Elective neck dissection in adenoid cystic carcinoma of head and neck: yes or no? A systematic review.
PURPOSE
Adenoid cystic carcinoma of head and neck (AdCCHN) is salivary gland malignancy known for its slow progression accompanied with perineural invasion, rare lymphatic spread to the neck, high rate of local recurrence and delayed onset of distant metastases. While local recurrence and distant metastases are most common patterns of relapse and cause of death in AdCCHN, it has been debated whether lymph node involvement affects the course of the disease. The aim of this systematic review was to address this important issue and to recommend guidelines on clinically node-negative neck management in patients with AdCCHN.


METHODS
A systematic review of the published literature on cases of elective neck dissection (END) among patients with AdCCHN was performed.


RESULTS
This analysis included a total of 5767 AdCCHN patients with 2450 ENDs, ranging from 10 to 1190. Elective lymphadenectomy was employed in 42.5% of patients with AdCCHN (range 9.2-100%). The overall rate of occult neck metastases in patients with AdCCHN was reported to range between 0 and 43.7%, the average being 13.9%.


CONCLUSIONS
If performed, END should be limited to levels I-III of the ipsilateral neck since occult metastases are exclusively located within these neck regions. Although END is associated with a prolonged regional recurrence-free period, it influence on final outcome or survival is still controversial. This review strongly supports conduction of prospective trials on indications, prognostic significance and extent of END in AdCCHN.
['Luksic|Ivica|I|http://orcid.org/0000-0002-9138-2037', 'Suton|Petar|P|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D003528:Carcinoma, Adenoid Cystic D017558:Elective Surgical Procedures D005260:Female D006258:Head and Neck Neoplasms D006801:Humans D008197:Lymph Node Excision D008207:Lymphatic Metastasis D008297:Male D008875:Middle Aged D037981:Neck Dissection D009364:Neoplasm Recurrence, Local D009367:Neoplasm Staging D011379:Prognosis D012468:Salivary Gland Neoplasms
Elective neck dissection Adenoid cystic carcinoma Recurrence Survival Head neck Occult neck metastasis