Elective neck dissection versus observation in primary parotid carcinoma

Otolaryngol Head Neck Surg. 2005 Mar;132(3):387-91. doi: 10.1016/j.otohns.2004.09.029.

Abstract

Objective: To evaluate the efficacy of elective neck dissection in the clinically negative neck of patients with primary carcinoma of the parotid gland. Study design and setting A retrospective analysis was undertaken at a university Department of Otorhinolaryngology-Head and Neck Surgery on 83 previously untreated patients with primary carcinoma of the parotid gland and a clinically negative neck. The reliability of fine needle aspiration cytology, frozen section, and the clinico-pathologic findings of patients with occult neck metastases were analyzed. The regional recurrence rate and the outcome were compared among 2 groups; one with elective neck dissection (N = 41) and one without elective neck dissection (N = 42).

Results: The diagnosis of malignancy was known preoperatively in 59 (71%) cases, the exact histologic tumor type in 36 (43%) and the grade in 37 (44%) of 83 cases. Occult metastases were detected in 8 (20%) of 41 cNO patients, in 5 cases associated with a high-grade and in 3 cases with a low-grade carcinoma. Recurrence of disease developed in 5 (12%) patients in the elective neck dissection group and in 11 (26%) patients in the observation group. All of the 7 neck recurrences occurred in the observation group. The 5-year actuarial and disease-free survival rate was 80% and 86% for patients with elective neck dissection and 83% and 69% for patients without neck dissection. Conclusion and significance A routine elective neck dissection is suggested in all patients with primary carcinoma of the parotid gland. The efficacy of elective neck dissection, nevertheless, has never been evaluated prospectively.

Publication types

  • Comparative Study

MeSH terms

  • Biopsy, Needle
  • Carcinoma / pathology*
  • Carcinoma / surgery*
  • Elective Surgical Procedures
  • Frozen Sections
  • Humans
  • Middle Aged
  • Neck Dissection*
  • Parotid Neoplasms / pathology*
  • Parotid Neoplasms / surgery*
  • Reproducibility of Results
  • Retrospective Studies