Occurrence of lymph node metastasis in early-stage parotid gland cancer

Abstract

Lymph node metastasis is one of the most important factors in therapy and prognosis for patients with parotid gland cancer. Nevertheless, the extent of the primary tumor resection and the necessity of a neck dissection still is a common issue. Since little is known about lymph node metastasis in early-stage parotid gland cancer, the purpose of the present study was to evaluate the occurrence of lymph node metastases in T1 and T2 carcinomas and its impact on local control and survival. We retrospectively analyzed 70 patients with early-stage (T1 and T2) primary parotid gland cancer. All patients were treated with parotidectomy and an ipsilateral neck dissection from 1987 to 2009. Clinicopathological and survival parameters were calculated. The median follow-up time was 51.7 months. A positive pathological lymph node stage (pN+) was found in 21.4% of patients with a significant correlation to the clinical lymph node stage (cN) (p = 0.061). There were no differences in the clinical and histopathological data between pN- and pN+ patients. In 73.3% of pN+ patients, the metastases were located intraparotideal. The incidence of occult metastases (pN+/cN-) was 17.2%. Of all patients with occult metastases, 30.0% had extraparotideal lymphatic spread. A positive lymph node stage significantly indicated a poorer 5-year overall as well as 5-year disease-free survival rate compared to pN- patients (p = 0.048; p = 0.011). We propose total parotidectomy in combination with at least a level II-III selective neck dissection in any case of early-stage parotid gland cancer.

Probability and pattern of occult cervical lymph node metastases in primary parotid carcinoma

“…I, III and V levels were involved in approximately 20% (±3%), while level IV was involved in only one series (<10%). Involvement of level V, especially Va, is not that obvious (3/6 series) and most probably it is associated with location and local stage of the tumour [3, 10–12, 15]. In the presented series and two other ones, there were no metastases in level I either [3, 11].…”

“…Lim et al showed that patients with cN0 neck and I/PLN metastases have statistically significant higher chance of locoregional recurrence and poorer prognosis [17]. In the published results from series of patients with cN0 salivary gland carcinomas, I/PLN metastases were coexistent with occult neck metastases (30–80%) [3, 5, 10, 12]. Some authors recommend total parotidectomy even in patients with early stage parotid gland carcinomas, since it is the only way to remove and identify all I/PLN metastases [3, 5].…”

“…Involvement of level V, especially Va, is not that obvious (3/6 series) and most probably it is associated with location and local stage of the tumour [3, 10–12, 15]. In the presented series and two other ones, there were no metastases in level I either [3, 11]. Teymoortash et al pointed out to the fact that even though all the lymph is drained to the superficial and deep intersalivary lymph nodes, from the anteroinferior part of the parotid gland it may pass though the masseter directly to submandibular lymph nodes [18].…”

Management of salivary gland carcinomas - a review

“…[37, 38] Elective neck dissection (END) should be indicated when the risk of subclinical disease in a clinically negative neck exceeds 15%. [36] Hence, it would be of great value to formulate a criteria to select patients for whom a neck dissection should be incorporated into the surgical management of the primary tumor.…”

Role of intraparotid node metastasis in mucoepidermoid carcinoma of the parotid gland

“…Firstly, lymph nodes existed in both lobes of the parotid gland, undiagnosed metastatic IPNs might be caused by non-total parotidectomy, and then recurrent disease might be expected owing to the residual disease. Therefore, total parotidectomy was suggested for all parotid cancer patients by previous authors [15]. The high 10-year RFS rate in current study came into our attention, it was better than previous researches [8, 11], the favorable outcome might be partially explained by our routine total parotidectomy.…”