Submandibular Gland Preservation in Oral Cavity Cancer is Oncologically Safe! Time to Think About Improving Quality...

Oral cavity squamous cell carcinoma (OCSCC) is the most common cancer among men and second most common cancer among women in India. Literature says that the submandibular salivary gland (SMG) can be involved by direct extension from the primary tumour (< 5%) or through metastatic node in level Ib (0.5-1.5%). Retrospective studies have shown that the SMG can be preserved in OCSCC except in those where the primary tumour or level 1b nodes are in close vicinity to the gland. The goal of our prospective observational study was to evaluate the involvement of SMG in OCSCC. We had enrolled a total of 142 patients from July 2018 to May 2020 fulfilling the selection criteria and planned for appropriate surgery with removal of the SMG. The postoperative histopathology report was then assessed to look for the involvement of SMG. We observed majority patients in their 4th-5th decade with mean age of 49 years. Majority of the primary tumor were staged as pT2-T3. Out of 142 patients, 76 (53.52%) were node-negative (pN0) and 66 (46.48%) were node-positive (pN +). Level Ib lymph node involvement was seen in 65.15% of the pN + cases. We did not find SMG involvement in any of the cases either from direct extension of primary tumor or from level Ib lymph node extranodal spread. We conclude that SMG involvement is extremely rare in OCSCC. It is better to preserve the gland for which a prospective study is warranted to assess the functional benefits of preserving the gland.