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Related Experiment Video

Updated: Jan 7, 2026

Lateral Molar Approach-Driven Transoral Endoscopic Procedure for Benign Infratemporal Fossa Tumor Resection
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Neck Management in Malignant Parotid Tumors: A Retrospective Analysis of Elective Neck Dissection Indications and

Andrea Battisti1, Giulio Pagnani1, Giulia Scivoletto1

  • 1Department of Odontostomatological and Maxillofacial Sciences, Sapienza University, 00185 Rome, Italy.

Diagnostics (Basel, Switzerland)
|December 30, 2025
PubMed
Summary

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Management of the clinically negative neck in malignant parotid tumors is debated. Elective neck dissection (END) did not improve disease-free survival (DFS) over observation in cN0 patients, but high-risk factors warrant a tailored approach.

Area of Science:

  • Head and Neck Surgery
  • Surgical Oncology
  • Otolaryngology

Background:

  • The optimal management strategy for the clinically negative neck (cN0) in patients with malignant parotid tumors remains controversial.
  • Predicting occult nodal metastasis is crucial for guiding treatment decisions in these patients.

Purpose of the Study:

  • To identify clinicopathologic predictors of nodal involvement in malignant parotid tumors.
  • To evaluate the impact of elective neck dissection (END) versus observation on disease-free survival (DFS) in cN0 patients.

Main Methods:

  • Retrospective cohort study of 74 adult patients with malignant parotid tumors and ≥24 months follow-up.
  • Analysis included demographics, tumor characteristics (T category, grade), neck management (END, therapeutic neck dissection, observation), and outcomes.
Keywords:
head and neck oncologyintraparotid lymph nodeslymphatic metastasisneck dissectionparotid neoplasms

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  • Statistical methods included Fisher's exact tests, Kaplan-Meier curves, log-rank tests, and a multivariable Cox proportional hazards model.

    • Main Results:

    • Overall pathologic nodal positivity (pN+) was 18.9%. T3-T4 tumors showed significantly higher odds of nodal metastasis compared to T1-T2 tumors.
    • Among cN0 patients, the occult metastasis rate was 17.6%, with all high-grade tumors undergoing END being pathologically positive for nodal metastasis (pN+).
    • Disease-free survival (DFS) did not differ significantly between cN0 patients managed with END versus observation. However, pN+ patients had significantly worse DFS than pN0 patients.

    Conclusions:

    • Higher tumor T category and high/intermediate histologic grade are strong predictors of nodal involvement.
    • Pathologic nodal positivity (pN+) is associated with worse DFS.
    • While END did not demonstrate a DFS advantage in cN0 patients, the rate of occult metastasis, particularly in high-grade disease, supports a risk-adapted END strategy and intraoperative assessment of intraparotid nodes.