Management of the neck in parotid carcinoma

Management of the clinically negative neck remains a controversial issue in patients with carcinoma of the parotid gland. Our treatment policy has always been conservative, reserving lymphadenectomy for selected patients.

We retrospectively evaluated 121 patients with malignant tumors of the parotid gland who received their definitive treatment at the Memorial Sloan-Kettering Cancer Center between 1966 and 1988.

A total of 35 neck dissections (ND) were performed, 14 of which involved removal of clinically positive nodes (radical in 10, modified in 2, and limited in 3). Twenty-one patients had an elective lymphadenectomy (radical in 14, modified in 2, and limited in 4), usually because of ominous histology or high T stage. In addition to histologically positive regional lymph nodes, facial nerve paralysis, gender, and advanced stage, the decision to perform a ND, whether elective or therapeutic, was significantly predictive of decreased survival (P < 0.001). In the majority of patients (86, or 65%), the neck was observed rather than treated electively, with no impact on overall survival. Only 4 of 121 patients developed neck recurrence following treatment, including 3 who had neck dissection as part of their initial management.

These data support our policy of reserving elective ND only for those histologic diagnoses that carry the highest risk of nodal metastases, as well as for selected patients whose primary tumor resection might be facilitated by lymphadenectomy.