Abstract
BackgroundThe feasibility of submandibular gland (SMG) preservation in oral squamous cell carcinoma (SCC) has occasionally been analyzed, but the differences in survival associated with the presence or absence of SMG preservation remain unknown. We aimed to prospectively evaluate the oncologic results of SMG preservation in cT1-2 N0 buccal SCC.MethodsThis was a prospective, non-randomized cohort study. Patients with surgically treated cT1-2 N0 buccal SCC were prospectively enrolled and divided into two groups based on the management of the SMG. Level 1b lymph nodes were categorized into six groups based on the positional relationship between the lymph node and the SMG. The main study endpoints were locoregional control (LRC) and disease-specific survival (DSS).ResultsA total of 31 of the 137 included patients underwent SMG-sparing neck dissection. Patients with SMG preservation were likely to be young persons. Superior metastasis occurred in 11 patients with a prevalence of 8.0%, followed by an anterior metastasis rate of 5.1%, and no metastases developed deeply or within the SMG. The 5-year LRC rates in the SMG-sparing and SMG-excision groups were 74 and 75%, respectively, and the difference was not significant (p = 0.970). The 5-year DSS rates in the SMG-sparing and SMG-excision groups were 74 and 69%, respectively, and the difference was not significant (p = 0.709).ConclusionsSMG involvement was rare, and the superior group carried the highest risk for lymph node metastasis. SMG-sparing neck dissection is selectively suggested in cT1-2 N0 buccal SCC patients, and could avoid postoperative asymmetric appearance and dry mouth.
Highlights
The feasibility of submandibular gland (SMG) preservation in oral squamous cell carcinoma (SCC) has occasionally been analyzed, but the differences in survival associated with the presence or absence of SMG preservation remain unknown
Considering the important function of the SMG, which is responsible for 70% of unstimulated saliva production, current evidence has explored the feasibility of SMG preservation in cT1-2 N0 oral SCC [9,10,11,12,13,14,15,16,17,18,19,20,21]
To the best of our knowledge, this is the first prospective evidence that supports the reliability of SMG preservation in cT1-2 N0 buccal SCC; these findings alleviate the concerns regarding the possible decreased disease control caused by SMG preservation and improve patients’ postoperative quality of life including avoidance of asymmetric appearance and decreased possibility of dry mouth
Summary
The feasibility of submandibular gland (SMG) preservation in oral squamous cell carcinoma (SCC) has occasionally been analyzed, but the differences in survival associated with the presence or absence of SMG preservation remain unknown. Buccal squamous cell carcinoma (SCC) is the second most common malignancy of the oral cavity in China [1]; surgical excision is the main treatment, and neck dissection is an important part of surgery even for earlystage (cT1-2 N0) disease, owing to the lack of an anatomic barrier and the relatively high cervical metastatic rate [2,3,4]. Very few authors have demonstrated a survival difference associated with the presence or absence of SMG preservation [22, 23], which represents the most important evidence
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