Quality of surgical reporting and adequacy of surgical treatment in salivary gland cancer: a quality assurance ancillary study of the GORTEC 2016-02 SANTAL trial.

INTRODUCTION: In the GORTEC 2016-02 SANTAL randomized trial, patients at intermediate-to-high risk of relapse underwent postoperative radiotherapy ± cisplatin. This ancillary study aimed to evaluate the adequacy of surgery and operative reporting of salivary gland carcinomas (SGC). MATERIALS AND METHODS: An independent post-hoc analysis of operative and pathological reports was undertaken for 87 patients with salivary gland carcinomas treated at 26 French centers. Surgical quality was assessed with respect to REFCOR guidelines. The quality of operative reporting was investigated. For both, deviations were classified as major, minor, or absent. RESULTS: Parotid tumors accounted for 53% of cases, submandibular 15%, and minor salivary glands 32% with 37% of adenoid cystic carcinomas. Total or extended parotidectomy was performed in 90.5% of parotid cases, and neck dissection in 70%. Operative reports were rated as adequate in 72% of cases, with 14% minor and 14% major deviations. The rates of inadequate surgical reporting varied between study centers. Surgical procedures were concordant with REFCOR guidelines in 62% of cases, or rated as minor deviations in 22%, 1% as not assessable, and 20% as major deviations, the latter by inadequate neck management or inadequate revision surgery after R2 resection. Quality of reporting by center was correlated with conformity of surgery. Deviations were well balanced between the two trial arms. CONCLUSION: Deviations from standardized surgical reporting and from REFCOR surgical guidelines were observed. These may influence postoperative radiotherapy planning; their impact on patient outcomes remains to be determined.