| Surgery-Based Salvage for Locoregional Recurrent Salivary Gland Carcinoma: Comparative Survival Evidence from a Systematic Review and Meta-analysis |
Gene Huh1
, Jeong Wook Kang2
, Geun-Jeon Kim3
, Jeong-Yeon Ji4
, Jooin Bang5
, Ji Won Kim6
, Jeon Yeob Jang7
, Eun-Jae Chung8
, Soon-Hyun Ahn8
, Heejin Kim2
, Sung Joon Park9
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1Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul Metropolitan Government-Seoul National University, Seoul, Republic of Korea
2Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
3Department of Otorhinolaryngology and Head&Neck surgery, College of medicine, The Catholic University of Korea, Yeouido St. Mary’s Hospital, Seoul, Republic of Korea
4Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
5Department of Otolaryngology-Head and Neck Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
6Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
7Department of Otolaryngology-Head and Neck Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
8Department of Otorhinolaryngology- Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
9Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea |
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Received: February 23, 2026; Revised: May 16, 2026 Accepted: May 28, 2026. Published online: May 29, 2026.
*Gene Huh and Jeong Wook Kang contributed equally to this work. |
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| ABSTRACT |
Objectives
To compare survival outcomes between surgery-based salvage and non-surgical management in patients with locoregional recurrent salivary gland carcinoma (RSGC), and to explore whether surgery-based salvage is associated with more favorable outcomes in appropriately selected patients.
Methods
A search was performed in MEDLINE (Ovid), EMBASE, and the Cochrane Library. Observational studies were included that reported comparative outcomes for surgery-based salvage (resection ± adjuvant therapy) versus non-surgical management (re-irradiation, brachytherapy, systemic therapy, or palliative treatment) in locoregional recurrent disease. Patients with distant metastasis at recurrence were excluded from the pooled analysis. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Hazard ratios (HRs) were calculated as non-surgical management versus surgery-based salvage and pooled using a random-effects model. Risk of bias was assessed using RoBANS 2.0.
Results
Five retrospective comparative studies (N = 163) met the inclusion criteria. Four studies contributed to a meta-analysis for OS (N = 153) and DFS (N = 145). In pooled observational analyses, non-surgical management showed higher hazard estimates for OS (pooled HR = 3.40; 95% confidence interval [CI], 1.17–9.84; p = 0.024) and DFS (pooled HR = 3.09; 95% CI, 1.21–7.91; p = 0.019) than surgery-based salvage. Heterogeneity was considerable for OS (I² = 80.1%) and moderate for DFS (I² = 56.4%). Most studies had moderate-to-high risk of bias, particularly for participant comparability and residual confounding.
Conclusion
Available comparative observational evidence suggests that surgery-based salvage may be associated with more favorable survival outcomes in appropriately selected patients with locoregional RSGC. However, the evidence base is small, retrospective, and clinically heterogeneous; therefore, these findings should be interpreted as exploratory rather than confirmatory, and treatment decisions should be individualized within a multidisciplinary approach. |
| Keywords:
Locoregional recurrence, Meta-analysis, Salivary gland carcinoma, Salvage surgery, Systematic review |
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