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Peraza LR, Wallerius KP, Bowen AJ, Hernandez-Herrera GA, O'Byrne TJ, Aden AA, Bayan SL, Wong Kee Song LM, Ekbom DC. Effect of tobacco use on Zenker's diverticulotomy outcomes. Am J Otolaryngol 2024; 45:104261. [PMID: 38574513 DOI: 10.1016/j.amjoto.2024.104261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/17/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To compare clinical outcomes in patients with and without history of tobacco use who underwent Zenker's diverticulotomy (ZD). STUDY DESIGN Single institution retrospective review. SETTING Tertiary care academic hospital. METHODS A retrospective review of patients who underwent ZD via an open stapler, rigid endoscopic CO2 laser, stapler or harmonic scalpel, and flexible endoscopic technique from January 2006 to December 2020 was performed. Data were abstracted for patient demographics, diverticular features, and rates of adverse events and symptomatic recurrence. RESULTS Out of 424 patients, 146 (34.4 %) had a history of tobacco use: 126 (29.7 %) were former smokers, and 20 (4.7 %) were active smokers. In univariable cross-sectional analyses, the likelihood of postoperative bleeding, perforation, emergency department visits, unplanned readmission, or recurrence did not demonstrate an association with tobacco use history even after adjustment for age, sex, and surgical approach. Similarly, in Cox Proportional Hazards regression, tobacco use was not associated with an increased risk of recurrence, even after correcting for age, sex, and type of surgery. The median time to recurrence observed in our cohort was 11.5 years amongst non-smokers, 8.7 years amongst former smokers, and 1.2 years amongst active smokers (p = 0.94). CONCLUSIONS There were no significant differences in post-operative adverse events or frequency of recurrence of ZD between active, former, and non-smokers. Although underpowered and not statistically significant, median time to recurrence appears to be shorter in smokers when compared with former and non-smokers following surgery.
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Affiliation(s)
- Lazaro R Peraza
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
| | | | - Andrew J Bowen
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - Thomas J O'Byrne
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Aisha A Aden
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Semirra L Bayan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Dale C Ekbom
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
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Aden AA, Olawuni FO, Abdel-Halim CN, Zhu AQ, Haller TJ, O'Byrne TJ, Moore EJ, Price DL, Tasche KL, Ma DJ, Lester SC, Gamez M, Neben-Wittich MA, Price K, Fuentes-Bayne HE, Routman D, Van Abel KM. Association Between Social Determinants of Health, Distance from Treatment Center, and Treatment Type with Outcomes in Human Papillomavirus Associated Oropharyngeal cancer. Oral Oncol 2024; 149:106675. [PMID: 38211528 DOI: 10.1016/j.oraloncology.2023.106675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVES Social determinants of health (SDOH) can influence access to cancer care, clinical trials, and oncologic outcomes. We investigated the association between SDOH, distance from treatment center, and treatment type with outcomes in human papillomavirus associated oropharyngeal squamous cell carcinoma [HPV(+)OPSCC] patients treated at a tertiary care center. STUDY DESIGN Retrospective review. METHODS HPV(+)OPSCC patients treated surgically from 2006 to 2021 were selected from our departmental Oropharyngeal Cancer RedCap database. Demographic data, treatment, and oncologic outcomes were extracted. Distance was calculated in miles between the centroid of each patient zip code and our hospital zip code (zipdistance). RESULTS 874 patients (89 % male; mean age: 58 years) were identified. Most patients (96 %) reported Non-Hispanic White as their primary race. 204 patients (23 %) had a high-school degree or less, 217 patients (25 %) reported some college education or a 2-year degree, 153 patients (18 %) completed a four-year college degree, and 155 patients (18 %) had post-graduate degrees. Relative to those with a high-school degree, patients with higher levels of education were more likely to live further away from our institution (p < 0.0001). Patients who received adjuvant radiation therapy elsewhere lived, on average, 104 miles further away than patients receiving radiation at our institution (Estimate 104.3, 95 % CI 14.2-194.4, p-value = 0.02). In univariable Cox PH models, oncologic outcomes did not significantly differ by zipdistance. CONCLUSIONS Education level-and access to resources-varied proportionally to a patient's distance from our center. Patients travelling further distances for surgical management of OPSCC were more likely to pursue adjuvant radiation therapy at an outside institution. Distance traveled was not associated with oncologic outcomes. Breaking down barriers to currently excluded populations may improve access to clinical trials and improve oncologic outcomes for diverse patient populations.
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Affiliation(s)
- Aisha A Aden
- Mayo Clinic Alix School of Medicine, MN, United States.
| | - Felicia O Olawuni
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | - Chadi N Abdel-Halim
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | - Agnes Q Zhu
- Mayo Clinic Alix School of Medicine, MN, United States
| | - Travis J Haller
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | | | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | - Kendall L Tasche
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, MN, United States
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, MN, United States
| | - Mauricio Gamez
- Department of Radiation Oncology, Mayo Clinic, MN, United States
| | | | - Katharine Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | | | - David Routman
- Department of Radiation Oncology, Mayo Clinic, MN, United States
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
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Wallerius KP, Bowen AJ, O'Byrne TJ, Aden AA, Peraza LR, Xie KZ, Richards BA, El-Badaoui J, Bayan SL, Wong Kee Song LM, Ekbom DC. Comparing Open Versus Rigid Endoscopic and Flexible Endoscopic Techniques for the Treatment of Zenker's Diverticulum. Otolaryngol Head Neck Surg 2023; 169:962-970. [PMID: 36906817 DOI: 10.1002/ohn.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/16/2023] [Accepted: 01/27/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE To describe the outcomes of patients undergoing open stapler versus transoral rigid and flexible endoscopic therapies for symptomatic Zenker's diverticulum. STUDY DESIGN Single institution retrospective review. SETTING Tertiary care academic hospital. METHODS We retrospectively evaluated the outcomes of 424 consecutive patients who underwent Zenker's diverticulotomy via an open stapler, rigid endoscopic CO2 laser, rigid endoscopic stapler, rigid endoscopic harmonic scalpel, or flexible endoscopic technique from January 2006 to December 2020. RESULTS A total of 424 patients (173 females, mean age 73.1 ± 11.2 years) from a single institution were included. A total of 142 patients (33%) underwent endoscopic laser treatment, 33 (8%) underwent endoscopic harmonic scalpel, 92 (22%) underwent endoscopic stapler, 70 (17%) underwent flexible endoscopic, and 87 (20%) underwent open stapler. All open and rigid endoscopic procedures and most of the flexible endoscopic procedures (65%) were performed under general anesthesia. The flexible endoscopic group had a higher percentage of procedure-related perforation, defined as subcutaneous emphysema or contrast leak on imaging (14.3%). The recurrence rates were higher in the harmonic stapler, flexible endoscopic, and endoscopic stapler groups at 18.2%, 17.1%, and 17.4%, respectively, and lower in the open group (1.1%). Length of hospital stay and return to oral intake were similar among groups. CONCLUSION The flexible endoscopic technique was associated with the highest rate of procedure-related perforation, while the endoscopic stapler had the lowest number of procedural complications. Recurrence rates were higher among the harmonic stapler, flexible endoscopic, and endoscopic stapler groups and lower in the endoscopic laser and open groups. Prospective comparative studies with long-term follow-up are needed.
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Affiliation(s)
- Katherine P Wallerius
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew J Bowen
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas J O'Byrne
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Aisha A Aden
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Lazaro R Peraza
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine Z Xie
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley A Richards
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph El-Badaoui
- Department of Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Semirra L Bayan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Dale C Ekbom
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
Blood samples from 3000 Somali camels (Camelus dromedarius) were examined for trypanosome infection. Of these, 160 (5.33%) were infected with Trypanosoma evansi, one (0.03%) with T. congolense and one (0.03%) with T. brucei. Camel trypanosomiasis occurred in most areas of tabanid infestation throughout the country. The tabanids Philoliche zonata and P. magretti are incriminated as the major vectors of the disease.
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Affiliation(s)
- M F Dirie
- National Tsetse and Trypanosomiasis Control Project (NTTCP), Mogadishu, Somalia
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