OBJECTIVETo describe the population-wide incidence of Zenker diverticulum over a 20-year period and characterize management strategies across specialties and treatment settings. DESIGN, SETTING, AND PARTICIPANTSThis retrospective national cohort study was conducted from January 1, 1996, through December 31, 2015, and reviewed patient records from the Care Register for Healthcare in Finland, from which patients with Zenker diverticulum were identified. The data were analyzed in October 2021. EXPOSURES Zenker diverticulum. MAIN OUTCOME AND MEASURE The incidence of Zenker diverticulum per 100 000 person-years. RESULTS A total of 2736 patients (median [IQR] age at diagnosis 72.0 [19-106] years; 1278 women [46.7%]) were identified, making the annual incidence of Zenker diverticulum in Finland 2.9/100 000 person-years. Men had higher incidence (3.7/100 000 person-years) compared with women (2.3/100 000 person-years), with an incidence rate ratio of 1.61 (95% CI, 1.48-1.76; P < .001). Within the study population, 1044 patients (38.2%) underwent surgical treatment and 227 (8.3%) underwent 2 or more surgeries. The choice of initial operative approach depended on the medical specialty (Cramer V = 0.41) and on specific catchment area (Cramer V = 0.41). Overall, endoscopic approaches for initial operations were most popular. CONCLUSIONS AND RELEVANCEThe cohort study results found that the incidence of Zenker diverticulum was 2.9/100 000 person-years. Most patients with Zenker diverticulum did not undergo definitive therapy. Some hospital districts and some medical specialties were more likely to opt for conservative treatment than others. The choice of operative approach depended more on physician-level factors rather than patient profiles.

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Very long-term health-related quality of life (HRQoL) is an important end point in operated early stage non esmall-cell lung cancer with good prognosis. The results for very long-term HRQoL after minimally invasive video-assisted thoracoscopic surgery (VATS) has not been evaluated and compared to thoracotomy. Surprisingly, inferior overall HRQoL was evident for patients operated with VATS, independent of preoperative factors including age, comorbidities, and pulmonary function tests. Background: As a result of routine low-dose computed tomographic screening, lung cancer is more frequently diagnosed at earlier, operable stages of disease. In treating local nonesmall-cell lung cancer, video-assisted thoracoscopic surgery (VATS), a minimally invasive surgical approach, has replaced thoracotomy as the standard of care. While short-term quality-of-life outcomes favor the use of VATS, the impact of VATS on long-term health-related quality of life (HRQoL) is unknown. Patients and Methods: We studied patients who underwent lobectomy for the treatment of nonesmall-cell lung cancer from January 2006 to January 2013 at a single institution (n ¼ 456). Patients who underwent segmentectomy (n ¼ 27), who received neoadjuvant therapy (n ¼ 13), or who were found to have clinical stage > T2 or > N0 disease (n ¼ 45) were excluded from analysis. At time of HRQoL assessment, 199 patients were eligible for study and were mailed the generic HRQoL instrument 15D. Results: A total of 180 patients (90.5%) replied; 92 respondents underwent VATS while 88 underwent open thoracotomy. The VATS group more often had adenocarcinoma (P ¼ .006), and lymph node stations were sampled to a lesser extent (P ¼ .004); additionally, hospital length of stay was shorter among patients undergoing VATS (P ¼ .001). No other clinical or pathologic differences were observed between the 2 groups. Surprisingly, patients who underwent VATS scored significantly lower on HRQoL on the dimensions of breathing, speaking, usual activities, mental function, and vitality, and they reported a lower total 15D score, which reflects overall quality of life (P < .05). Conclusion: In contrast to earlier short-term reports, long-term quality-of-life measures are worse among patients who underwent VATS compared to thoracotomy.

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