Surgical treatment of the neck in patients with salivary gland carcinoma

Background Elective neck dissection (END) in patients with salivary gland carcinoma is controversial and there are no universally accepted guidelines. Methods Patients were identified from the Danish Head and Neck Cancer Group. Between 2006 and 2015, 259 patients with primary salivary gland carcinoma were treated with END. Variables potentially associated with regional metastases were analyzed using logistic regression. Neck recurrence-free survival was calculated using the Kaplan-Meier method. Results Occult metastases were found in 36 of the patients treated with END (14%) and were particularly frequent among patients with T3/T4 tumors and high-grade histology tumors. In multivariate analyses, high-grade histology and vascular invasion were associated with occult metastases. Conclusion We recommend END of levels II and III for patients with high-grade or unknown histological grade tumors, and for T3/T4 tumors. Levels I, II, and III should be included in END in patients with submandibular, sublingual, or minor salivary gland carcinomas.

Automated summary

The study showed that high-grade histology and vascular invasion are associated with occult metastases in patients with salivary gland carcinoma. It is recommended to perform elective neck dissection for patients with T3/T4 tumors, high-grade histology, or unknown histological grade. In patients with submandibular, sublingual, or minor salivary gland carcinomas, levels I, II, and III should be included in the surgical procedure.