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.