Evolution of Quality of Life in the Decade Following Parotidectomy for Benign Tumors

Introduction: Parotidectomy for benign etiologies is associated with great oncologic outcomes, but little is known about long-term QOL. This study aims to evaluate how patient-reported QOL evolves over the decade after parotidectomy for benign etiologies.

Methods: A cross-sectional survey study was conducted of all adult patients from the departmental AI-populated registry who underwent parotidectomy at a tertiary center from 2005-2025 for benign pathology. Patients with a history of prior head and neck radiation or parotid surgery elsewhere were excluded. The previously validated 35-item Parotidectomy Quality of Life (PQOL) Index was administered to eligible patients. Associations of demographics and clinical histories with PQOL scores were assessed using Spearman rank correlation coefficients and Wilcoxon rank sum tests.

Results: 359 patients completed the PQOL, resulting in a survey response rate of 56%. 63% of responders were female. The most common pathologies were pleomorphic adenoma (n=206, 57%) and Warthin’s tumor (n=38, 11%). Median (IQR) patient-reported PQOL Global Score was high at 93 (83-96) out of 100 at 1-2 years after surgery and remained high at 94 (87-98) 10+ years after surgery (p=0.07). Total parotidectomy was associated with worse Global, Pain and Sensations, Facial Appearance, and Facial Nerve Function scores (p < 0.05 for all). Women had significantly worse Tumor Concern scores compared to men (p=0.005). At 10 years after surgery and beyond, median (IQR) Tumor Concerns scores improved to 100 (75-100) from 83 (75-100) 1-2 years after surgery (p < 0.001).

Conclusions: Patients who underwent parotidectomy for benign pathology report excellent QOL in the decade after surgery, but total parotidectomy is associated with worse QOL across all domains. Patients experience the most concern over tumor recurrence in the first few years after surgery, although this improves over time. Focused counseling on extent of surgery and tumor recurrence risk should be considered to educate and reassure patients on recovery expectations and true oncologic risk.