title: Head and neck salivary gland carcinomas--elective neck dissection, yes or no?
abstract: OBJECTIVE
  Surgical resection and subsequent neck dissection (ND) in cases of clinically positive lymph nodes is an accepted primary treatment strategy for salivary gland carcinomas. Because of uncertainty in the extent of lymphogenic metastasis, the authors advocate a strategy of surgical resection and elective ND (END) for all patients. The authors evaluated their treatment by estimating the frequency of metastatic disease and identifying factors associated with an increased risk for metastatic disease.
  
  
  METHODS
  A retrospective cohort study was implemented using patient data obtained from the university's interdisciplinary board for head and neck tumors. Data were screened for age, gender, tumor entity, localization, grade, and TNM Classification of Malignant Tumors (by UICC, International Union Against Cancer) status. Statistical analysis was performed to identify possible predictors of lymph node metastasis. Nodal status groups (N(+) and N0) were compared with respect to age by t tests; other comparisons involved χ(2) tests.
  
  
  RESULTS
  Ninety-four patients (50% female, 50% male; mean age, 59.12 yr) were identified, of whom 87 had an indication for END. On postsurgical histopathologic examination, 34 (39%; 17 male, 17 female) were diagnosed with N(+). Statistical analysis for nodal status produced explorative P values (age, P = .001; gender, P = .792; anatomic region, P = .114; tumor entity, P = .854; tumor status, P = .263; grade, P = .000).
  
  
  CONCLUSIONS
  All studied malignancies were capable of lymph node dissemination. Therefore, no reliable preoperative predictors for lymphogenic metastasis are currently identifiable. Because of difficulties in safely predicting lymphogenic metastasis and the high rate of N(+) results on postoperative examination, the authors strongly advise END for all patients with salivary gland carcinoma.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany. Electronic address: christopher-nobis@t-online.de.
authors.forename: Christopher-Philipp
authors.initials: CP
authors.lastname: Nobis
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany.
authors.forename: Nils H
authors.initials: NH
authors.lastname: Rohleder
authors.affiliation: Professor, Head of Department, Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany.
authors.forename: Klaus-Dietrich
authors.initials: KD
authors.lastname: Wolff
authors.affiliation: Professor, Head of Department, Institute for Medical Biometry, Epidemiology and Medical Informatics, Universität des Saarlandes, Homburg/Saar, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wagenpfeil
authors.affiliation: Associate Professor, Department of Otorhinolaryngology, Technische Universität München, Munich, Germany.
authors.forename: Elias Q
authors.initials: EQ
authors.lastname: Scherer
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany.
authors.forename: Marco R
authors.initials: MR
authors.lastname: Kesting
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D003528:Carcinoma, Adenoid Cystic / Q000556:secondary / Q000601:surgery; D018277:Carcinoma, Mucoepidermoid / Q000556:secondary / Q000601:surgery; D002648:Child; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010307:Parotid Neoplasms / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012468:Salivary Gland Neoplasms / Q000601:surgery*; D012470:Salivary Glands, Minor / Q000601:surgery; D013365:Submandibular Gland Neoplasms / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult