Comparison of various surgical incisions in parotidectomy: A systematic review and network meta-analysis

Siyue Yin; Yanxun Han; Yuchen Liu; Bangjie Chen; Ziyue Fu; Shuyan Sheng; Jianpeng Wang; Chuanlu Shen; Xinyi Wang; Yiwen Jia

doi:10.3389/fonc.2022.972498

Comparison of various surgical incisions in parotidectomy: A systematic review and network meta-analysis

Front Oncol. 2022 Aug 5:12:972498. doi: 10.3389/fonc.2022.972498. eCollection 2022.

Authors

Siyue Yin^{1

2}, Yanxun Han^{2

3}, Yuchen Liu^{2

3}, Bangjie Chen^{1

2}, Ziyue Fu², Shuyan Sheng², Jianpeng Wang², Chuanlu Shen², Xinyi Wang², Yiwen Jia⁴

Affiliations

¹ Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
² Anhui Medical University, Hefei, China.
³ Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
⁴ Department of Gastroenterology, The Third Affiliated Hospital of Anhui Medical University (Hefei first people's Hospital), Hefei, China.

Abstract

Background: This network meta-analysis aimed to comprehensively compare the operative and postoperative outcomes of different parotidectomy incisions.

Methods: Embase, PubMed, Web of Science, and Cochrane Central Register of Controlled Trials were searched up to April 2022. A complete Bayesian network meta-analysis was performed using the Markov Monte Carlo method in OpenBUGS.

Results: Seventeen studies with 1609 patients were included. Thirteen were retrospective cohort studies, three were prospective cohort studies, and one was a randomized controlled study. The quality of evidence was rated as very low in most comparisons. The incision satisfaction score of the modified facelift incision (MFI), retroauricular hairline incision (RAHI), V-shaped incision (VI) were higher than that of the modified Blair incision (MBI) (MBI vs. MFI: mean difference [MD] -1.39; 95% credible interval [CrI] -2.23, -0.57) (MBI vs. RAHI: MD -2.25; 95% CrI -3.40, -1.12) (MBI vs. VI: MD -2.58; 95% CrI -3.71, -1.46); the tumor size treated by VI was smaller than that by MBI (MD 5.15; 95% CrI 0.76, 9.38) and MFI (MD 5.16; 95% CrI 0.34, 9.86); and the risk of transient facial palsy in the MFI was lower than that in the MBI (OR 2.13; 95% CrI 1.28, 3.64). There were no differences in operation time, drainage volume, wound infection, hematoma, salivary complications, Frey syndrome, or permanent facial palsy between incision types.

Conclusion: The traditional MBI is frequently used for large tumor volumes, but the incision satisfaction score is low and postoperative complication control is poor. However, emerging incisions performed well in terms of incision satisfaction scores and control of complications. More randomized controlled trials are needed to compare the different parotidectomy incisions. Patients should be fully informed about the characteristics of each incision to make the most informed decision, along with the physician's advice.

Systematic review registration: PROSPERO, identifier CRD42022331756.

Keywords: Bayesian network meta-analysis; V-shaped incision; modified Blair incision; modified facelift incision; parotidectomy; retroauricular hairline incision; surgical incision.

Publication types

Systematic Review