Rate of Occult Neck Nodal Metastasis in Parotid Cancer: A Meta-Analysis
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REVIEW ARTICLE – HEAD AND NECK ONCOLOGY
Rate of Occult Neck Nodal Metastasis in Parotid Cancer: A MetaAnalysis Anton Warshavsky, MD, Roni Rosen, MD, Nidal Muhanna, MD, PhD, Omer Ungar, MD, Narin Nard-Carmel, MD, MSc, Avraham Abergel, MD, Dan M. Fliss, MD, and Gilad Horowitz, MD Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated With the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
ABSTRACT Background. The risk for occult neck nodal metastasis in carcinoma of the parotid gland is inconclusive. Therefore, addressing a negative neck prophylactically and the extent to do so remain controversial. This systematic review aimed to determine the rate of occult nodal metastasis for each neck level, and consequently, to elucidate the proper extent of elective neck dissection (END). Methods. A meta-analysis of all studies that included patients with a diagnosis of parotid malignancies who underwent an END was performed. The risk for occult nodal metastasis was calculated for each neck level separately. Results. The search strategy identified 124 papers from January 1980 to December 2019 in the various databases. Nine retrospective studies (n =548) met the inclusion criteria. The risk for occult neck nodal metastasis ranged from 0.0 to 9.43% with a random-effect model of 2.2% for level 1 (n =459), from 3.4 to 28.38% with a random-effect model of 16.51% for level 2 (n =548), from 0.0 to 21.63% with a random-effect model of 4.23% for level 3 (n =518), from 0.0 to 17.02% with a fixed-effect model of 0.39% for level 4 (n =310), and from 0.0 to 11.63% with a fixedeffect model of 1.7% for level 5 (n =417).
Conclusion. The rate of occult neck nodal metastasis in parotid malignancies is low, with neck level 2 the most commonly involved. The results of this meta-analysis prevented the authors from substantiating the appropriate extent of an END in parotid cancer.
Treatment of the node-negative neck in carcinoma of the parotid gland remains controversial.1 The controversies concern the dilemma of whether to address the neck prophylactically or not, and if so, to what extent.2 Previous publications have recommended elective neck dissection (END) according to certain tumor characteristics such as histology, grade, and stage.3 Unfortunately, these features are not always apparent before surgery.4 In deciding whether to treat the neck prophylactically, the actual levels at risk in parotid cancer are somewhat vague.5 The parotid is the only salivary gland with two nodal layers, both of which drain into the superficial and deep cervical lymphatic systems.6 Studies on therapeutic neck dissections in parotid cancer have demonstrated extensive nodal involvement whereupon comprehensive neck dissections (i.e. levels 1–5) should be performed.7 In contrast, the rate of occult nodal metastasis in a clinically negative neck is poorly defined, and consequently, so also is the extent of END. This study aimed to determine the rate of occult nodal metastasis f
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