Utility of Elective Neck Dissection in Clinically Node-Negative Parotid Malignancy.

Area of Science:

• Oncology
• Surgical Oncology
• Head and Neck Cancer

Background:

• Parotid gland malignancies require careful staging and treatment planning.
• The role of elective neck dissection (END) in clinically node-negative (cN0) parotid cancer remains debated.
• Identifying predictive factors for occult nodal metastasis is crucial for treatment decisions.

Purpose of the Study:

• To evaluate the utility of END in cN0 parotid malignancy.
• To identify factors associated with receiving END.
• To analyze the survival outcomes of patients undergoing END.

Main Methods:

• Retrospective cohort study using the National Cancer Database (NCDB).
• Patients with cN0 parotid malignancy were identified.
• END was defined as pathological examination of ≥5 lymph nodes.
• Univariate and multivariate analyses assessed predictors of END, occult metastasis rates, and survival.

Main Results:

• 36.1% of 9405 patients underwent END.
• END was most common for squamous cell carcinoma (SCC) and salivary duct histology.
• Occult node disease rates were highest for salivary ductal carcinoma (39.8%) and adenocarcinoma (30.0%).
• Kaplan-Meier survival analysis revealed significantly improved 5-year overall survival for patients receiving END with poorly differentiated mucoepidermoid carcinoma and moderately/poorly differentiated SCC.

Conclusions:

• Histological classification is a primary factor in determining END eligibility for cN0 parotid cancer.
• END is associated with improved overall survival in patients with poorly differentiated mucoepidermoid and SCC.
• Histology, clinical T-stage, and occult nodal metastasis rates should guide END decisions.