Elective neck dissection in patients with head and neck adenoid cystic carcinoma: an international collaborative study.

BACKGROUND: Adenoid cystic carcinoma (ACC) accounts for 3-5 % of all head and neck malignancies. Investigations of outcomes from elective neck dissection (END) for patients with ACC are sparse. This study aimed to assess the impact of END on the survival of patients with ACC. METHODS: This retrospective multicentered study investigated 270 patients who underwent neck dissection. A multivariate analysis assessed associations of clinical and histopathologic characteristics with survival outcomes. RESULTS: The primary tumor sites included the oral cavity in 250 patients (55 %), the major salivary glands in 133 patients (29 %), the sinonasal mucosa in 68 patients (15 %), and the larynx in six patients (1 %). The overall rate of occult nodal metastases among the patients who underwent END was 17 % (38/226). The highest incidence of occult nodal metastases was with the oral cavity (66 %). The 5-year overall survival (72 and 79 % for patients with or without END, respectively) and disease-specific survival (74 and 81 % for patients with or without END, respectively) were similar in the two groups. The subgroup analysis of patients according to the primary site showed no significant impact of END on outcome. In the multivariate analysis, primary site, T classification, and N classification were the only variables associated with outcome. CONCLUSIONS: The incidence of occult neck metastases among patients with ACC is 17 %. The highest incidence of occult metastases is with the oral cavity. Statistical analysis showed no survival advantage for patients who underwent END compared with those who did not.

Surgical management of metastases to the thyroid gland.

BACKGROUND: Metastases to the thyroid gland are uncommon, with rates reported between 0.02% and 1.4% of surgically resected thyroid specimens. Our goal was to present our experience with surgical management of metastases to the thyroid gland. METHODS: Twenty-one patients with metastatic disease to the thyroid were identified from a database of 1,992 patients with thyroid cancer who had surgery during 1986-2005. Patient, tumor, treatment, and outcome details were recorded by analysis of charts. The median age at time of surgery was 68 (range, 39-83) years; 12 were men and 9 were women. RESULTS: All patients were managed by surgery, including lobectomy in ten patients, total thyroidectomy in six, completion thyroidectomy in two, and subtotal thyroidectomy in one. In two patients, the thyroid lesion was found to be unresectable at the time of surgery. Histopathology revealed renal cell carcinoma in ten, malignant melanoma in three, gastrointestinal adenocarcinoma in three, breast cancer in one, sarcoma in one, and adenocarcinoma from an unknown primary site in three patients. Seventeen patients have died. The cause of death in all 17 was widespread metastatic disease from their respective primary tumors. The median survival from surgery to death or last follow-up was 26.5 (range, 2-114) months. CONCLUSIONS: In patients with metastases to the thyroid gland, local control of metastatic disease in the central compartment of the neck can be successfully achieved with minimal morbidity with surgical resection in selected patients.

Preoperative embolization in carotid body tumor surgery: is it required?

OBJECTIVES: We compared estimated blood loss (EBL) in patients who underwent surgical excision of carotid body tumors (CBTs) after preoperative superselective angiography with embolization (PSE) with that in patients who underwent excision of CBTs without PSE. METHODS: We performed a retrospective chart review of a consecutive case series in a single surgeon's practice within an academic tertiary care medical center. Twenty-five patients underwent surgical resection of a CBT from 1989 to 2009. From 1989 to 1996, 10 consecutive patients had PSE of the CBT, whereas the subsequent 15 patients (1996 to 2009) had no PSE. Demographic data including age, sex, and tumor size were collected. The EBL was obtained from intraoperative records and operative notes dictated at the time of surgery. Tumor size was based on preoperative radiographic measurements by a senior radiologist and the surgeon. RESULTS: In the 10 patients with PSE, the mean age was 41 years (range, 22 to 72 years) and the mean tumor size was 4.8 cm (range, 2.9 to 8.3 cm). The mean EBL was 305 mL (range, 50 to 1,000 mL); 2 patients had an EBL of more than 400 mL. In the 15 patients without PSE, the mean age was 43.7 years (range, 20 to 75 years) and the mean tumor size was 4.4 cm (range, 2.8 to 7.9 cm). The mean EBL was 265.6 mL (range, 40 to 900 mL); 2 patients had an EBL of more than 400 mL. There were no significant differences between the 2 groups with regard to age, tumor size, or EBL. CONCLUSIONS: Preoperative superselective angiography with embolization of a CBT does not lead to a significant reduction in intraoperative EBL.

Incidence of cervical lymph node metastasis and its association with outcomes in patients with adenoid cystic carcinoma. An international collaborative study.

BACKGROUND: The patterns of regional metastasis in adenoid cystic carcinoma (ACC) of the head and neck and its association with outcome is not established. METHODS: We conducted a retrospective multicentered multivariate analysis of 270 patients who underwent neck dissection. RESULTS: The incidence rate of neck metastases was 29%. The rate observed in the oral cavity is 37%, and in the major salivary glands is 19% (p = .001). The rate of occult nodal metastases was 17%. Overall 5-year survival rates were 44% in patients undergoing therapeutic neck dissections, and 65% and 73% among those undergoing elective neck dissections, with and without nodal metastases, respectively (p = .017). Multivariate analysis revealed that the primary site, nodal classification, and margin status were independent predictors of survival. CONCLUSION: Our findings support the consideration of elective neck treatment in patients with ACC of the oral cavity.