title: Incidence and patterns of regional metastasis in early oral squamous cell cancers: feasibility of submandibular gland preservation.
abstract: BACKGROUND
  We aimed to study the incidence of metastasis to the submandibular gland (SMG) and to establish the oncologic basis of SMG preservation in early-stage cancer of the oral cavity (OSCC).
  
  
  METHODS
  This was a retrospective study of 261 patients with OSCC treated primarily with surgery at a tertiary medical center. One hundred thirty-two early-stage (T1-2, N0) OSCCs were further analyzed.
  
  
  RESULTS
  The mean age was 59 years with male-to-female sex ratio of 1.4:1. Two hundred sixty-one neck dissections were performed with SMG removal in 253 patients. One patient with an advanced floor of mouth cancer had obvious infiltration of the SMG. Only 2.5% (3 of 116) patients with early-stage OSCC had level I metastasis; none had SMG metastases.
  
  
  CONCLUSIONS
  SMG preservation in early cancers (T1-2, N0) of the oral cavity should be feasible unless there is evidence of direct invasion of the gland or close proximity of the cancer to it.
authors.affiliation: Department of Otolaryngology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Razfar
authors.forename: Rohan R
authors.initials: RR
authors.lastname: Walvekar
authors.forename: Antoine
authors.initials: A
authors.lastname: Melkane
authors.forename: Jonas T
authors.initials: JT
authors.lastname: Johnson
authors.forename: Eugene N
authors.initials: EN
authors.lastname: Myers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000556:secondary* / Q000628:therapy; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003131:Combined Modality Therapy; D055088:Early Detection of Cancer; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D037981:Neck Dissection; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D013363:Submandibular Gland / Q000473:pathology / Q000601:surgery; D013365:Submandibular Gland Neoplasms / Q000453:epidemiology* / Q000556:secondary* / Q000601:surgery; D016019:Survival Analysis; D055815:Young Adult