OBJECTIVES: Locally advanced lung cancers present a significant challenge to minimally invasive thoracic surgeons. An increasing number of centres have adopted robotic-assisted thoracoscopic surgeries for these complex operations. In this study, we compare surgical margins achieved, conversion rates to thoracotomy, perioperative mortality and 30-day readmission rates for robotic and video-assisted thoracoscopic surgery (VATS) lobectomy for locally advanced lung cancers. METHODS: Using the National Cancer Database, we identified patients with non-small-cell lung cancer who received neoadjuvant chemotherapy/radiotherapy, had clinical N1/N2 disease or in the absence of these 2 features had a tumour >5 cm treated with either robotic or VATS lobectomy between 2010 and 2016. Perioperative outcomes and conversion rates were compared between robotic and VATS lobectomy. RESULTS: A total of 9512 patients met our inclusion criteria with 2123 (22.3%) treated with robotic lobectomy and 7389 (77.7%) treated with VATS lobectomy. Comparable R0 resections, 30- and 90-day mortality and 30-day readmission rates were observed for robotic and VATS lobectomy while a higher rate of conversion to thoracotomy was observed for VATS (aOR = 1.99, 95% confidence interval = 1.65, 2.39, P < 0.001). CONCLUSIONS: Our analysis of the National Cancer Database suggests that robotic lobectomy for complex lung resections achieves similar perioperative outcomes and R0 resections as VATS lobectomy with the exception of a lower rate of conversion to thoracotomy.

Introduction:Androgen deprivation therapy first became the treatment of choice for advanced prostate cancer in the 1940s with Charles Huggins' discoveries. Eight decades later, androgen deprivation therapy has significantly evolved, and yet is still utilized in various ways to treat certain forms of prostate cancer. For local recurrence after failed primary treatment and for locally advanced and metastatic disease, continuous androgen deprivation therapy has been standard of treatment. However, intermittent androgen deprivation therapy has emerged as a therapeutic alternative to continuous androgen deprivation therapy. The purpose of this meta-analysis is to provide an update on mortality, specifically prostate cancer-specific and nonprostate cancer causes, in order to offer some guidance when selecting the appropriate form of systemic androgen deprivation therapy.Methods:The PubMed database was searched for prospective randomized clinical trials. Inclusion and exclusion criteria were defined. Using statistical software, we analyzed random-effects models with the assumption that the data were randomly sampled, estimated the pooled log risk ratio, assessed heterogeneity, and created funnel plots to evaluate publication bias.Results:A total of 12 randomized clinical trials met all inclusion criteria for final analysis. There was no statistically significant difference in prostate cancer-specific mortality between intermittent androgen deprivation therapy and continuous androgen deprivation therapy (RR=1.10 [0.85-1.42]). The analysis of nonprostate cancer mortality favored intermittent androgen deprivation therapy over continuous androgen deprivation therapy, but the difference was statistically insignificant (RR=0.94 [0.76-1.17]).Conclusions:These 2 treatment modalities can be considered as equivalent in long-term treatment outcomes. As intermittent androgen deprivation therapy is more cost-efficient and less likely to yield adverse side effects, future treatment guidelines should consider these advantages over continuous androgen deprivation therapy.

Background: High-risk human papillomaviruses (HPV-HR) are implicated in more than 99% of cervical/vaginal malignancies. Despite this strong association, current guidelines recommend PET/CT imaging over HPV-HR DNA testing as the standard prognostic tool following definitive therapy. This retrospective, single-institution, proof-of-concept study evaluated HPV-HR DNA testing as a potential alternative to PET/CT imaging for posttreatment surveillance in cervical and vaginal cancers. Methods: Female patients with cervical or vaginal cancer treated between 2010 and 2023 at our institution were retrospectively analyzed. Eligible patients had complete documentation of pre- and posttreatment PET/CT imaging and HPV-HR DNA testing. Of more than 100 patients identified, only 53 met the inclusion criteria, and both radical hysterectomy and chemoradiation patients were included. Statistical analyses, including sensitivity, specificity, and predictive values, were conducted using Stata, with significance set at 0.05. Results: Posttreatment HPV-HR DNA testing demonstrated a superior sensitivity (92.31%) and negative predictive value (97.44% NPV) compared with PET/CT imaging (76.92% sensitivity and 92.31% NPV). Although PET/CT imaging maintained higher specificity over HPV-HR DNA testing (100% vs. 95%) and positive predictive value (100% vs. 85.71%), HPV-HR DNA testing offers a more sensitive and cost-effective method for identifying patients requiring further evaluation. Conclusions: HPV-HR DNA testing is a promising, cost-effective surveillance tool with higher sensitivity and NPV than PET/CT. Its clinical use may reduce PET/CT need, improve safety, and lower costs and require further validation. Impact: HPV-HR DNA testing offers a cost-effective alternative to PET/CT, reducing costs, unnecessary imaging, and improving accessibility.

The need for maternal medications is a known barrier to breastfeeding. Though most medications are compatible with lactation, healthcare providers use abundant caution, often viewing medications and breastfeeding as mutually exclusive. A dual intervention of an educational webinar and access to a mobile app for lactation pharmacology was used to enhance provider familiarity, confidence, and access to knowledge in medication use during breastfeeding. Surveys were administered before, one week after, and three months after the webinar to evaluate performance gap improvement. Usage data of the mobile app was collected over twelve months to monitor topic engagement. Results suggested the interventions temporarily increased provider confidence in maternal medication use during lactation; however, the increase was not sustained at three months. Even with one-time training and lactation-specific mobile app access, simply providing an informational resource is insufficient to support evidence-informed care for lactating patients. Longitudinal training on evidence-based medication safety is critical to care for the lactating dyad.