training course of an otolaryngologist Thus, it is useful to analyze the operation time and determine the factors affecting it to evaluate the progress in the operation skill. To measure the operation time and determine the factors affecting it, 71 cases, including 43 cases of pleomorphic adenomas and 28 cases Warthin's tumor, were retrospectively reviewed to the determine if the operation time depended on the age, sex, operated side, presence of complications, BMI, bleeding volume, tumor size, tumor location, exposure of branches of the facial nerve, and experience of the surgeon. Multivariate analysis was used to determine the factors correlated with the operation time. The results revealed that the bleeding volume, tumor size, tumor location and experience of the surgeon were significantly correlated with the operation time, whereas age, sex, operated side, presentation of complications and BMI showed no correlation with the operation time. Furthermore, surgeons with the experience of operating 20-39 cases took almost the same time for the operation as the surgeon with the experience of operating more than 40 cases. Taken together, to shorten the operation time, the inexperienced surgeon should start with smaller tumors and surgery in the superficial lobe in the initial training period, and supervision by well-experienced supervised surgeons is required until 30-40 are undertaken.

[Clinical study of adenoid cystic carcinoma of the parotid gland]

We report results of a retrospective study of 12 cases of adenoid cystic carcinoma (ACC) in the parotid gland. Local pain was often observed in ACC among other malignant parotid tumors. Although fine-needle aspiration cytology (FNA) was not effective for preoperative diagnosis, frozen section diagnosis (FS) during surgery showed excellent results. Cases with T3 or T4 underwent total or enlarged parotidectomy, but, often showed positive surgical margins. Postoperative radiation therapy seemed useful in these cases and the 5-and 10-year disease-specific survivals in these 12 cases were 90.0% and 80.8%. These compare favorably with other reports in the literature. All 12 cases showed NO and no cervical relapse with or without neck dissection, indicating little effectiveness in prophylactic neck dissection. Tumor size, positive surgical margins, and perineural invasion are risk factors for this tumor as mention previously. Patients with perineural invasion, especially preoperative facial nerve palsy (T4a), are more likely to fail than those with two other factors, so, it seems conceivable for cases of T4a to undergo more positive treatment with surgery and postoperative radiation.