Zoukaa Sargi

Objective: To identify the risk factors for Otolaryngology–Head and Neck Surgery (OHNS) resident attrition.Study Design: Retrospective cohort study.Setting: Annual Graduate Medical Education track survey.Methods: We conducted a retrospective analysis of OHNS residents who matriculated between 2006 and 2015. Variables analyzed included age at matriculation, sex, race/ethnicity, medical degree type, program location, attrition status, and matriculation year period (2006‐2010, 2011‐2015). A logistic regression model was used to determine factors predictive of attrition, with a significance level set at P < .05.Results: A total of 3073 residents were analyzed. The overall attrition rate was 3.7%. Multivariable regression showed older residents (≥30 years) had a 2.1 times higher risk of attrition compared to younger residents (≤29 years) (adjusted odds ratio [aOR]: 2.1; 95% confidence interval, CI [1.383‐3.316], P < .001). Underrepresented minorities in medicine (URiM) residents had a 3.5 times higher risk of attrition compared to whites (aOR: 3.5; 95% CI [1.823‐6.806], P < .001). Southern US programs had a 2.5 times higher risk of attrition compared to northeastern programs (aOR: 2.5; 95% CI [1.480‐4.315], P < .001). There was no statistically significant difference in attrition based on sex, medical degree type, or matriculation year period.Conclusion: A higher risk of attrition was found among OHNS trainees who were older, self‐identified as URiM, and in the southern US programs. There was no significant difference in attrition risk based on gender, medical degree type, or matriculation period. Further research is needed to understand the reasons for attrition and to develop strategies to promote inclusion and diversity in OHNS.

Emerging evidence suggests that not only the frequency and composition of tumor-infiltrating leukocytes but also their spatial organization might be a major determinant of tumor progression and response to therapy. Therefore, mapping and analyzing the fine tumor immune architecture could potentially provide insights for predicting cancer prognosis. Here, we performed an explorative, prospective clinical study to assess whether structures within the tumor microenvironment can predict recurrence after salvage surgery in head and neck squamous cell carcinoma (HNSCC). The major immune subsets were measured using flow cytometry and co-detection by indexing (CODEX) multiparametric imaging. Flow cytometry underestimated the number of PMN-MDSCs and neutrophils in the tumor and overestimated the tumor-infiltrating lymphocyte frequency. An ad hoc computational framework was used to identify and analyze discrete cellular neighborhoods. A high frequency of tertiary lymphoid structures composed of CD31highCD38high plasma cells was associated with reduced recurrence after surgery in HNSCC. These data support the notion that the structural architecture of the tumor immune microenvironment plays an essential role in tumor progression and indicates that type 1 tertiary lymphoid structures and long-lived CD31highCD38high plasma cells are associated with good prognosis in HNSCC.Significance:Imaging the spatial tumor immune microenvironment and evaluating the presence of type 1 tertiary lymphoid structures enables prediction of recurrence after surgery in patients with head and neck squamous cell carcinoma.

Emerging evidence suggests that not only the frequency and composition of tumor-infiltrating leukocytes but also their spatial organization might be a major determinant of tumor progression and response to therapy. Therefore, mapping and analyzing the fine tumor immune architecture could potentially provide insights for predicting cancer prognosis. Here, we performed an explorative, prospective clinical study to assess whether structures within the tumor microenvironment can predict recurrence after salvage surgery in head and neck squamous cell carcinoma (HNSCC). The major immune subsets were measured using flow cytometry and co-detection by indexing (CODEX) multiparametric imaging. Flow cytometry underestimated the number of PMN-MDSCs and neutrophils in the tumor and overestimated the tumor-infiltrating lymphocyte frequency. An ad hoc computational framework was used to identify and analyze discrete cellular neighborhoods. A high frequency of tertiary lymphoid structures composed of CD31highCD38high plasma cells was associated with reduced recurrence after surgery in HNSCC. These data support the notion that the structural architecture of the tumor immune microenvironment plays an essential role in tumor progression and indicates that type 1 tertiary lymphoid structures and long-lived CD31highCD38high plasma cells are associated with good prognosis in HNSCC.Significance:Imaging the spatial tumor immune microenvironment and evaluating the presence of type 1 tertiary lymphoid structures enables prediction of recurrence after surgery in patients with head and neck squamous cell carcinoma.

Emerging evidence suggests that not only the frequency and composition of tumor-infiltrating leukocytes but also their spatial organization might be a major determinant of tumor progression and response to therapy. Therefore, mapping and analyzing the fine tumor immune architecture could potentially provide insights for predicting cancer prognosis. Here, we performed an explorative, prospective clinical study to assess whether structures within the tumor microenvironment can predict recurrence after salvage surgery in head and neck squamous cell carcinoma (HNSCC). The major immune subsets were measured using flow cytometry and co-detection by indexing (CODEX) multiparametric imaging. Flow cytometry underestimated the number of PMN-MDSCs and neutrophils in the tumor and overestimated the tumor-infiltrating lymphocyte frequency. An ad hoc computational framework was used to identify and analyze discrete cellular neighborhoods. A high frequency of tertiary lymphoid structures composed of CD31highCD38high plasma cells was associated with reduced recurrence after surgery in HNSCC. These data support the notion that the structural architecture of the tumor immune microenvironment plays an essential role in tumor progression and indicates that type 1 tertiary lymphoid structures and long-lived CD31highCD38high plasma cells are associated with good prognosis in HNSCC.Significance: Imaging the spatial tumor immune microenvironment and evaluating the presence of type 1 tertiary lymphoid structures enables prediction of recurrence after surgery in patients with head and neck squamous cell carcinoma.

Background: We had previously analyzed the variables that determine the rates of opioid use at 1‐year postradiotherapy in patients with head and neck cancer. Here we analyze the variables associated with opioid abstinence during and in the 12 months after radiotherapy at our institution.Methods: We identified a cohort of patients with head and neck cancer who received radiotherapy as part of curative treatment at our institution. Logistic regression analyses were performed to determine socioeconomic and clinical factors associated with opioid abstinence.Results: The cohort included 376 patients. On multivariable analysis, patients from an upper‐income class (p = 0.004), black race (p = 0.004), older (p = 0.008), with dependent children (p < 0.001) or receiving surgery (p = 0.002) were more likely to abstain from opioids, while patients using analgesic mouthwash (p = 0.009) or higher pain scale (p = 0.002) were less likely.Conclusion: Socioeconomic and treatment characteristics are associated with opioid abstinence during and following radiation treatment in patients with head and neck cancer.

Objective: To analyze rates, risk factors, and complications for 30‐day readmission among head and neck cancer (HNC) patients.Methods: Retrospective review of administrative records from Vizient (Irving, Texas) Clinical Data Base/Resource Manager on HNC patients who underwent a head and neck surgical procedure from January 2013 through September 2015 at 176 academic and community medical centers.Results: Of the 18,121 patients included in the study, 2502 patients were readmitted within 30 days (13.8%). Mean time to readmission was 11 ± 8.2 days. Cancer of the hypopharynx, oropharynx, pharynx, and larynx all had higher odds of readmission compared to oral cavity (odds ratio [OR], 1.8, 1.7, 1.6, and 1.5; 95% confidence interval [CI], 1.4‐2.2, 1.4‐1.9, 1.2‐2.3, and 1.3‐1.7, respectively). Consistent with this, flap procedures and laryngectomy had the highest odds of readmission (OR, 1.4 and 1.3; 95% CI, 1.3‐1.6 and 1.0‐1.5 vs glossectomy, respectively). The most common surgical causes for readmission were postoperative infection (17.6%) and surgical wound dehiscence (16.8%), which most commonly presented on postdischarge days 4 to 5. Acute cardiac events occurred in up to 15.4% of patients depending on complexity of surgery. Dysphagia and electrolyte disturbances were common (15.8% and 15.4%, respectively); patients with these complications typically presented earlier, between days 3 and 4.Discussion: Patients with HNC are at high risk of readmission. The cancer subsite and procedure significantly influenced the risk, rate, and reason for readmission.Implications for Practice: Findings from this study can help quality improvement and patient safety administrators develop interventions that uniquely target HNC populations.

Esophageal perforation is a catastrophic complication of anterior cervical discectomy and fusion (ACDF). While direct surgical repair has been reported as optimal for restoration of upper gut function, we present the case of a 58-year-old woman who achieved complete resolution when treated only with debridement and drainage. We find that a supportive approach, surgical management without direct repair, may play a vital role in select patient populations in order to avoid potentially long-term consequences or radical treatments, like esophageal diversion. Decisions regarding direct repair versus debridement and inspection only should be made on a case-by-case basis through a multidisciplinary approach.

Objective: Resection of advanced malignancies of the lateral skull base often results in extensive complex surgical defects, sometimes including dura and temporal bone exposure. Reconstruction is challenging due to the complex regional anatomy, sheer defect size, frequent history of prior surgery or radiation, and need for reliable tissue coverage before adjuvant radiation. The goal of reconstruction is to provide adequate soft tissue coverage with well-vascularized tissue to seal dural defects, cover exposed bone, obliterate dead space, restore optimal function, and restore cosmesis. Free tissue transfer when possible is the commonly accepted gold standard for larger defects. This study reviews our experience with reconstruction and postoperative complications of patients undergoing combined lateral skull base resection for advanced lateral skull base malignancies. Design: A retrospective, single-institution case series was conducted in an academic tertiary care hospital. Methods: All cases with reconstruction of defects resulting from combined temporal bone resection and parotidectomy for advanced lateral skull base malignancy at the University of Miami/Jackson Memorial Hospital between September 1999 and August 2010 were included. Patient demographics, tumor characteristics, operative reports, postoperative complications, and clinical follow-up were recorded. Results: The 118 patients (26 women and 93 men) with a mean age of 66 years underwent 119 reconstructions after combined approaches to the lateral skull base. Of these 118 patients, 86 had either primary or metastatic skin cancer, 28 had primary parotid malignancies, 41 had previous surgeries to the lateral skull base, 33 had received radiation preoperatively, 16 had received preoperative chemotherapy, and 11 underwent a neurosurgical approach as part of their surgery. Repair of the surgical defect was performed with primary closure in 8 patients, local/regional skin flaps in 14 patients, local/regional myocutaneous flaps in 54 patients, and microvascular free tissue transfer in 43 patients. Wound-related complications were seen in 50 cases (46%), 15 of which were major (mandating revision surgery). Conclusions: Surgical outcome and complications were reviewed with relation to significant potential prognostic variables. Based on this review, an algorithm for reconstruction of lateral skull base defects following combined parotidectomy and temporal bone resection is presented.