title: Elective neck dissection versus observation in primary parotid carcinoma.
abstract: OBJECTIVE
  To evaluate the efficacy of elective neck dissection in the clinically negative neck of patients with primary carcinoma of the parotid gland. Study design and setting A retrospective analysis was undertaken at a university Department of Otorhinolaryngology-Head and Neck Surgery on 83 previously untreated patients with primary carcinoma of the parotid gland and a clinically negative neck. The reliability of fine needle aspiration cytology, frozen section, and the clinico-pathologic findings of patients with occult neck metastases were analyzed. The regional recurrence rate and the outcome were compared among 2 groups; one with elective neck dissection (N = 41) and one without elective neck dissection (N = 42).
  
  
  RESULTS
  The diagnosis of malignancy was known preoperatively in 59 (71%) cases, the exact histologic tumor type in 36 (43%) and the grade in 37 (44%) of 83 cases. Occult metastases were detected in 8 (20%) of 41 cNO patients, in 5 cases associated with a high-grade and in 3 cases with a low-grade carcinoma. Recurrence of disease developed in 5 (12%) patients in the elective neck dissection group and in 11 (26%) patients in the observation group. All of the 7 neck recurrences occurred in the observation group. The 5-year actuarial and disease-free survival rate was 80% and 86% for patients with elective neck dissection and 83% and 69% for patients without neck dissection. Conclusion and significance A routine elective neck dissection is suggested in all patients with primary carcinoma of the parotid gland. The efficacy of elective neck dissection, nevertheless, has never been evaluated prospectively.
authors.affiliation: Department of Oto-Rhino-Laryngology, Head, and Neck Surgery, University Hospital, Berne, Switzerland. zbaeren@insel.ch
authors.forename: P
authors.initials: P
authors.lastname: Zbären
authors.forename: J
authors.initials: J
authors.lastname: Schüpbach
authors.forename: M
authors.initials: M
authors.lastname: Nuyens
authors.forename: E
authors.initials: E
authors.lastname: Stauffer
mesh_terms: D001707:Biopsy, Needle; D002277:Carcinoma / Q000473:pathology* / Q000601:surgery*; D017558:Elective Surgical Procedures; D005629:Frozen Sections; D006801:Humans; D008875:Middle Aged; D037981:Neck Dissection; D010307:Parotid Neoplasms / Q000473:pathology* / Q000601:surgery*; D015203:Reproducibility of Results; D012189:Retrospective Studies