Lymph node surgery for salivary gland cancer: REFCOR recommendations by the formal consensus method - 30/11/23

Doi : 10.1016/j.anorl.2023.11.001

B. Baujat ^a, S. Vergez ^b,^c, F. Jegoux ^d, B. Barry ^e, B. Verillaud ^f, N. Pham Dang ^g, N. Fakhry ^h, E. Chabrillac ^b,^⁎
^a Département d’ORL et chirurgie cervicofaciale, hôpital Tenon, Sorbonne université, AP–HP, Paris, France
^b Département de chirurgie, institut universitaire du cancer Toulouse – Oncopole, Toulouse, France
^c Département de chirurgie ORL et cervicofaciale, CHU de Toulouse-Larrey, université Toulouse III Paul-Sabatier, Toulouse, France
^d Département d’ORL et chirurgie cervicofaciale, CHU de Rennes, Rennes, France
^e Département d’ORL et chirurgie cervicofaciale, hôpital Bichat, AP–HP, Paris, France
^f Inserm U1141, département d’ORL et de chirurgie cervico-faciale, hôpital Lariboisière, université Paris-Cité, AP–HP, Paris, France
^g Inserm, Neuro-Dol, service de chirurgie maxillofaciale, université Clermont Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
^h Département d’ORL et chirurgie cervicofaciale, hôpital La Conception, AP–HM, Marseille, France

^⁎Corresponding author. 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France.1, avenue Irène-Joliot-CurieToulouse31100France

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Abstract

Objective

To determine the indications for neck dissection in the management of parotid, submandibular or minor salivary gland cancers depending on the clinical situation: i.e., clinical lymph node involvement (cN+) or not (cN0); low or high risk of occult nodal metastasis; diagnosis of malignancy before, during or after surgery.

Material and methods

The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group which drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group according to the formal consensus method.

Results

In cN+ salivary gland cancer, ipsilateral neck dissection is recommended. In cN0 salivary gland cancer, ipsilateral neck dissection is recommended, except for tumors at low risk of occult nodal metastasis. If definitive pathology reveals a high risk of occult nodal involvement, additional neck treatment is recommended: ipsilateral neck dissection or elective nodal irradiation.

Conclusion

The rate of occult lymph node involvement, and therefore the indication for elective neck dissection, depends primarily on the pathologic grade of the salivary gland cancer.

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Keywords : Salivary gland cancer, Neck dissection, Parotid gland, Submandibular gland, Minor salivary glands