Treatment of Submandibular Gland Cancer: Resectable, Low-Grade Histology, Intraglandular Tumour with Clinically Node-Negative Neck (cN0)
This protocol applies to patients with submandibular gland cancer that is resectable, confined entirely within the submandibular gland (intraglandular), carries proven low-grade histology, and presents with a clinically node-negative neck (cN0).
Clinical Scenario
When submandibular gland cancer is completely intraglandular and low-grade histology is confirmed preoperatively, with no clinical evidence of cervical nodal involvement, evidence supports that a more limited surgical approach to the neck may be sufficient — distinct from the broader selective neck dissection (levels I–III) that would otherwise be indicated.
For completely intraglandular tumours where high-grade histology can be confidently excluded preoperatively, a targeted regional resection may suffice.
Surgical Approach
The recommended intervention centres on resection of the submandibular gland and the immediately surrounding regional lymph nodes. The complete evidence-based algorithm — including the precise extent of resection and all decision criteria — is available in the full structured regimen.
References
DOI: 10.1016/j.esmoop.2022.100602
Including the gland in a selective neck dissection involving levels I, II and III is indicated, unless the tumour is intraglandular and if low-grade histology is proven (in which case resection of the gland and level Ib lymph nodes may suffice) [IV, B].
For completely intraglandular tumours, if preoperatively certain to not be high grade, resection of the gland and the surrounding level Ib lymph nodes may suffice.
Tumours confined within the submandibular gland require resection of the gland and the surrounding level Ib lymph nodes to ensure negative margins.
Malignant tumours confined within the submandibular gland require at least resection of the gland and the surrounding level Ib lymph nodes [IV, A].
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