Elective neck dissection versus observation in primary parotid carcinoma

Zbären, Peter; Schüpbach, Jonas; Nuyens, Michel; Stauffer, Edouard

doi:10.1016/j.otohns.2004.09.029

Cited by 115 publications

(104 citation statements)

References 22 publications

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“…This is encouraged by a study of 168 primary parotid gland malignancies, in which Walvekar et al [19] could show that of low-risk histology patients who underwent neck dissection 40% had pN+ disease. Furthermore, comparing elective neck dissection versus observing in high-and low-grade primary parotid gland carcinoma, Zbaren et al [20] conclude that a routine elective neck dissection is suggested in all patients with primary carcinoma of the parotid gland. The occurrence of intraparotideal metastases in cN¡/pN+ patients was 70.0%.…”

Section: Discussionmentioning

confidence: 99%

Occurrence of lymph node metastasis in early-stage parotid gland cancer

Stenner

Molls

Lüers

et al. 2011

Eur Arch Otorhinolaryngol

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Lymph node metastasis is one of the most important factors in therapy and prognosis for patients with parotid gland cancer. Nevertheless, the extent of the primary tumor resection and the necessity of a neck dissection still is a common issue. Since little is known about lymph node metastasis in early-stage parotid gland cancer, the purpose of the present study was to evaluate the occurrence of lymph node metastases in T1 and T2 carcinomas and its impact on local control and survival. We retrospectively analyzed 70 patients with early-stage (T1 and T2) primary parotid gland cancer. All patients were treated with parotidectomy and an ipsilateral neck dissection from 1987 to 2009. Clinicopathological and survival parameters were calculated. The median follow-up time was 51.7 months. A positive pathological lymph node stage (pN+) was found in 21.4% of patients with a significant correlation to the clinical lymph node stage (cN) (p = 0.061). There were no differences in the clinical and histopathological data between pN- and pN+ patients. In 73.3% of pN+ patients, the metastases were located intraparotideal. The incidence of occult metastases (pN+/cN-) was 17.2%. Of all patients with occult metastases, 30.0% had extraparotideal lymphatic spread. A positive lymph node stage significantly indicated a poorer 5-year overall as well as 5-year disease-free survival rate compared to pN- patients (p = 0.048; p = 0.011). We propose total parotidectomy in combination with at least a level II-III selective neck dissection in any case of early-stage parotid gland cancer.

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Section: Discussionmentioning

confidence: 99%

Occurrence of lymph node metastasis in early-stage parotid gland cancer

Stenner

Molls

Lüers

et al. 2011

Eur Arch Otorhinolaryngol

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“…The incidence of occult metastasis in elective neck dissection (END) specimens has been reported to be between 20 and 37% [34,35] . Thus, the performing of END for all cN0 parotid cancers implies that more than half of patients are over-treated.…”

Section: Sentinel Node Biopsy In Primary Parotid Cancermentioning

confidence: 99%

Management of Regional Metastases of Malignant Salivary Gland Neoplasms

Medina¹,

Zbären

Bradley

2016

Salivary Gland Neoplasms

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Metastases from salivary gland carcinomas to the cervical lymph nodes are relatively uncommon. However, their impact on prognosis is significant and, thus, it is important to manage them appropriately. Treatment of clinically evident metastases consists primarily of surgery, frequently followed by radiation. Management of the N0 neck, on the other hand, remains controversial. While there seems to be agreement regarding the tumor and patient factors that make it more likely for a patient to harbor subclinical metastases in the lymph nodes, some clinicians prefer to treat those patients with surgery, i.e. a neck dissection, and others prefer to use elective radiation. These different approaches and their rationale will be discussed in detail.

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“…The overall incidence of LN metastases at presentation for primary parotid carcinomas in all age groups ranges between 18 and 28 % [67,68]. In the adult literature, recommendations range from routine elective neck dissection in all patients with primary carcinoma of the parotid gland [67] to neck dissection under specific circumstances including patients with tumors larger than 3 cm, high-grade tumors, facial paralysis, extra-glandular extension, and perilymphatic invasion [69]. Others argue in support of a supra-omohyoid neck dissection in patients with high-grade tumors for staging purposes, reserving an elective full neck dissection for patients with undifferentiated and squamous cell carcinomas [70].…”

Section: Surgerymentioning

confidence: 99%