OBJECTIVES Proponents of open thoracotomy (OPEN) and robot-assisted thoracic surgery (RATS) claim its oncological superiority over video-assisted thoracic surgery (VATS) in terms of the accuracy of lymph node staging. METHODS The National Cancer Database was queried for patients with non-small-cell lung cancer (NSCLC) undergoing lobectomy without neoadjuvant therapy from 2010 to 2014. Nodal upstaging rates were compared using a surgical approach. Overall survival adjusted for confounding variables was examined using the Cox proportional hazards model. RESULTS A total of 64 676 patients fulfilled the selection criteria. The number of patients who underwent lobectomy by RATS, VATS and OPEN approaches was 5470 (8.5%), 17 545 (27.1%) and 41 661 (64.4%), respectively. The mean number of lymph nodes examined for each of these approaches was 10.9, 11.3 and 10 (P < 0.01) and upstaging rates were 11.2%, 11.7% and 12.6% (P < 0.01), respectively. For patients with clinical stage I disease (N = 46 826; RATS = 4338, VATS = 13 416 and OPEN = 29 072), the mean lymph nodes examined were 10.6, 10.8 and 9.4 (P < 0.01), and upstaging rates were 10.8%, 11.1% and 12.1% (P < 0.01), respectively. A multivariable analysis suggested an association with improved survival with RATS and VATS compared with OPEN surgery [hazard ratio (HR) = 0.89 and 0.89, respectively; P < 0.01] for patients with all stages. In stage I disease, VATS but not RATS was associated with increased overall survival compared with the OPEN approach (HR = 0.81; P < 0.01). CONCLUSIONS RATS lobectomy is not superior to VATS lobectomy with respect to lymph node yield or upstaging of NSCLC. Increased nodal upstaging by the OPEN approach does not confer a survival advantage in any stage of NSCLC and may be associated with decreased overall survival.

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total volume of 74.0AE14.5 cc), the average percent volumes receiving minimal LQED2 of 70 (V 70) Gy (corresponding to BED of 116.7 Gy 3) was 12.4AE15.5%, corresponding to an absolute mandibular volume of 8.3AE10.1 cc. Thus, while the mandible might be considered as a serial organ as far as ORN is concerned, it might be associated with a moderate volume effect. Conclusion: ORN can result from increased LQED2 or BED which may not be conspicuous from a dosimetric plan based solely on physical dose display. This study demonstrates the utilization of radiobiologically sound dosimetry which clinicians can use to quantify risk of late complications due to the "double trouble" arising from altered fractionation schemes. For the mandible, DVH guidelines based on BED or LQED2 might be better representations to predict true incidence of ORN, and useful when constructing the doseresponse relation as a normal-tissue complication probability (NTCP) curve.

, respectively), with outcomes significantly worsening with increasing smoking exposure. The 5-year OS for more than 10, 20, and 30 pack-year smoking history was 73.2%, 64.7%, and 59.1% respectively. Current smokers managed with CRT had a 5-year OS of 64.2% compared with former and never smokers (93.1% and 78.2%, respectively). For current smokers managed primarily by surgery, the 5-year OS was 57.6% compared with former and never smokers (69.6% and 73.5%, respectively). Conclusion: Smoking is an independent prognostic factor in HPVassociated locally advanced OPC. Current smokers and those with higher smoking exposure had poorer outcomes irrespective of their primary modality of treatment, and therefore it is not possible to recommend a preferential modality of treatment for patients with HPV positive tumors who have a significant smoking history. Outcomes were worse for patients managed surgically compared to CRT; however, as this review did not specifically compare outcomes between the two treatment modalities, this requires further evaluation.

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