Surgery-Based Salvage for Locoregional Recurrent Salivary Gland Carcinoma: Comparative Survival Evidence from a Systematic Review and Meta-analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
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.
Institutions: Seoul National University, Seoul Metropolitan Government, SNUH SMG-SNU Boramae Medical Center, Hallym University Sacred Heart Hospital, The Catholic University of Korea Yeouido St. Mary's Hospital, Catholic University of Korea, Seoul National University Bundang Hospital, The Catholic University of Korea Eunpyeong St. Mary's Hospital, Chungnam National University Sejong Hospital, Ajou University, Seoul National University Hospital, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $300
OpenAlex ID: W7162758015
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