Survival Outcomes of Temporal Bone Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis.

OBJECTIVE: Temporal bone squamous cell carcinoma (TBSCC) is a rare malignancy with poor prognosis, and optimal treatment for advanced cases is uncertain. Our systematic literature review aimed to assess 5-year survival outcomes for advanced TBSCC across different treatment modalities. DATA SOURCES: EMBASE, Medline, PubMed, and Web of Science. REVIEW METHODS: A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for articles published between January 1989 and June 2023. RESULTS: The review yielded 1229 citations of which 31 provided 5-year survival data for TBSCC. The final analysis included 1289 patients. T classification data was available for 1269 patients and overall stage for 1033 patients. Data for 5-year overall survival (OS) was 59.6%. Five-year OS was 81.9% for T1/2 and 47.5% for T3/4 (P < .0001). OS for T1/T2 cancers did not significantly differ between surgery and radiation (100% vs 81.3%, P = .103). For advanced-stage disease (T3/T4), there was no statistical difference in OS when comparing surgery with postoperative chemoradiotherapy (CRT) (OS 50.0%) versus surgery with postoperative radiotherapy (XRT) (OS 53.3%) versus definitive CRT (OS 58.1%, P = .767-1.000). There was not enough data to assess the role of neoadjuvant CRT. CONCLUSION: Most patients will present with advanced-stage disease, and nodal metastasis is seen in nearly 22% of patients. This study confirms the prognostic correlation of the current T classification system. Our results suggest that OS did not differ significantly between surgery and XRT for early stage disease, and combined treatment modalities yield similar 5-year OS for advanced cancers.

The effects of COVID-19 on Canadian surgical residents' education and wellness.

Background: The COVID-19 pandemic has challenged health care systems. We sought to comprehend the impact of the COVID-19 pandemic on surgical residents' education and mental well-being across Canada. Methods: An online 51-question survey was distributed to surgical residents across all 17 Canadian post- graduate surgical residency programs. The questionnaire contained questions concerning demographic factors, perceived effects of COVID-19 pandemic on surgical training and residents' mental health (categorically demonstrating whether it improved, stayed the same, or worsened). Health habits were measured as continuous variables and compared before and during the pandemic. Additionally, participants reported the performance of wellness offices' response to their needs during this crisis. Results: A total of 122 out of 650 (19%) residents from all surgical specialities anonymously completed the survey. The majority (68%) reported a worsening in their surgical training. 94% of participants favored online teaching as a complementary method to in-person teaching. As to health habits, 38% reported a rise in their alcohol consumption and time spent seated. Only a minority (25%) felt happier and 41% reported experiencing more anxiety in comparison to surgical training pre-COVID-19. Merely 14% reported benefitting from wellness programs. Conclusion: The COVID-19 pandemic had a negative effect on the perceived quality of surgical training, education, and resident mental health. There is an urgent need to reconsider the implemented measures in medical education and urge us to develop better agendas to face the current or future waves.

Contexte: La pandémie de la COVID-19 a mis au défi les systèmes de soins de santé. Nous avons tenté de mesurer les impacts de la pandémie sur la formation et le bien-être mental des résidents en chirurgie au Canada. Méthodes: Un sondage en ligne comportant 51 questions a été effectué auprès des résidents des 17 programmes de résidence en chirurgie au Canada. Les questions concernaient les facteurs démographiques et les effets perçus de la pandémie de la COVID-19 sur la formation en chirurgie et sur la santé mentale des résidents (indiquant si leur santé mentale s'était améliorée, si elle était restée inchangée ou si elle s'était détériorée). Les habitudes de santé ont été mesurées en tant que variables continues, et comparées avant et pendant la pandémie. De plus, les participants se sont prononcés sur la capacité des services d'aide au bien-être de répondre à leurs besoins pendant la crise. Résultats: Au total, 122 des 650 résidents (19 %), toutes spécialités chirurgicales confondues, ont répondu au sondage de manière anonyme. La plupart des participants (68 %) ont signalé une détérioration de leur formation en chirurgie et 94 % d'entre eux se sont dits favorables à l'enseignement en ligne comme méthode complémentaire à l'enseignement en personne. En ce qui concerne les habitudes de santé, 38 % des participants ont signalé une augmentation de leur consommation d'alcool et du temps passé assis. Une minorité de résidents (25 %) se sont sentis plus heureux et 41 % ont déclaré éprouver plus d'anxiété dans leur formation chirurgicale qu'avant la pandémie. Seulement 14 % des participants affirment avoir profité des programmes d'aide au bien-être. Conclusion: La pandémie de la COVID-19 a eu un effet négatif sur la perception des résidents quant à la qualité de la formation chirurgicale, de l'éducation et de leur santé mentale. Il est urgent de revoir les mesures mises en œuvre dans l'enseignement médical et d'élaborer de meilleurs plans d'action pour faire face à la vague actuelle ou toute autre vague future.

Neurorrhaphy of anterior and posterior interosseous nerves in the prevention of neuroma following a radical neurectomy: A case report.

Selective wrist denervation is a surgical technique frequently performed for the treatment of chronic wrist pain. While this technique is often effective in pain reduction, it is still associated with certain complications such as pain recurrence secondary to neuroma formation. We present a case report that details the clinical case of a young yoga teacher suffering from debilitating chronic wrist pain, refractory to conservative treatments. We describe a new surgical technique for the treatment of chronic wrist pain: posterior interosseous nerve and anterior interosseous nerve neurectomy followed by neurorrhaphy in preventing neuroma formation. Post-operatively, the patient's wrist pain continuously improved and completely resolved without any signs of recurrence. Posterior interosseous nerve and anterior interosseous nerve neurectomy followed by an end-to-end neurorrhaphy can be used as an effective novel surgical technique in the management of chronic wrist pain with prevention of neuroma formation.

Prognostic factors of head and neck cutaneous squamous cell carcinoma: a systematic review.

BACKGROUND: Head and neck cutaneous squamous cell carcinoma (HNCSCC) is a non-melanoma skin cancer that is mostly caused by solar ultraviolet radiation exposure. While it usually has an excellent prognosis, a subset of patients (5%) develops nodal metastasis and has poor outcomes. The aim of this study was to systematically review the literature and evaluate the prognostic factors of HNCSCC in order to better understand which patients are the most likely to develop metastatic disease. METHODS: A comprehensive literature search was performed on PubMed and EMBASE to identify the studies that evaluated the prognostic factors of HNCSCC. Prognostic factors were deemed significant if they had a reported p-value of < 0.05. Proportions of studies that reported a given factor to be statistically significant were calculated for each prognostic factor. RESULTS: The search yielded a total of 958 citations. Forty studies, involving a total of 8535 patients, were included in the final analysis. The pre-operative/clinical prognostic factors with the highest proportion of significance were state of immunosuppression (73.3%) and age (53.3%); while post-operative/pathological prognostic factors of importance were number of lymph nodes involved with carcinoma (70.0%), margins involved with carcinoma (66.7%), and tumor depth (50.0%). CONCLUSION: This systematic review is aimed to aid physicians in assessing the prognosis of HNCSCC and identifying the subsets of patients that are most susceptible to metastasis. It also suggests that immunosuppressed patients with a high-risk feature on biopsy, such as invasion beyond subcutaneous fat, could possibly benefit from a sentinel lymph node biopsy.