This paper from Stanford University presents impressive figures to guide the debate on the extent of surgical management in adenoid cystic disease. Adenoid cystic carcinomas present a particular problem in that they can recur even after 20 years. They have potential for perineural spread and, as highlighted in this paper, nodal metastases are not uncommon and have a significant effect on survival. The UK Guidelines published in 2016 advocate neck dissection in patients with preoperatively identified nodal disease from parotid malignancies, and recommend postoperative radiotherapy for all adenoid cystic carcinomas. Having a data set of 720 major salivary gland adenoid cystic carcinomas showing a difference in disease-free survival of 41.7% vs 89.6% depending on the presence of metastases certainly attracts our attention. The results presented here suggest that more aggressive management, particularly in T3/T4 tumours, may be worthwhile. The one note of caution, as was rightly commented on, is that there may be no survival advantage in elective neck dissection. If postoperative radiotherapy is routine, will this control any microscopic neck disease as successfully as a neck dissection? This will certainly add to the MDT discussion and hopefully further research will be in the offing.

Risk of nodal metastasis in major salivary gland adenoid cystic carcinoma.
Megwalu UC, Sirjani D.
OTOLARYNGOLOGY – HEAD AND NECK SURGERY
2017;156(4):660-4.
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Stuart Burrows

Norfolk and Norwich University Hospital, UK.

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