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Mannelli G, Comini LV, Sacchetto A, Santoro R, Spinelli G, Bonomo P, Desideri I, Bossi P, Orlandi E, Alderotti G, Franchi A, Palomba A, Eccher A, Marchioni D, Nocini R, Piazza C, Molteni G. Estimating survival after salvage surgery for recurrent salivary gland cancers: Systematic review. Head Neck 2022; 44:1961-1975. [PMID: 35441406 PMCID: PMC9545583 DOI: 10.1002/hed.27062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
Recurrent salivary gland carcinomas (RSCs) are poorly characterized and their clinical features and treatment options have not yet been fully described. The goal of this study was to analyze the therapeutic strategies and oncological outcomes of RSC patients through a literature review analysis. This systematic review was performed according to the PRISMA statements. Inclusion criteria for the systematic review were based on the population, intervention, comparison, and outcomes according to (PICO) framework. Two thousand seven hundred and four records were selected and 1817 recurrences were studied. Three hundred and sixty-five patients underwent salvage surgery (20.1%) and their 5-year mortality rate, overall survival and disease-free survival were 35%, 70%, and 42%, respectively. RSCs are aggressive neoplasms with a high rate of distant metastases (28.9%). Salvage surgery can be considered in patients with limited local and/or regional recurrences, even in case of single distant relapse, appearing within the first 3 years of follow-up.
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Affiliation(s)
- Giuditta Mannelli
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorence
| | - Lara V. Comini
- Head and Neck Oncology and Robotic Surgery, Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Andrea Sacchetto
- Otorhinolaryngology‐Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and PediatricsUniversity of Verona, University Hospital of VeronaVeronaItaly
| | - Roberto Santoro
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorence
| | - Giuseppe Spinelli
- Department of Maxillo Facial SurgeryAzienda Ospedaliero‐Universitaria CareggiFlorenceItaly
| | - Pierluigi Bonomo
- Radiation OncologyAzienda Ospedaliero‐Universitaria CareggiFlorenceItaly
| | - Isacco Desideri
- Radiation OncologyAzienda Ospedaliero‐Universitaria CareggiFlorenceItaly
| | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of Brescia, ASST (Azienda Socio Sanitaria Territoriale) Spedali CiviliBresciaItaly
| | - Ester Orlandi
- Radiation Oncology, Clinical DepartmentNational Center for Oncological Hadrontherapy (CNAO)PaviaItaly
| | - Giammarco Alderotti
- Department of Statistics, Computer ScienceApplications “G. Parenti” (DiSIA), University of FlorenceFlorenceItaly
| | - Alessandro Franchi
- Department of Translational ResearchSchool of Medicine, University of PisaPisaItaly
| | - Annarita Palomba
- Unit of Histopathology and Molecular Diagnostics, Careggi University HospitalFlorenceItaly
| | - Albino Eccher
- Pathology Unit, Department of Pathology and DiagnosticsUniversity Hospital of VeronaVeronaItaly
| | - Daniele Marchioni
- Otorhinolaryngology‐Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and PediatricsUniversity of Verona, University Hospital of VeronaVeronaItaly
| | - Riccardo Nocini
- Otorhinolaryngology‐Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and PediatricsUniversity of Verona, University Hospital of VeronaVeronaItaly
| | - Cesare Piazza
- Unit of Otorhinolaryngology—Head and Neck Surgery, ASST Spedali Civili of BresciaUniversity of BresciaBresciaItaly
| | - Gabriele Molteni
- Otorhinolaryngology‐Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and PediatricsUniversity of Verona, University Hospital of VeronaVeronaItaly
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2
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Adachi M, Tomioka T, Fujii S, Morishita Y, Okano W, Shinozaki T, Matsuura K, Hayashi R. Is elective neck dissection necessary for patients with cT3-4N0 parotid gland cancer? Auris Nasus Larynx 2022; 49:856-861. [PMID: 35351350 DOI: 10.1016/j.anl.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/08/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Management of the cervical lymph nodes in patients with cT3-4N0 parotid gland cancer (PGC) has been controversial. This study investigated the need for elective neck dissection (END) in patients with cT3-4N0 PGC. METHODS We retrospectively examined cervical lymph node metastasis, overall survival (OS), and disease-free survival (DFS) rates in 40 patients with cT3-4N0 PGC according to whether or not END was performed. RESULTS Cervical lymph node metastasis occurred in 27.5% of patients and level II was the most common area. Recurrence could be treated by salvage neck dissection. There was no significant difference in OS (P=0.581) or DFS (P=0.728) between the group that underwent END and the group that did not. CONCLUSION END at level II is worth performing because of the occult lymph node metastasis rate. The area of neck dissection should be limited because there is no evidence that END improves the prognosis of cT3-4N0 PGC.
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Affiliation(s)
- Masahiro Adachi
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan.
| | - Toshifumi Tomioka
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Satoshi Fujii
- Department of Molecular Pathology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yohei Morishita
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Wataru Okano
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Takeshi Shinozaki
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Ryuichi Hayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
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3
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Yan F, Lao WP, Nguyen SA, Sharma AK, Day TA. Elective neck dissection in salivary gland malignancies: Systematic review and meta-analysis. Head Neck 2021; 44:505-517. [PMID: 34862810 DOI: 10.1002/hed.26923] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/25/2021] [Accepted: 10/26/2021] [Indexed: 12/27/2022] Open
Abstract
We defined the occult nodal metastasis (ONM) rate of clinical node-negative salivary gland malignancies and examined the role of elective neck dissection (END). Meta-analysis querying four databases, from inception of databases to March 25th, 2020. Fifty-one studies with 11 698 patients were included. ONM rates were 64% for salivary ductal carcinoma (SDC), 51% for undifferentiated carcinoma, 34% for carcinoma ex-pleomorphic adenoma (CXPA), 32% for adenocarcinoma not otherwise specified (ANOS), 31% for lymphoepithelial carcinoma (LE), 20% for mucoepidermoid carcinoma, 17% for acinic cell carcinoma, and 17% for adenoid cystic carcinoma. T3/T4 tumors had a 2.3 times increased risk of ONM than T1/T2 tumors. High-grade tumors had a 3.8 times increased risk of ONM than low/intermediate-grade tumors. ONM rates were exceedingly high for T3/T4, high-grade, and undifferentiated, SDC, ANOS, CXPA, and LE tumors, indicating the potential role of END.
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Affiliation(s)
- Flora Yan
- Department of Otolaryngology-Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Wilson P Lao
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - Shaun A Nguyen
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Anand K Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terry A Day
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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4
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Yamamoto H, Kojima T, Okanoue Y, Otsuki S, Hasebe K, Yuki R, Hori R. Impact of Changing Surgical Strategies on Clinical Outcomes in Patients with Parotid Carcinoma: A 53-Year Single-Institution Experience. MEDICINA-LITHUANIA 2021; 57:medicina57080745. [PMID: 34440951 PMCID: PMC8399018 DOI: 10.3390/medicina57080745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: We investigated the clinical outcomes of patients who underwent surgery for parotid carcinoma in a single institution during a 53-year period. This study aimed to estimate the impact of changing the surgical approach to parotid carcinoma on clinical outcomes including the incidence rate of the facial nerve palsy. Materials and Methods: Sixty-seven patients with parotid carcinoma who underwent surgery between 1966 and 2018 were retrospectively reviewed. Group A consisted of 29 patients who underwent surgery from 1966 to 2002, and Group B consisted of 38 patients from 2002 to 2018. Treatment outcomes were estimated. Additionally, candidate prognostic factors of Group B, the current surgical approach group, were evaluated. Results: Partial parotidectomy and total parotidectomy were performed in 35 and 32 patients, respectively. Partial parotidectomy was performed in 4 patients in Group A and 31 patients in Group B, with a predominant increase in Group B. The facial nerve was preserved in 43 patients, among whom 8 in Group A (8/17; 47.1%) and 7 in Group B (7/26; 26.9%) had temporary postoperative facial nerve palsy. Postoperative radiotherapy was performed on 35 patients. The 5-year OS, DSS, and DFS rates for Group A were 77.1%, 79.9%, and 71.5%, respectively. The 5-year OS, DSS, and DFS rates for Group B were 77.1%, 77.1%, and 72.4%, respectively. Clinical T4 stage, clinical N+ stage, stage IV disease, and tumor invasion of the facial nerve were independent prognostic factors in Group B. Conclusions: The incidence of facial nerve palsy in the current surgical approach group decreased compared with that in the previous surgical approach group. The current surgical management and treatment policies for parotid carcinoma have led to improved outcomes.
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Affiliation(s)
- Hirotaka Yamamoto
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
- Department of Otolaryngology, Shizuoka City Hospital, 10-93 Otte-cho, Aoi-ku, Shizuoka 420-8630, Japan
| | - Tsuyoshi Kojima
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Yusuke Okanoue
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Shuya Otsuki
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Koki Hasebe
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Ryohei Yuki
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Ryusuke Hori
- Department of Otolaryngology—Head and Neck Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Aichi, Japan
- Correspondence: ; Tel.: +81-562-93-9291
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5
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Geiger JL, Ismaila N, Beadle B, Caudell JJ, Chau N, Deschler D, Glastonbury C, Kaufman M, Lamarre E, Lau HY, Licitra L, Moore MG, Rodriguez C, Roshal A, Seethala R, Swiecicki P, Ha P. Management of Salivary Gland Malignancy: ASCO Guideline. J Clin Oncol 2021; 39:1909-1941. [PMID: 33900808 DOI: 10.1200/jco.21.00449] [Citation(s) in RCA: 170] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations for practicing physicians and other healthcare providers on the management of salivary gland malignancy. METHODS ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, neuroradiology, pathology, and patient advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2020. Outcomes of interest included survival, diagnostic accuracy, disease recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 293 relevant studies to inform the evidence base for this guideline. Six main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, and follow-up evaluations. RECOMMENDATIONS When possible, evidence-based recommendations were developed to address the diagnosis and appropriate preoperative evaluations for patients with a salivary gland malignancy, therapeutic procedures, and appropriate treatment options in various salivary gland histologies.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | - Marnie Kaufman
- Adenoid Cystic Carcinoma Research Foundation, Needham, MA
| | | | | | - Lisa Licitra
- Istituto Nazionale Tumori, Milan, Italy.,University of Milan, Milan, Italy
| | | | | | | | | | | | - Patrick Ha
- University of California San Francisco, San Francisco, CA
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6
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Westergaard-Nielsen M, Möller S, Godballe C, Grau Eriksen J, Larsen SR, Kiss K, Agander T, Parm Ulhøi B, Charabi B, Ehlers Klug T, Jacobsen H, Johansen J, Kristensen CA, Andersen E, Andersen M, Bjørndal K. Prognostic scoring models in parotid gland carcinoma. Head Neck 2021; 43:2081-2090. [PMID: 33734517 DOI: 10.1002/hed.26672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/28/2021] [Accepted: 02/27/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim was to identify prognostic factors and test three prognostic scoring models that predicted the risk of recurrence in patients with parotid gland carcinoma. METHODS All Danish patients with parotid gland carcinoma, treated with curative intent, from 1990 to 2015 (n = 726) were included. Potential prognostic factors were evaluated using Cox regression and competing risk analyses. The concordance of each prognostic model was estimated using Harrel's C index. RESULTS The study population consisted of 344 men and 382 women, with a median age of 63 years. Age above 60 years, high grade histology, T3/T4 tumor, regional lymph node metastases, and involved surgical margins were all associated with a significant reduction in recurrence-free survival. The prognostic model that agreed best with actual outcomes had a C-index of 0.76. CONCLUSION Prognostic scoring models may improve individualized follow-up strategies after curatively intended treatment for patients with parotid gland carcinoma.
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Affiliation(s)
- Marie Westergaard-Nielsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Christian Godballe
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Katalin Kiss
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Tina Agander
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | | | - Birgitte Charabi
- Department of Otorhinolaryngology, Head and Neck Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Jacobsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | | | - Elo Andersen
- Department of Oncology, Herlev Hospital, Herlev, Denmark
| | - Maria Andersen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Kristine Bjørndal
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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7
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Westergaard-Nielsen M, Godballe C, Grau Eriksen J, Larsen SR, Kiss K, Agander T, Parm Ulhøi B, Wittenborg Charabi B, Ehlers Klug T, Jacobsen H, Johansen J, Kristensen CA, Andersen E, Andersen M, Bjørndal K. Surgical treatment of the neck in patients with salivary gland carcinoma. Head Neck 2021; 43:1898-1911. [PMID: 33733522 DOI: 10.1002/hed.26667] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/21/2021] [Accepted: 02/19/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Elective neck dissection (END) in patients with salivary gland carcinoma is controversial and there are no universally accepted guidelines. METHODS Patients were identified from the Danish Head and Neck Cancer Group. Between 2006 and 2015, 259 patients with primary salivary gland carcinoma were treated with END. Variables potentially associated with regional metastases were analyzed using logistic regression. Neck recurrence-free survival was calculated using the Kaplan-Meier method. RESULTS Occult metastases were found in 36 of the patients treated with END (14%) and were particularly frequent among patients with T3/T4 tumors and high-grade histology tumors. In multivariate analyses, high-grade histology and vascular invasion were associated with occult metastases. CONCLUSION We recommend END of levels II and III for patients with high-grade or unknown histological grade tumors, and for T3/T4 tumors. Levels I, II, and III should be included in END in patients with submandibular, sublingual, or minor salivary gland carcinomas.
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Affiliation(s)
- Marie Westergaard-Nielsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
| | - Christian Godballe
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Katalin Kiss
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Tina Agander
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Jacobsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | | | | | - Maria Andersen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Kristine Bjørndal
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
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8
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Borsetto D, Iocca O, De Virgilio A, Boscolo-Rizzo P, Phillips V, Nicolai P, Spriano G, Fussey J, Di Maio P. Elective neck dissection in primary parotid carcinomas: A systematic review and meta-analysis. J Oral Pathol Med 2020; 50:136-144. [PMID: 33222323 DOI: 10.1111/jop.13137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/01/2020] [Accepted: 10/19/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND To estimate the rate of occult cervical lymph node metastases in cN0 patients affected by primary parotid carcinomas and to scrutinize the evidence on the indication and extent of elective neck dissection in these neoplasms. METHODS Medline, Embase, Web of Science, Cochrane Library and Scopus were searched until August 31, 2020, to identify studies reporting the use of elective neck dissection in the management of malignant parotid tumours. The PRISMA checklist was used. A single arm meta-analysis was then made to determine the pooled rate of occult lymph node metastases. Risk of bias of the included studies was assessed through the ROBINS-E tool. RESULTS The initial search returned 20 541 articles, of which twelve met the inclusion criteria and were included in the meta-analysis. They comprised 1310 patients with parotid carcinoma, of whom 542 cN0 underwent elective neck dissection, which led to the diagnosis of lymph node metastasis (pN+/cN0) in 113 cases. Meta-analysis of the results of elective neck dissection showed an overall rate of occult metastases of 0.22 (99% CI: 0.14-0.30). Locally advanced or high-grade tumours were the commonest indications for elective neck dissection in the included studies. The most dissected lymph node levels were I-II-III, and level II was the commonest site of occult nodal metastases. CONCLUSIONS An occult metastasis rate of 0.22 (99% CI: 0.14-0.30) represents a not negligible percentage value, which should encourage further research to outline the most appropriate elective neck management in cN0 patients with parotid carcinomas.
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Affiliation(s)
- Daniele Borsetto
- Department of Otolaryngology, Guy's and St Thomas Hospital, London, UK
| | - Oreste Iocca
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Armando De Virgilio
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Paolo Boscolo-Rizzo
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Italy
| | | | - Piero Nicolai
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Italy
| | - Giuseppe Spriano
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Jonathan Fussey
- Department of Otolaryngology, New Cross Hospital, Wolverhampton, UK
| | - Pasquale Di Maio
- Department of Otolaryngology-Head and Neck Surgery, Giovanni Borea Civil Hospital, Sanremo, Italy
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9
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Westergaard-Nielsen M, Rosenberg T, Gerke O, Dyrvig AK, Godballe C, Bjørndal K. Elective neck dissection in patients with salivary gland carcinoma: A systematic review and meta-analysis. J Oral Pathol Med 2020; 49:606-616. [PMID: 32430929 DOI: 10.1111/jop.13034] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Elective neck dissection in patients with salivary gland carcinoma and clinically negative lymph nodes is controversial. Reported proportion of occult nodal metastases vary with histological subtype, tumour classification and preoperative diagnostic methods. This is a systematic review and meta-analysis on the role of END in salivary gland carcinoma. METHODS A search in PubMed, Embase and Cochrane was performed. Original articles in English with data on tumour characteristics, clinical and pathological N-classification, and neck dissection were included. Reporting Items for Systematic Reviews and Meta-analyses were followed. Random effect modelling was performed to pool the data. Meta-analysis of proportions was performed for occult metastases overall, for T3/T4 versus T1/T2 tumours and for tumours with high-grade versus low-grade histology. Heterogeneity across studies was assessed with I-squared statistics. RESULTS We included 22 articles in the qualitative synthesis and meta-analysis. The pooled proportion of occult metastases was 21%. In patients with T3/T4 tumour, the pooled proportion of occult metastases was 36%, and in patients with high-grade histology, it was 34%. Most studies concluded that END should be performed in patients with advanced T-classification and high-grade histology tumours. Nine studies assessed occult metastases per level. CONCLUSION The overall occult metastases proportion does not require END in all patients with salivary gland carcinoma. We recommend END in patients with high-grade or unknown histology or T3/T4 tumours. END should involve level II and III, and level I should be included in tumours in the submandibular gland, sublingual gland and minor oral salivary glands.
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Affiliation(s)
- Marie Westergaard-Nielsen
- Research Unit for ORL Head & Neck Surgery and Audiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Tine Rosenberg
- Research Unit for ORL Head & Neck Surgery and Audiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Research Unit for Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne-Kirstine Dyrvig
- Department of Database Section 1: Cardiovascular, Surgical and Acute Domains, Danish Clinical Registries, Odense, Denmark
| | - Christian Godballe
- Research Unit for ORL Head & Neck Surgery and Audiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Kristine Bjørndal
- Research Unit for ORL Head & Neck Surgery and Audiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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10
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Lee H, Roh JL, Cho KJ, Choi SH, Nam SY, Kim SY. Positive lymph node number and extranodal extension for predicting recurrence and survival in patients with salivary gland cancer. Head Neck 2020; 42:1994-2001. [PMID: 32115841 DOI: 10.1002/hed.26135] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/06/2020] [Accepted: 02/20/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This study compared our proposed N classification including the addition of the number of positive lymph node (LN+) and extranodal extension (ENE) with the current and previous American Joint Committee on Cancer (AJCC) N classifications in salivary gland cancer (SGC). METHODS This study involved 172 SGC patients who underwent surgery. Cox proportional hazard regression analyses were used to identify factors associated with overall survival (OS) and disease-free survival (DFS). RESULTS In multivariate analyses, LN+ number, LN ratio, and ENE were associated with OS and DFS outcomes (all P < .05). Our new N classification proposed three categories: N0 (0 LN+), N1 (1 LN+), and N2 (≥2 LN+ or ENE). The C-index of our N classification showed improvement in OS prediction (0.768) compared with the AJCC seventh (0.743) and eighth (0.756) edition N classifications. CONCLUSIONS Our proposed N classification incorporating LN+ number and ENE may improve prediction of post-treatment survival and recurrence in patients with SGC.
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Affiliation(s)
- Hojun Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Kyung-Ja Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Giotakis EI, Giotakis AI. Modified facelift incision and superficial musculoaponeurotic system flap in parotid malignancy: a retrospective study and review of the literature. World J Surg Oncol 2020; 18:8. [PMID: 31918725 PMCID: PMC6953144 DOI: 10.1186/s12957-020-1785-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background Data reporting the use of modified facelift incision (MFI) approach with or without superficial musculoaponeurotic system (SMAS) reconstruction in parotid malignancy are limited. To enhance the limited knowledge in this subject, the authors of the current study report quality data of MFI in patients with parotid malignancy with or without SMAS reconstruction. Methods We performed a retrospective review of parotid malignancy patients treated with the MFI over a 5-year period (2015–2019) in the 1st ENT University Department, University of Athens, Greece. Results We identified five patients with parotid malignancy. We performed MFI parotidectomy in 5/5 patients and SMAS reconstruction in 2/5 patients. All tumors were classified as T1N0M0. After a mean follow-up of 43.6 months (minimum, 36; maximum, 55), we noted no recurrence. The patients reported no Frey’s syndrome. Conclusions The authors of the current study suggest consideration of the MFI approach in parotid malignancy. A MFI approach should at least favor small parotid tumors without neck metastatic disease (T1cN0). Surgeons could also address larger tumors with a MFI approach. Surgeons should reconstruct the parotid lodge with a SMAS advancement flap in tumors not in proximity with the SMAS.
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Affiliation(s)
- Evangelos I Giotakis
- First Department of Otorhinolaryngology, Hippocration Hospital, Medical University of Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece
| | - Aris I Giotakis
- First Department of Otorhinolaryngology, Hippocration Hospital, Medical University of Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece.
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