Clinical Outcomes with Transoral and External Surgical Approaches for Resection of Parapharyngeal Space Tumors: Systematic Review and Meta-Analysis

Importance There are few studies comparing the various surgical approaches for the resection of parapharyngeal space tumors (PPSTs). Objective To compare surgical outcomes between transoral approaches (conventional transoral approach, endoscopic-assisted transoral approach, and transoral robotic surgery) and external approaches (EAs) in treating PPSTs. Design Systematic review with meta-analysis. Setting Embase, MEDLINE, CINAHL, Cochrane, and Web of Science databases were searched until August 2024. Findings were reported as per the PRISMA guidelines. Participants Adult patients with PPST. Interventions Surgical tumor resection using external or transoral approaches. Main Outcomes and Measures Overall effect size for primary outcomes (overall, neurological, non-neurological postoperative complications, and recurrence rates) was presented as event rate, while secondary outcomes (intraoperative bleeding, operation time, and hospitalization duration) were presented as mean differences (MDs). Results Forty-eight studies involving 1728 patients with PPST were included. EAs were associated with higher incidences of overall [0.40 (0.32-0.48) vs 0.11 (0.08-0.15)] and neurological [0.30 (0.22-0.38) vs 0.05 (0.03-0.07); P < .0001] postoperative complications than transoral approaches (P < .0001 for both) with no significant difference in non-neurological complications. In addition, transoral approaches were associated with significantly fewer postoperative complications than EAs for benign [0.12 (0.22-0.35) vs 0.39 (0.29-0.48); P < .0001], malignant [0.17 (−0.08- 0.41) vs 0.63 (0.30-0.95); P = .03], and prestyloid [0.11 (0.06-0.17) vs 0.39 (0.22-0.05); P = .001] but not poststyloid tumors. Furthermore, transoral approaches were associated with significantly lower intraoperative blood loss (MD: −104.30 mL; P < .00001) and shorter hospitalization (MD: −1.70 days; P = .002) compared to EAs. Conclusion Transoral surgical approaches may be safe and feasible surgical treatments for selected patients, particularly in the prestyloid compartment, when performed in centers with expertise in advanced transoral surgery. Compared to EAs, these approaches had fewer postoperative neurological complications, less intraoperative bleeding, and shorter hospitalization.