Abstract This retrospective cohort study aimed to evaluate the oncologic safety and functional outcomes of extracapsular dissection (ECD) as the primary surgical approach in patients with low-grade malignant parotid tumors. Conducted at a tertiary academic center, the study included 17 patients treated with ECD between 2012 and 2020, all of whom had preoperative benign or non-diagnostic cytology and were followed for at least 60 months. The primary outcome measures included recurrence rate, need for additional surgery or adjuvant therapy, facial nerve preservation, and disease-free survival. With a mean follow-up of 89.7 months, no local or regional recurrence was observed. ECD alone was sufficient in 76.5% of cases; three patients underwent completion superficial parotidectomy due to positive margins, yet no residual tumor was identified. Only two patients (11.8%) required adjuvant therapy due to perineural invasion. All patients maintained normal facial nerve function, and two died from unrelated causes while the remainder remained disease-free. These findings suggest that in carefully selected patients with small, well-circumscribed, low-grade parotid malignancies, ECD may provide oncologic outcomes comparable to more extensive surgery while minimizing surgical morbidity. ECD thus represents a viable definitive treatment option aligned with evolving, risk-adapted approaches to salivary gland cancer management. Keywords:Parotid gland tumor, extracapsular dissection, low-grade malignancy, conservative surgery, facial nerve preservation, salivary gland cancer, oncologic outcomes, functional results

Objective: This study aimed to evaluate the long-term oncologic and functional outcomes of extracapsular dissection (ECD) as the primary surgical approach for low-grade malignant parotid tumors. Methods: We retrospectively analyzed 17 patients who underwent ECD between 2012 and 2020, all of whom were diagnosed postoperatively with low-grade parotid malignancies despite benign or non-diagnostic preoperative FNAB. Patients were followed for a minimum of 60 months, with surgical outcomes, recurrence, and adjuvant therapy requirements assessed. Results: The most common histopathologic diagnosis was low-grade mucoepidermoid carcinoma. ECD alone was sufficient in 76.5% of patients, while 17.7% required completion parotidectomy due to positive surgical margins. Adjuvant therapy was needed in 11.76% of cases due to perineural invasion. Over a mean follow-up of 89.7 months, no recurrences were observed. Two patients died of unrelated causes. Conclusion: ECD may offer an oncologically safe and functionally favorable alternative to traditional parotidectomy in well-selected low-grade parotid malignancies. Our results support a risk-adapted surgical approach and represent the longest follow-up data published to date in this context.