Management of the Clinically Node-Negative Neck in Intermediate-Grade Mucoepidermoid Carcinoma of the Head and Neck:...

Management of the clinically node-negative (cN0) neck in intermediate-grade mucoepidermoid carcinoma (MEC) of the head and neck remains controversial.

We retrospectively reviewed patients with cN0 intermediate-grade MEC treated between 2008 and 2025. Patients underwent observation or elective neck treatment, including elective neck dissection and/or radiotherapy. Survival outcomes were analyzed using Kaplan-Meier methods and Cox proportional hazards models.

Sixty patients were included (27 observation, 33 elective treatment). After a median follow-up of 53 months, regional recurrence occurred in three patients in the observation group and in none receiving elective treatment. Five-year regional recurrence-free survival, disease-free survival, and disease-specific survival were high in both groups, without significant differences. Perineural invasion was associated with worse disease-free survival.

In cN0 intermediate-grade MEC, regional control outcomes were favorable, and a statistically significant benefit of elective neck treatment was not demonstrated in this cohort. For carefully selected patients without adverse clinicopathologic features, close observation of the neck may be a reasonable strategy. These findings should be interpreted cautiously given the limited sample size and low event rate.