Agnes Modée Borgström

Objective: To evaluate the incidence and nature of short‐term complications following cholesteatoma surgery in a heterogeneous cohort. Design: A retrospective cohort study including complete coverage of cholesteatoma surgery in a Swedish region between 1 January 2005 and 31 December 2015. A total of 966 patients were followed for 6 weeks postoperatively. Severe complications were defined as facial palsy, thromboembolic events, cerebrospinal fluid (CSF) leakage, serious postoperative infection, or death within 6 weeks of surgery. Results: Severe complications were uncommon, occurring in 14 patients (1.4%). Thromboembolic events were observed in five patients (0.5%), two of which (0.2%) resulted in postoperative mortality—one following cardiac arrest in the postoperative care unit and one due to a thromboembolic event approximately 3 weeks after surgery. Serious infections occurred in five patients (0.5%): three retroauricular abscesses, one case of meningitis, and one infected preauricular fistula with abscess formation. Additional severe complications included three cases of facial palsy and one case of CSF leakage. Conclusion: Cholesteatoma surgery demonstrates a low rate of severe short‐term complications, underscoring its overall safety with risks mainly attributable to general surgical or medical causes rather than cholesteatoma‐specific factors. The present cholesteatoma‐specific data constitute a solid basis for preoperative counselling and benchmarking within otology.

Purpose: Exploring a possible link between upper airway inflammation and the development of cholesteatoma by studying the association between mucosa-affecting diseases of the upper airways and cholesteatoma surgery. Methods: This is a nationwide case–control study of 10,618 patients who underwent surgery for cholesteatoma in Sweden between 1987 and 2018. The cases were identified in the National Patient Register and 21,235 controls matched by age, sex and place of residency were included from national population registers. Odds ratios (OR) and corresponding 95% confidence intervals were used to assess the association between six types of mucosa-affecting diseases of the upper airways and cholesteatoma surgery. Results: Chronic rhinitis, chronic sinusitis and nasal polyposis were more common in cholesteatoma patients than in controls (OR 1.5 to 2.5) as were both adenoid and tonsil surgery (OR > 4) where the strongest association was seen for adenoid surgery. No association was seen between allergic rhinitis and cholesteatoma. Conclusion: This study supports an association between mucosa-affecting diseases of the upper airways and cholesteatoma. Future studies should aim to investigate the mechanisms connecting mucosa-affecting diseases of the upper airways and cholesteatoma formation regarding genetic, anatomical, inflammatory and mucosa properties.

Background: The aim of this follow-up study was to assess whether there has been any increase in the percentage of patients offered attempted curative surgery for pancreatic carcinoma and whether the overall survival rate has improved, during the time period 1977–1991. Methods: Details of new cases of pancreatic carcinoma arising in the population of Malmö during the study period were retrieved from the Local Tumour Register in Lund, Sweden. In all, 740 patients were found; 575 of these were diagnosed before death. Kaplan–Meier analysis was used to calculate overall survival rates, and Cox regression analysis was used to assess survival in relation to year of diagnosis after adjustment for sex, age at diagnosis and stage of disease. Results: Cytological or histopathological evidence of the disease was given in 95 per cent of cases. The overall 5-year survival rate was 0·5 per cent (three of 575). Curative surgery was attempted in 24 patients (4·2 per cent); the proportion undergoing curative surgery increased in the last part of the study. Two of the 24 patients in this group survived for 5 years. Conclusion: The prognosis in pancreatic carcinoma remains dismal. Attempted curative surgery still is the only hope for cure, but the group of patients that can be offered this possibility is very limited. In this study, an increase was found in the proportion of patients who were offered attempted curative surgery, but there was no statistically significant increase in the 5-year survival rate following surgery.

The city of Malmö (population 230 000), situated in the south of Sweden, is in an area which has the highest incidence of pancreatic cancer in the country. The present study was designed to assess time trends of the incidence of pancreatic cancer 1961-90. The 1314 incident cases, 651 men and 663 women, were retrieved from the Regional Tumour Register and the National Cause-of-Death Register. In 75% of cases diagnosis was based on autopsy. Twenty per cent of the these cases were first found at autopsy, being undiagnosed. The average age-standardised incidence was 20.4 per 10(5) person-years for men and 13.7 for women. The incidence was higher for men than for women in all age groups above 44 years. No change in incidence over time was observed for men. In older and middle-aged women there was however a statistically significant increase. The average relative change in women above age 64 was 1.7% per year after age adjustment and in women aged 55-64 years 2.6% per year. We have found no results indicating that this increasing incidence could be caused by detection bias as a result of changing autopsy rates during the study period and hence conclude that the observed increase is explained by a growing number of women being exposed to factors with a potential tumour-promoting or -initiating effect.