A Sanabria, P Bradley, R de Bree, O Guntinas-Lichius, M Hamoir, L P Kowalski, J P Rodrigo, P Strojan, V Vander Poorten, A Ferlito
{"title":"Deciding whether to do elective neck dissection in patients with salivary gland tumors with no evidence of neck lymph node metastasis.","authors":"A Sanabria, P Bradley, R de Bree, O Guntinas-Lichius, M Hamoir, L P Kowalski, J P Rodrigo, P Strojan, V Vander Poorten, A Ferlito","doi":"10.1016/j.anorl.2025.02.001","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim: </strong>The treatment of salivary gland cancers with clinically negative neck is controversial, with divergent guidelines about elective neck dissection (END). Even though these guidelines are widely used, they mostly rely on retrospective research that are subject to methodological flaws and selection bias.</p><p><strong>Methods: </strong>A critical narrative review. Problem description, identification of likely clinical scenarios, appraisal of previous recommendations, critical examination of available data, and presentation of clinical decision-making options comprised the article creation.</p><p><strong>Results: </strong>One of the most important factors is the rate of occult lymph node metastases, which ranges from 2-30% and varies greatly depending on the kind and grade of tumor. The use of risk classification according to preoperative findings, such as tumor size, grade, and clinical signs such involvement of the facial nerve, offers some guidance. Nevertheless, unanticipated cancers are frequently discovered by intraoperative and postoperative histological results, which makes decision-making even more difficult. Alternatives to END, including elective neck irradiation, have similar effectiveness in reducing regional recurrence in high-risk scenarios. Although END may enhance regional control, it carries risks of surgical complications, such as injury to nerves and functional impairment. No prospective randomized studies have definitively demonstrated the advantage of END regarding survival or recurrence.</p><p><strong>Conclusion: </strong>END may be appropriate in certain high-risk situations, but its regular use in cN0 salivary gland cancers is still up for debate. A personalized strategy that accounts for tumor-specific and patient-related variables, together with careful use of adjuvant treatments, is advised until substantial prospective data is available.</p>","PeriodicalId":48834,"journal":{"name":"European Annals of Otorhinolaryngology-Head and Neck Diseases","volume":" ","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Annals of Otorhinolaryngology-Head and Neck Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.anorl.2025.02.001","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Aim: The treatment of salivary gland cancers with clinically negative neck is controversial, with divergent guidelines about elective neck dissection (END). Even though these guidelines are widely used, they mostly rely on retrospective research that are subject to methodological flaws and selection bias.
Methods: A critical narrative review. Problem description, identification of likely clinical scenarios, appraisal of previous recommendations, critical examination of available data, and presentation of clinical decision-making options comprised the article creation.
Results: One of the most important factors is the rate of occult lymph node metastases, which ranges from 2-30% and varies greatly depending on the kind and grade of tumor. The use of risk classification according to preoperative findings, such as tumor size, grade, and clinical signs such involvement of the facial nerve, offers some guidance. Nevertheless, unanticipated cancers are frequently discovered by intraoperative and postoperative histological results, which makes decision-making even more difficult. Alternatives to END, including elective neck irradiation, have similar effectiveness in reducing regional recurrence in high-risk scenarios. Although END may enhance regional control, it carries risks of surgical complications, such as injury to nerves and functional impairment. No prospective randomized studies have definitively demonstrated the advantage of END regarding survival or recurrence.
Conclusion: END may be appropriate in certain high-risk situations, but its regular use in cN0 salivary gland cancers is still up for debate. A personalized strategy that accounts for tumor-specific and patient-related variables, together with careful use of adjuvant treatments, is advised until substantial prospective data is available.
期刊介绍:
European Annals of Oto-rhino-laryngology, Head and Neck diseases heir of one of the oldest otorhinolaryngology journals in Europe is the official organ of the French Society of Otorhinolaryngology (SFORL) and the the International Francophone Society of Otorhinolaryngology (SIFORL). Today six annual issues provide original peer reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches and review articles giving most up-to-date insights in all areas of otology, laryngology rhinology, head and neck surgery. The European Annals also publish the SFORL guidelines and recommendations.The journal is a unique two-armed publication: the European Annals (ANORL) is an English language well referenced online journal (e-only) whereas the Annales Françaises d’ORL (AFORL), mail-order paper and online edition in French language are aimed at the French-speaking community. French language teams must submit their articles in French to the AFORL site.
Federating journal in its field, the European Annals has an Editorial board of experts with international reputation that allow to make an important contribution to communication on new research data and clinical practice by publishing high-quality articles.