In patients with resectable submandibular gland carcinoma and clinically or radiologically confirmed cervical lymph node involvement, a specific multi-modality approach is recommended. The extent of disease in the cervical lymph nodes shapes both the surgical and post-operative management plan.
Cervical lymph node metastases in submandibular gland carcinoma may span multiple levels, with positive nodes most commonly found at level I, followed by levels II and III. However, involvement can extend further, with skip metastases documented across all levels — including levels IV and V — at rates that directly inform the required surgical scope.
The recommended approach for cN+ resectable submandibular gland cancer involves comprehensive surgical neck dissection combined with post-operative radiotherapy. The precise extent of dissection, the radiation fields, and the specific dosing strategy vary by pathological findings.
Complete dissection levels, fractionation parameters, and dose specifications are available in the full protocol below.
DOI: 10.1016/j.esmoop.2022.100602
Positive lymph nodes are often found in level I followed by levels II and III, although all lymph nodes can be involved with the possibility for skip metastases in levels IV and V.
Some series have even shown positive lymph node involvement of 40% and 25% in levels IV and V, respectively, warranting a level I-V neck dissection for submandibular gland carcinomas with cN+ disease.
Patients with positive lymph nodes (clinical or radiological) should undergo a comprehensive lymph node dissection involving levels I-V [IV, A].
Post-operative RT is indicated for all cases of pN+ neck.
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