Long-term risk of recurrence after intact excision of pleomorphic adenomas of the lacrimal gland.

OBJECTIVE To ascertain the need for follow-up after excision of pleomorphic adenoma of the lacrimal gland. METHODS Medical records were reviewed for 133 patients and only those patients with 5 years or more of follow up were classified into the following 5 subgroups: those with intact excision (group IA, n = 46), those with surgically intact excision but areas of complete attenuation of the pseudocapsule at histologic analysis (group IB, n = 7), those with previous inadvertent incisional biopsy (group IIA, n = 9), those with breach of the pseudocapsule during attempted intact excision (group IIB, n = 5), and those undergoing definitive surgery because of tumor recurrence after previous incomplete excision (group III, n = 5). RESULTS Seventy-two patients were followed up longer than 5 years; there were no known tumor recurrences among 61 patients excluded with shorter follow-up. Patients in groups IA and IB exhibited no tumor recurrences at 8.2 to 34.1 years of follow-up. A benign recurrence occurred along the superior orbital fissure in 1 patient in group IIA 12(1/2) years after the initial surgery and was resected. There were no recurrences in patients in groups IIB or III. CONCLUSIONS Discharge would seem justified after intact excision of lacrimal gland pleomorphic adenoma, even when histologic examination shows extreme attenuation of the pseudocapsule. Long-term follow-up is, however, necessary when there has been tumor disruption, either inadvertently during previous biopsy or by capsular breach during definitive excision.