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Meta-Analysis
. 2023 Sep;280(9):4205-4214.
doi: 10.1007/s00405-023-08007-8. Epub 2023 Jun 6.

Submandibular gland involvement in oral cavity squamous cell carcinoma: a retrospective multicenter study

Oreste Iocca  1 , Chiara Copelli  2 , Paolo Garzino-Demo  3 , Guglielmo Ramieri  3 , Stefano Rubattino  3 , Luca Sedran  3 , Fabio Volpe  3 , Alfonso Manfuso  4 , Francesco Longo  4 , Gregorio Sanchez-Aniceto  5 , Álvaro Rivero-Calle  5 , Aitor García-Sánchez  6 , Raul Pellini  7 , Gerardo Petruzzi  7 , Silvia Moretto  7 , Laith Al-Qamachi  8 , Hiba Aga  8 , Stephen Ridley  8 , Pasquale Di Maio  9
Affiliations
Meta-Analysis

Submandibular gland involvement in oral cavity squamous cell carcinoma: a retrospective multicenter study

Oreste Iocca et al. Eur Arch Otorhinolaryngol. 2023 Sep.

Abstract

Background: The submandibular gland (SMG) is routinely excised during neck dissection. Given the importance of the SMG in saliva production, it is important to understand its involvement rate by cancer tissue and the feasibility of its preservation.

Methods: Retrospective data were collected from five academic centers in Europe. The study involved adult patients affected by primary oral cavity carcinoma (OCC) undergoing tumor excision and neck dissection. The main outcome analyzed was the SMG involvement rate. A systematic review and a meta-analysis were also conducted to provide an updated synthesis of the topic.

Results: A total of 642 patients were enrolled. The SMG involvement rate was 12/642 (1.9%; 95% CI 1.0-3.2) when considered per patient, and 12/852 (1.4%; 95% CI 0.6-2.1) when considered per gland. All the glands involved were ipsilateral to the tumor. Statistical analysis showed that predictive factors for gland invasion were: advanced pT status, advanced nodal involvement, presence of extracapsular spread and perivascular invasion. The involvement of level I lymph nodes was associated with gland invasion in 9 out of 12 cases. pN0 cases were correlated with a reduced risk of SMG involvement. The review of the literature and the meta-analysis confirmed the rare involvement of the SMG: on the 4458 patients and 5037 glands analyzed, the involvement rate was 1.8% (99% CI 1.1-2.7) and 1.6% (99% CI 1.0-2.4), respectively.

Conclusions: The incidence of SMG involvement in primary OCC is rare. Therefore, exploring gland preservation as an option in selected cases would be reasonable. Future prospective studies are needed to investigate the oncological safety and the real impact on quality of life of SMG preservation.

Keywords: Head and neck cancer; Meta-analysis; Neck dissection; Oral cancer; Oral squamous cell carcinoma; Submandibular gland; Submandibular gland invasion; Systematic review.

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Conflict of interest statement

No conflict of interest to disclose.

Figures

Fig. 1
Fig. 1
Forest plot showing the cumulative rate of SMG involvement per patient
Fig. 2
Fig. 2
Forest plot showing the cumulative rate of SMG involvement per gland
See this image and copyright information in PMC

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