Extracapsular Dissection Versus Superficial or Partial Superficial Parotidectomy for Pleomorphic Adenoma of the Parotid Gland: A Systematic Review and Meta-Analysis

Background/Objectives: The optimal extent of surgery for parotid pleomorphic adenoma remains debated. This systematic review and meta-analysis compared postoperative recurrence following extracapsular dissection (ECD) versus superficial or partial superficial parotidectomy (SP/PSP). Methods: PubMed, Scopus and Web of Science were searched up to 19 September 2026. Direct comparative studies reporting extractable pleomorphic adenoma-specific recurrence events and corresponding patient denominators were eligible. Odds ratios (ORs) were pooled using an inverse-variance random-effects model with restricted maximum likelihood estimation and Hartung–Knapp adjustment. Between-study heterogeneity and a 95% prediction interval were estimated. Studies reporting no recurrences in either group were retained descriptively but excluded from the pooled OR. Results: Fifteen studies involving 2392 patients were included: 1363 underwent ECD and 1029 underwent SP/PSP. Recurrence occurred in 40 and 43 patients, respectively. Nine studies comprising 2066 patients contributed to the pooled estimate. No statistically significant difference in recurrence was identified (OR = 0.80; 95% confidence interval [CI]: 0.51–1.25; p = 0.288). The point estimates of heterogeneity were zero (I2 = 0%; τ2 = 0), although the 95% CI for I2 extended to 64.8%. The 95% prediction interval ranged from 0.46 to 1.40. Interpretation was limited by predominantly observational evidence, potential selection bias, and variation in follow-up duration. Conclusions: Available comparative evidence showed no statistically significant difference in recurrence between ECD and SP/PSP, without establishing equivalence. These findings support consideration of ECD in appropriately selected patients. Prospective comparative studies with standardized surgical definitions and long-term follow-up are needed.