Impact of facial nerve resection in parotid cancer abutting the facial nerve without preoperative paralysis: A multicentric propensity score-based analysis

Florian Chatelet; Sylvie Chevret; Nicolas Fakhry; Caroline Even; Olivier Malard; Erwan de Monès; Nicolas Saroul; François Mouawad; Marie de Boutray; Olivier Mauvais; Sébastien Vergez; Diane Evrard; Christian Righini; Philippe Schultz; Robin Baudouin; Gilles Poissonnet; Sarah Atallah; Fabienne Haroun; Sylvain Morinière; Camille Evrard; Pierre Philouze; Agnès Paasche; Maria Lesnik; Yann Lelonge; Philippe Herman; Benjamin Verillaud; REFCOR members

doi:10.1016/j.ejso.2024.108746

Impact of facial nerve resection in parotid cancer abutting the facial nerve without preoperative paralysis: A multicentric propensity score-based analysis

Eur J Surg Oncol. 2024 Oct 10:108746. doi: 10.1016/j.ejso.2024.108746. Online ahead of print.

Authors

Florian Chatelet¹, Sylvie Chevret², Nicolas Fakhry³, Caroline Even⁴, Olivier Malard⁵, Erwan de Monès⁶, Nicolas Saroul⁷, François Mouawad⁸, Marie de Boutray⁹, Olivier Mauvais¹⁰, Sébastien Vergez¹¹, Diane Evrard¹², Christian Righini¹³, Philippe Schultz¹⁴, Robin Baudouin¹⁵, Gilles Poissonnet¹⁶, Sarah Atallah¹⁷, Fabienne Haroun¹⁸, Sylvain Morinière¹⁹, Camille Evrard²⁰, Pierre Philouze²¹, Agnès Paasche²², Maria Lesnik²³, Yann Lelonge²⁴, Philippe Herman²⁵, Benjamin Verillaud²⁵; REFCOR members

Collaborators

REFCOR members:
C Ala-Eddine, K Aubry, E Babin, C Bach, C Badoual, A C Baglin, B Barry, V Bastit, B Baujat, K Benezery, R J Bensadoun, N Benzerdjeb, M Bernadach, C Bertolus, J Bettoni, A Biet, D Bodmer, P Boisselier, C Boulagnon-Rombi, L Bozec, A Bozorg Grayeli, E Brenet, L Brugel, G Calais, V Calugaru, S Camby, O Casiraghi, E Cassagnau, C Castain, J Castelli, P Ceruse, F Chabolle, D Chevalier, O Choussy, M Classe, F Clatot, E Colin, J M Constans, A Coste, F Coste, V Costes, J P Cottier, A Coutte, J P Cristofari, D Cupissol, J Delgrande, J P Delord, B Devauchelle, L Digue, G Dolivet, M Doré, S Duflo, X Dufour, C Dupin, E Eker, F Espitalier, C Even, C Evrard, E Fabiano, S Faivre, N Fakhry, F R Ferrand, J Frandon, D Franetti, L de Gabory, C Galy, M Garcier, R Garrel, H Gauthier, L Gilain, S Guihard, S Guillerm, C Halimi, S Hans, P Herman, A Houessinon, M Hourseau, F Huguet, E Jadaud, R Jankowski, C Jeanne, F Jegoux, M Juliéron, R Kaci, M-C Kaminsky, H de Kermadec, F Kolb, S Kreps, M Laadhari, J Lacau Saint Guily, L Laccoureye, M Lae, F Lagarde, A Lagrange, B Lallemant, M Lamuraglia, P Lang, M Lapeyre, A Lapierre, A Lasne Cardon, C Le Tourneau, G Lefebvre, M Lefevre, Y Lelonge, X Leroy, M Lesnik, X Liem, C Linassier, P Maingon, C Majoufre, O Malard, G Malouf, C Marchand, J-P Marie, T Maurina, O Mauvais, J-C Merol, J Michel, G Mineur, S Mirafzal, H Mirghani, A Modesto, S Molinier-Blossier, E de Monès, S Morinière, F Mouawad, A Moya-Plana, L Muller, E Musat, F Nguyen, G Noel, F R Obongo-Anga, M Onea, H Orliac, C Page, V Patron, J Pestre, N Pham Dang, P Philouze, G Poissonnet, C Pons, C Pouliquen, J-M Prades, A Prevost, C Queiros, A Rahmani, A Rambeau, L Ramin, S Renard, C A Righini, F Rolland, E Saada, F Sacino, S Salas, N Saroul, P Schultz, A Simonaggio, O Sterkers, V Strunski, A Sudaka, S Xu-Shan, R Taouachi, M Tassart, S Testelin, J Thariat, M Timar David, A Timochenko, B Toussaint, E Uro Coste, G Valette, T Van den Abbeele, A Varoquaux, E Vauleon, S Vergez, B Verillaud, J Villa, A Villepelet, M Volondat, N Vulquin, I Wagner, M Wassef, L Webert, S Wong

Affiliations

¹ Université Paris Cité, ENT - Head and Neck Surgery Department, AP-HP, Hôpital Lariboisière, INSERM UMR 1153 ECSTRRA team, F-75010, Paris, France. Electronic address: [email protected].
² Université Paris Cité, SBIM AP-HP Hôpital Saint Louis, INSERM UMR 1153 ECSTRRA Team, F-75010, Paris, France.
³ Department of Otolaryngology - Head and Neck Surgery, Universitary Hospital of la Conception, 147 Boulevard Baille, F-13005, Marseille, France.
⁴ Head and Neck Oncology Department, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, F-94807, Villejuif, France.
⁵ ENT and Head and Neck Department, CHU Nantes, 1 place A. Ricordeau Hôtel Dieu, F-44093, Nantes cedex, INSERM U1229-RMeS, France.
⁶ University of Bordeaux, ENT and Head and Neck Department, CHU Bordeaux, F-33000, Bordeaux, France.
⁷ ENT and Head and Neck Department, CHU Clermont-Ferrand, Clermont Ferrand University, F-63000, Clermont-Ferrand, France.
⁸ ENT and Head and Neck Department, Huriez Hospital, Lille University, CHU Lille, rue Michel Polonovski, F-59037, Lille cedex, France.
⁹ Department of ENT, Neck Surgery and Maxillofacial Surgery, Gui de Chauliac University Hospital, Montpellier University, Montpellier, France.
¹⁰ ENT and Head and Neck Department, CHU Besancon, 3 boulevard Alexandre Fleming, F-25030, Besançon Cedex, France.
¹¹ Head and Neck Surgery Department, University Hospital of Toulouse-Larrey, 24 chemin de Pouvourville, F-31059, Toulouse, cedex9, France.
¹² Université Paris Cité, ENT and Head and Neck Surgery Department, AP-HP, Hôpital Bichat, France.
¹³ Head and Neck Surgery, University Hospital of Grenoble Alpes, UGA/UMR/CNRS 5309/Inserm 1209, groupe 5, Grenoble, France.
¹⁴ ENT and Head and Neck Department, Hautepierre Hospital, CHU Strasbourg, Avenue Molière, F-67098, Strasbourg cedex, France.
¹⁵ ENT and Head and Neck Department, Foch Hospital, 40 rue Worth, F-92150, Suresnes, France; Paris Saclay University, France.
¹⁶ Face and Neck University Institute, 31 Av. de Valombrose, F-06103, Nice, France; Antoine Lacassagne Center, 33 Av. de Valombrose, F-06189, Nice, France.
¹⁷ Sorbonne University, APHP, Department of ENT-Head and Neck Surgery, Tenon Hospital, 4 rue de la chine, F-75020, Paris, France; Doctoral School of Public Health, CESP, University of Paris Sud, 16 Avenue Paul Vaillant Couturier, F-94807, Villejuif, France.
¹⁸ ENT and Head and Neck Department, Université Paris Cité, HEGP, AP-HP, 20-40, rue Leblanc, F-75015, Paris, France.
¹⁹ ENT and Head and Neck Department, CHU Tours, 2, boulevard Tonnellé, F-37044, Tours, France; Université François-Rabelais, 10 boulevard Tonnellé, F-37000, Tours, France.
²⁰ Department of Medical Oncology, CHU, Université de Poitiers, Poitiers, France.
²¹ Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard University Lyon 1, France.
²² Department of Maxillofacial Surgery, CHU Amiens, CHIMERE team UR 7516 UPJV Amiens, France.
²³ Department of ENT Surgery, Institute Curie, F-75005, Paris, France.
²⁴ ENT and Head and Neck Department, CHU Saint-Étienne, Avenue Albert Raimond, F-42270, Saint-Priest en Jarez, France.
²⁵ Université Paris Cité, ENT - Head and Neck Surgery Department, AP-HP, Hôpital Lariboisière, INSERM U1141, F-75010, Paris, France.

PMID: 39424524
DOI: 10.1016/j.ejso.2024.108746

Abstract

Objectives: The management of the facial nerve (FN) is a major issue in parotid cancer, especially when there is no preoperative facial palsy and FN invasion is discovered intraoperatively. The aim of this study was to assess the impact of FN resection in patients with parotid cancer abutting the FN, without pretreatment facial palsy, using a propensity score matching.

Materials and methods: Data from all patients treated between 2009 and 2020 for a primary parotid cancer abutting or invading the FN but without pretreatment facial palsy were extracted from the national multicentric REFCOR database. Three different definitions of tumors abutting the FN were used for sensitivity analyses, in a retrospective setting. Propensity score matching was used to assess the impact of FN resection on disease-free survival (DFS), overall survival (OS) and locoregional recurrence-free survival (LRRFS).

Results: A total of 163 patients with parotid cancer abutting or invading the FN without pretreatment facial palsy were included. Among them, 99 patients (61 %) underwent FN resection. After overlap weighting and multiple imputation, no benefit of FN resection over preservation was found in terms of OS (HR = 1.21, p = 0.6), DFS (HR = 0.88, p = 0.5) and LRRFS (HR = 0.99, p = 1). Sensitivity analyses revealed similar results, and no significant efficacy was found in the subgroup analyses.

Conclusion: In this retrospective study with propensity score analysis, FN resection did not improve survival outcomes in patients without preoperative facial palsy treated surgically for a primary parotid cancer abutting the FN. In line with recent guidelines, the results of this study suggest that FN preservation should be considered whenever possible in this specific group of patients.

Keywords: Facial nerve; Parotid cancer; Surgery; propensity score.