Extracapsular Enucleation Versus Partial Superficial Parotidectomy and Extracapsular Dissection in Warthin's Tumor: A Retrospective Matched Cohort Study.

Background/

Objectives

Warthin's tumor (WT) is a benign parotid neoplasm increasingly managed with tissue-preserving surgical approaches to reduce postoperative morbidity. Partial superficial parotidectomy (PSP) and extracapsular dissection (ECD) are commonly performed, whereas extracapsular enucleation (EN) remains less systematically evaluated. This study compared postoperative morbidity among EN, PSP, and ECD in a matched cohort of patients with unifocal WT.

Methods

A retrospective matched cohort study was conducted at a single tertiary referral center, including patients with histologically confirmed, unifocal WT treated between 2009 and 2023. A total of 360 patients were organized into 120 matched triplets (EN, PSP, ECD), with exact matching on age group and sex and balancing for smoking status, body mass index, and alcohol use. To enable comparison under technically uncomplicated conditions, cases with documented intraoperative capsular rupture or tumor spillage were excluded. The primary endpoint was overall postoperative morbidity, defined as the occurrence of at least one predefined complication. Associations between surgical technique and morbidity were assessed using conditional logistic regression, with estimation of odds ratios (ORs), absolute risk differences (RDs), and numbers needed to treat (NNT).

Results

Overall complication rates were 8.3% after EN, 29.2% after ECD, and 32.5% after PSP (p < 0.001). EN was associated with lower odds of postoperative complications compared with ECD (OR 0.23, 95% CI 0.10-0.50) and PSP (OR 0.18, 95% CI 0.08-0.41). Adjusted absolute risks were 8.3% for EN, 29.3% for ECD, and 32.4% for PSP, corresponding to absolute risk differences of 21% and 24% and numbers needed to treat of 4.8 and 4.2, respectively.

Conclusions

In this selected cohort of unifocal, anatomically favorable Warthin's tumors without intraoperative capsular violation, ΕΝ was associated with lower observed postoperative morbidity compared with ECD and PSP. These findings are context-dependent and reflect outcomes achieved under strict selection and technical conditions. Therefore, they should not be extrapolated to anatomically complex, inflamed, or diagnostically uncertain lesions. Prospective multicenter studies with standardized selection criteria are warranted to better define the role of EN in contemporary WT management.