Malignancies requiring temporal bone resection: An Australian single-institution experience.

BACKGROUND: Malignancies in and around the temporal bone are aggressive and difficult to manage. In Queensland (Australia), where skin cancer rates are exceedingly high, tumours extending to the temporal bone from surrounding structures occur more commonly than primary cancers. Yet, a paucity of evidence exists as to their management and outcomes. This study aimed to review an Australian centre's experience of managing temporal and peritemporal bone malignancies, reporting on patient and tumour characteristics, treatment, and survival outcomes. METHODS: Retrospective analysis of patients with primary temporal bone cancer and cancers extending to the temporal bone managed by the Queensland Skull Base Unit (Princess Alexandra Hospital) between 2000 and 2019. RESULTS: A total of 222 patients were identified, of which 203 (91.4%) had cutaneous primaries, with 167 (75.2%) being squamous cell carcinoma (SCC). 73.9% presented with locoregionally recurrent or residual disease. Secondary tumours (92.8%) were 12 times more frequent than primary malignancies (7.2%), with the preauricular subsite the most common (45.5%). In the 201 patients (90.5%) who underwent curative intent surgery, 5-year overall survival, disease-free survival (DFS), and disease-specific survival was 46.6%, 52.2%, and 65.9%, respectively. The preauricular subsite (p = 0.004), melanoma (vs. SCC, p = 0.027), involved margins (p < 0.001), and pathologically involved nodes (p < 0.001) were associated with significantly worse DFS. CONCLUSION: This is one of the largest studies of temporal bone malignancy in the literature, comprised primarily of secondary cutaneous malignancies. Although clear differences in epidemiological characteristics exist around the world, survival remains poor. Treatment should focus on achieving a clear margin of resection to optimize outcomes.

Commitment and burnout: where should surgeons draw the line?

For all its abundant rewards, many assert that surgery is a career that requires significant commitment and sacrifice. Many suggest that when left unchecked, this commitment may incite burnout owing principally to the unique time and emotional demands of the profession. Burnout is variably defined as a complex stress reaction that disproportionately affects healthcare workers, including surgeons. Its significance is owed to the propensity of burnout to detriment personal and professional functioning of the surgeon and potentially impair the care they deliver to their patients. As a result of this, the phenomenon of burnout is increasing attracting attention in contemporary healthcare. This essay examines the extent to which commitment is required in a surgical career and offsets it against the risks and consequences of burnout. Ultimately, the authors conclude that surgeons must be aware of both when and how overzealous, unchecked commitment may paradoxically impair their care via the incubation of burnout.