Lymph node surgery for salivary gland cancer: REFCOR recommendations by the formal consensus method

Area of Science:

• Head and Neck Oncology
• Surgical Oncology
• Rare Tumors

Background:

• Salivary gland cancers require careful management of regional lymph nodes.
• Indications for neck dissection in these cancers are not always clearly defined.
• Clinical staging (cN+ vs cN0) and risk stratification are crucial.

Purpose of the Study:

• To establish clear indications for neck dissection in parotid, submandibular, and minor salivary gland cancers.
• To guide management based on clinical presentation and risk of nodal metastasis.
• To develop consensus-based recommendations for neck dissection in salivary gland malignancies.

Main Methods:

• A narrative literature review was conducted by the French Network of Rare Head and Neck Tumors (REFCOR).
• Recommendations were drafted by a steering group and assessed by a rating group.
• The formal consensus method was employed to finalize recommendations.

Main Results:

• Ipsilateral neck dissection is recommended for cN+ salivary gland cancer.
• For cN0 salivary gland cancer, ipsilateral neck dissection is recommended unless the tumor has a low risk of occult nodal metastasis.
• High-risk pathology in cN0 cases warrants further treatment, such as ipsilateral neck dissection or elective nodal irradiation.

Conclusions:

• The pathological grade of salivary gland cancer is the primary determinant for occult lymph node involvement.
• This influences the decision-making process for elective neck dissection.
• Recommendations aim to optimize treatment strategies for salivary gland cancers.