Objective Non‐squamous cell carcinoma (non‐SCC) variants of sinonasal cancer are rare cancers which are optimally managed with complete surgical resection. This study aims to assess the impact of surgical approach on outcomes by comparison of cases managed with open versus endoscopic resection. Methods The National Cancer Database 2004–2015 datasets were queried for all cases of non‐SCC initially managed with definitive surgery. Patients were grouped according to surgical approach (endoscopic vs. open) and compared for patient, tumor, and treatment variables using chi‐squared analyses. Logistic regression was used to determine predictors of receiving endoscopic surgery. Subgroups were compared for survival using Cox regression and perioperative outcomes. Results Of the 1595 cases of non‐SCC sinonasal cancers managed with definitive surgery, 42.2% were treated endoscopically. Open and endoscopic groups differed significantly by stage, primary site, histology, facility type, margin status, and clinical stage. Logistic regression showed that increased income was a significant predictor of receiving endoscopic surgery whereas stage IV (odds ratio: 0.58, P = .017) reduced the odds of receiving endoscopic surgery. Open resection patients had longer mean length of stay (LOS) than those who underwent endoscopic resection (5.09 vs. 3.16 days, P < .001). On Cox regression, no difference in survival was observed between open and endoscopic patients (P = .534). Conclusions Patients with non‐SCC sinonasal cancer managed with endoscopic surgery had a decreased LOS and no significant difference in survival compared to patients undergoing open resection. Therefore, an endoscopic approach may be considered a viable alternative to open resection. Level of Evidence NA Laryngoscope, 130: 1872–1876, 2020
BACKGROUND Trauma is a major cause of death and disability in all ages. Previous reviews have suggested that National Institutes of Health (NIH) funding for trauma is not commensurate with its burden of disease, but a detailed analysis has been lacking. We postulated that NIH spending on trauma research was lower than previously thought and was distributed widely, preventing a comprehensive research strategy that could decrease trauma morbidity and mortality. METHODS The NIH Research Portfolio Online Reporting Tool was initially screened using a search of over 20 terms including “trauma,” “injury,” “shock,” “MVC,” and excluding clearly unrelated conditions, for example, “cancer.” The details of all grants that screened positive underwent manual review to identify true trauma-related grants. An expert panel was used to adjudicate any ambiguity. RESULTS In FY2016, NIH awarded 50,137 grants, of which 6,401 (13%) were captured by our initial screen. Following review, 1,888 (28%) were identified as trauma-related; 3.7% of all NIH grants. These grants (US $720 million) represent only 2.9% of the NIH extramural budget. In addition, the grants were funded and administered by 24 of the institutes and centers across the NIH ranging from 0.01% (National Cancer Institute) to 11% (National Institute of Neurological Disorders and Stroke and National Institute of Arthritis and Musculoskeletal and Skin Diseases) of their extramural portfolios. CONCLUSION Given the extreme burden of trauma-related disability and years of life lost, this review of extramural NIH funding definitively demonstrates that trauma is severely underfunded. The lack of a dedicated home for trauma research at NIH leads to a diffusion of grants across many institutes and makes it impossible to direct a focused and effective national research endeavor to improve outcomes. These data demonstrate the need for a National Institute of Trauma at the NIH to help set an agenda to reach the national goal of Zero Preventable Deaths.
Background: Sinonasal mucosal melanoma (SMM) is a rare, aggressive cancer, optimally managed with complete surgical resection. This study aimed to assess the impact of surgical approach on outcomes by comparison of cases managed with open vs endoscopic resection. Methods:The National Cancer Database 2010-2015 datasets were queried for all cases of non-metastatic SMM initially managed with definitive surgery. Patients were grouped according to surgical approach (open vs endoscopic) and compared for patient, tumor, and treatment variables using chi-square analyses. Case-control matching was used to generate subgroups of cases paired 1:1 between groups, matched for significantly distributed variables. Subgroups were compared for perioperative outcomes and overall survival (OS) using Kaplan-Meier analyses. Results:Of the 686 cases of SMM managed with definitive surgery, 46.2% were treated endoscopically. Open and endoscopic groups did not differ significantly by T-stage, primary site, or rates of adjuvant therapies. Case-control matching for these variables generated a subpopulation of 240 paired cases. Comparison of matched groups found no significant differences in 30-day or 90-day mortality. Endoscopically managed patients had higher rates of unplanned readmission whereas open resection patients had longer length of stay (LOS). There was no significant difference in OS between groups. Conclusion:In surgically managed SMM, open resection patients have significantly longer LOS, whereas endoscopic patients have higher rates of unplanned readmission. Surgical approach does not appear to influence OS. C 2019 ARS-AAOA, LLC.
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