Unreliable follow-up: With patients with malignant tumours and unlikely to attend regular follow-up to detect early recurrence or metastases, electively treat Levels Ia,b, IIa and III of the neck by surgery (preferably) or radiation therapy
Unavailability of postoperative radiation therapy (PORT)
- Most patients with salivary malignancy receive PORT (Indications for PORT)
- Not having PORT to treat residual microscopic cancer or nodal metastases has the following surgical implications:
- Consider resecting nerves adherent to a malignant tumour
- Elective neck dissection Levels Ia,b, IIa and III for malignancies
- Consider who not to offer surgery for advanced tumours when outcomes without PORT will be poor
Palliative surgery
- Patients often present with advanced cancers that might either be treated with surgery and PORT, or palliated with radiation therapy
- In the absence of radiation, it raises the issue of surgical palliation for incurable salivary cancers to improve quality of life
- Some patients with adenoid cystic carcinoma with lung and bone metastases at presentation may survive some years (van Weert S, et al. Adenoid cystic carcinoma of the head and neck: A single-center analysis of 105 consecutive cases over a 30-year period. Oral Oncol. 2013 Aug;49(8):824-9)
Hence “palliative surgery” can be recommended for selected patients
Index: Clinical Practice Guidelines for Submandibular Gland
Resource Appropriate Submandibular Gland Guideline Scenarios
African Head & Neck Society (AfHNS) Clinical Practice Guidelines for Head & Neck Cancers in Developing Countries and Limited Resource Settings 