European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 11, pp 2957–2962 | Cite as

Elective neck dissection in adenoid cystic carcinoma of head and neck: yes or no? A systematic review

  • Ivica LuksicEmail author
  • Petar Suton
Review Article



Adenoid cystic carcinoma of head and neck (AdCCHN) is salivary gland malignancy known for its slow progression accompanied with perineural invasion, rare lymphatic spread to the neck, high rate of local recurrence and delayed onset of distant metastases. While local recurrence and distant metastases are most common patterns of relapse and cause of death in AdCCHN, it has been debated whether lymph node involvement affects the course of the disease. The aim of this systematic review was to address this important issue and to recommend guidelines on clinically node-negative neck management in patients with AdCCHN.


A systematic review of the published literature on cases of elective neck dissection (END) among patients with AdCCHN was performed.


This analysis included a total of 5767 AdCCHN patients with 2450 ENDs, ranging from 10 to 1190. Elective lymphadenectomy was employed in 42.5% of patients with AdCCHN (range 9.2–100%). The overall rate of occult neck metastases in patients with AdCCHN was reported to range between 0 and 43.7%, the average being 13.9%.


If performed, END should be limited to levels I–III of the ipsilateral neck since occult metastases are exclusively located within these neck regions. Although END is associated with a prolonged regional recurrence-free period, it influence on final outcome or survival is still controversial. This review strongly supports conduction of prospective trials on indications, prognostic significance and extent of END in AdCCHN.


Head neck Adenoid cystic carcinoma Elective neck dissection Occult neck metastasis Survival Recurrence 


Compliance with ethical standards

Research involving human participants and/or animals

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

This is a systematic review on retrospective studies which were conducted on already available data for which formal consent was obtained. Therefore, institutional ethical approval is not required according on the law and the national ethical guidelines.

Informed consent

Informed consent was not obtained from individual participants due the fact that this review included retrospective studies for which formal consent was obtained.


  1. 1.
    Ellis GL, Auclair PL (1996) Atlas of tumor pathology: tumors of the salivary glands. Third series fascicles 17. Armed Forces Institute of Pathology, Washington, DC, pp 203–216Google Scholar
  2. 2.
    Chaudhry AP, Leifer C, Cutler LS, Satchidanand S, Labay GR, Yamane GM (1986) Histogenesis of adenoid cystic carcinoma of the salivary glands: light and electronmicroscopic study. Cancer 1:72–82CrossRefGoogle Scholar
  3. 3.
    Spiro RH, Huvos AG, Strong EW (1974) Adenoid cystic carcinoma of salivary origin: a clinicopathologic study of 242 cases. Am J Surg 128:512–520CrossRefGoogle Scholar
  4. 4.
    Spiro RH (1986) Salivary neoplasms: overview of a 35-year experience with 2,807 patients. Head Neck Surg 8:177–184CrossRefGoogle Scholar
  5. 5.
    Spiro RH (1997) Distant metastasis in adenoid cystic carcinoma of salivary origin. Am J Surg 174:495–498CrossRefGoogle Scholar
  6. 6.
    Agarwal JP, Jain S, Gupta T, Tiwari M, Laskar SG, Dinshaw KA, Chaturvedi P, D’cruz AK, Shrivastava SK (2008) Intraoral adenoid cystic carcinoma: prognostic factors and outcome. Oral Oncol 44:986–993CrossRefGoogle Scholar
  7. 7.
    Ali S, Palmer FL, Katabi N, Lee N, Shah JP, Patel SG, Ganly I (2017) Long-term local control rates of patients with adenoid cystic carcinoma of the head and neck managed by surgery and postoperative radiation. Laryngoscope 127:2265–2269CrossRefGoogle Scholar
  8. 8.
    Amit M, Binenbaum Y, Sharma K, Ramer N, Ramer I, Agbetoba A, Miles B, Yang X, Lei D, Bjoerndal K, Godballe C, Mücke T, Wolff KD, Fliss D, Eckardt AM, Copelli C, Sesenna E, Palmer F, Patel S, Gil Z (2013) Adenoid cystic carcinoma of the nasal cavity and paranasal sinuses: a meta-analysis. J Neurol Surg B Skull Base 74:118–125CrossRefGoogle Scholar
  9. 9.
    Amit M, Na'ara S, Sharma K (2015) Elective neck dissection in patients with head and neck adenoid cystic carcinoma: an international collaborative study. Ann Surg Oncol 22:1353–1359CrossRefGoogle Scholar
  10. 10.
    Balamucki CJ, Amdur RJ, Werning JW, Vaysberg M, Morris CG, Kirwan JM, Mendenhall WM (2012) Adenoid cystic carcinoma of the head and neck. Am J Otolaryngol 33:510–518CrossRefGoogle Scholar
  11. 11.
    Bhayani MK, Yener M, El-Naggar A (2012) Prognosis and risk factors for early-stage adenoid cystic carcinoma of the major salivary glands. Cancer 118:2872–2878CrossRefGoogle Scholar
  12. 12.
    Cohen AN, Damrose EJ, Huang RY, Nelson SD, Blackwell KE, Calcaterra TC (2004) Adenoid cystic carcinoma of the submandibular gland: a 35-year review. Otolaryngol Head Neck Surg 131:994–1000CrossRefGoogle Scholar
  13. 13.
    Cordesmeyer R, Kauffmann P, Laskawi R, Rau A, Bremmer F (2018) The incidence of occult metastasis and the status of elective neck dissection in salivary adenoid cystic carcinoma: a single center study. Oral Surg Oral Med Oral Pathol Oral Radiol 125:516–519CrossRefGoogle Scholar
  14. 14.
    Garden AS, Weber RS, Morrison WH, Ang KK, Peters LJ (1995) The influence of positive margins and nerve invasion in adenoid cystic carcinoma of the head and neck treated with surgery and radiation. Int J Radiat Oncol Biol Phys 32:619–626CrossRefGoogle Scholar
  15. 15.
    Iyer NG, Kim L, Nixon IJ, Palmer F, Kraus D, Shaha AR, Shah JP, Patel SG, Ganly I (2010) Factors predicting outcome in malignant minor salivary gland tumors of the oropharynx. Arch Otolaryngol Head Neck Surg 136:1240–1247CrossRefGoogle Scholar
  16. 16.
    Lee SY, Shin HA, Rho KJ, Chung HJ, Kim SH, Choi EC (2013) Characteristics, management of the neck, and oncological outcomes of malignant minor salivary gland tumours in the oral and sinonasal regions. Br J Oral Maxillofac Surg 51:e142–e147CrossRefGoogle Scholar
  17. 17.
    Lee SY, Kim BH, Choi EC (2014) Nineteen-year oncologic outcomes and the benefit of elective neck dissection in salivary gland adenoid cystic carcinoma. Head Neck 36:1796–1801CrossRefGoogle Scholar
  18. 18.
    Luksic I, Baranovic S, Suton P, Gerbl D (2016) Adenoid cystic carcinoma of the head and neck: a single-institution's analysis of 45 consecutive cases over a 29-year period. Oral Surg Oral Med Oral Pathol Oral Radiol 122:152–157CrossRefGoogle Scholar
  19. 19.
    Nobis CP, Rohleder NH, Wolff KD, Wagenpfeil S, Scherer EQ, Kesting MR (2014) Head and neck salivary gland carcinomas—elective neck dissection, yes or no? J Oral Maxillofac Surg 72:205–210CrossRefGoogle Scholar
  20. 20.
    Qian ZJ, Chen MM, Divi V, Megwalu UC (2019) Impact of lymph node sampling on survival in cN0 major salivary gland adenoid cystic carcinoma. Head Neck 41:1903–1907CrossRefGoogle Scholar
  21. 21.
    Stenner M, Molls C, Luers JC, Beutner D, Klussmann JP, Huettenbrink KB (2012) Occurrence of lymph node metastasis in early-stage parotid gland cancer. Eur Arch Otorhinolaryngol 269:643–648CrossRefGoogle Scholar
  22. 22.
    Wang YL, Li DS, Gan HL, Lu ZW, Li H, Zhu GP, Huang CP, Zhu YX, Chen TZ, Wang Y, Sun GH, Wang ZY, Shen Q, Wu Y, Ji QH (2012) Predictive index for lymph node management of major salivary gland cancer. Laryngoscope 122:1497–1506CrossRefGoogle Scholar
  23. 23.
    Xiao R, Sethi RKV, Feng AL, Fontanarosa JB, Deschler DG (2019) The role of elective neck dissection in patients with adenoid cystic carcinoma of the head and neck. Laryngoscope 129:2094–2104CrossRefGoogle Scholar
  24. 24.
    Ning C, Zhao T, Wang Z, Li D, Kou Y, Huang S (2018) Cervical lymph node metastases in salivary gland adenoid cystic carcinoma: a systematic review and meta-analysis. Cancer Manag Res 10:1677–1685CrossRefGoogle Scholar
  25. 25.
    Cheuk W, Chan JK, Ngan RK (1999) Dedifferentiation in adenoid cystic carcinoma of salivary gland: an uncommon complication associated with an accelerated clinical course. Am J Surg Pathol 23:465–472CrossRefGoogle Scholar
  26. 26.
    Seethala RR, Hunt JL, Baloch ZW, Livolsi VA, Leon Barnes E (2007) Adenoid cystic carcinoma with high-grade transformation: a report of 11 cases and a review of the literature. Am J Surg Pathol 31:1683–1694CrossRefGoogle Scholar
  27. 27.
    Hellquist H, Skálová A, Barnes L, Cardesa A, Thompson LD, Triantafyllou A, Williams MD (2016) Cervical lymph node metastasis in high-grade transformation of head and neck adenoid cystic carcinoma: a collective international review. Adv Ther 33:357–368CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Maxillofacial SurgeryUniversity Hospital Dubrava, University of Zagreb School of MedicineZagrebCroatia
  2. 2.Department of Radiotherapy and Medical OncologyUniversity Hospital for Tumours, University Hospital Center “Sisters of Mercy”ZagrebCroatia

Personalised recommendations