Incidence and spread pattern of lymph node metastasis from submandibular gland cancer

Q: What was the main objective regarding neck dissection in this study?

To clarify the indication for neck dissection for patients with submandibular gland cancer.

Q: How many patients underwent neck dissection, and why were some excluded?

Forty-one of 43 patients underwent neck dissection; two did not because preoperative diagnoses were benign.

Sep 24, 2026

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Objectives To define indications for neck dissection (ND) in patients with submandibular gland (SMG) cancer. Methods Retrospective analysis of 43 patients with histologically confirmed SMG cancer: 41 underwent ND with different cervical level selections (Levels I–V, I–III, and Level Ib), while two did not undergo ND because preoperative findings suggested benign disease. Postoperative radiotherapy was administered to 19 patients with positive surgical margins, high-grade tumors, or stage IV disease. Results Lymph node metastases were pathologically confirmed in all cN+ patients and in 6 of 31 cN− patients, with no regional recurrence during follow-up. Final confirmation was 17/27 in high-grade, 1/9 in intermediate-grade, and none in 7 low-grade cases. Conclusions Prophylactic neck dissection should be considered for T3/4 and high-grade SMG cancers.

LanguageEnglish

CategoryResearch & Report

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Pages6

Reading Time15 min

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Abstract

Introduction

Materials and methods

Patients

Clinical features and pathology

Results

Conclusions

European Archives of Oto-Rhino-Laryngology (2023) 280:4233–4238 [https://doi.org/10.1007/s00405-023-08020-x](https://doi.org/10.1007/s00405-023-08020-x) Incidence and spread pattern of lymph node metastasis from submandibular gland cancer Kotaro Tamagawa1 · Naoki Otsuki1,2 · Hikari Shimoda1 · Naruhiko Morita1 · Tatsuya Furukawa1 · Masanori Teshima1 · Hirotaka Shinomiya1 · Ken‑ichi Nibu1 Received: 10 October 2022 / Accepted: 8 May 2023 / Published online: 22 May 2023 © The Author(s) 2023 Abstract Objectives To clarify the indication of neck dissection (ND) for patient with submandibular gland (SMG) cancer. Methods A total of 43 patients with SMG cancer were retrospectively analyzed. Forty-one patients underwent ND: Levels I–V in 19 patients, Levels I–III in 18 patients, and Level Ib in 4 patients. The other two patients did not undergo ND, since preoperative diagnoses were benign. Postoperative radiotherapy was performed in 19 patients with positive surgical margin, high grade cancer or stage IV disease. Results LN metastases were pathologically confirmed in all patients with cN + and 6 out of 31 patients with cN–. No patients developed regional recurrence during follow-up periods. Ultimately, LN metastases were pathologically confirmed in 17 of 27 high grade, one out of 9 intermediate grade, but not in 7 low grade. Conclusions Prophylactic neck dissection should be considered in T3/4 and high grade SMG cancers. Keywords Submandibular gland cancer · Cervical lymph node · Neck dissection · Occults metastasis Introduction Salivary gland cancers represent about 6% of all head and neck malignant neoplasms, comprising various pathological types with differing biological behavior [1] . About 10% of all salivary gland neoplasms arise in SMG and 30–50% of them were malignant [2, 3] . Radical resection followed by postoperative radiotherapy is a mainstay treatment for patients with high-risk features (advanced clinical T stage, pathological high grade, or a positive or close surgical margin) to improve loco-regional control [2 , 3] . Metastasis to cervical lymph nodes (LN) has been reported as a major prognostic factor for patients with SMG cancer [4] . Reported rate of occult LN metastasis in submandibular * Naoki Otsuki [naokies@med.kobe-u.ac.jp](naokies@med.kobe-u.ac.jp) 1 Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo 650-0017, Japan 2 Present Address: Department of Otolaryngology-Head and Neck Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264, Kamiya-Cho, Himeji, Hyogo 670-8560, Japan cancers ranged from 15 to 48% and high-grade histological type and advanced clinical stage have been reported to be associated with nodal disease [5, 6] . However, indicationsand extents of neck dissection (ND) for SMG cancer have not been well-defined due to its low incidence. The aim of this study was to clarify the risk factors of LN metastasis and identify appropriate indication and extent of neck dissection in individual patients with SMG cancers. Materials and methods Patients Medical records of 43 patients who had radical resection of histologically confirmed SMG cancer between January 1994 and December 2018 were retrospectively reviewed. Two patients with lung metastasis at the time of initial diagnosis were included in this analysis, since lung metastases were small and we considered that loco-regional control by surgical resection would improve the quality of life of these patients. The clinical characteristics of 43 patients are outlined in Table 1. The median age was 68 years ranging from 18 to 93 years. The pathological grade was classified Table 1 Clinical features of the 43 patients | Clinical features | n | (%) | | --- | --- | --- | | Gender | | | | Male | 25 | (58) | | Female | 18 | (42) | | Age (years) | | | | < 65 | 16 | (37) | | ≧65 | 27 | (63) | | Clinical T | | | | T1 |

FAQs

What was the main objective regarding neck dissection in this study?

To clarify the indication for neck dissection for patients with submandibular gland cancer.

How many patients underwent neck dissection, and why were some excluded?

Forty-one of 43 patients underwent neck dissection; two did not because preoperative diagnoses were benign.

Which patient groups did the study recommend for prophylactic neck dissection?

Prophylactic neck dissection should be considered for T3/4 and high-grade submandibular gland cancers.

Sep 24, 2026

Upload by Aria Callaghan