Across the United States (U.S.), many communities experience disproportionate exposure to environmental health hazards due to their proximity to coal-fired power plants and associated coal ash disposal sites. These facilities release toxic heavy metals such as arsenic, mercury, and lead into the surrounding environment, posing serious public health risks. Although prior research has documented adverse health effects of coal-fired power plants, few studies have specifically examined the relationship between cancer incidence and proximity to coal ash impoundments, as well as exposure to elevated concentrations of toxic constituents in coal ash. Using complementary contingency table analyses, bivariate spatial association techniques, and spatial regression methods, this study finds consistent evidence that counties containing or adjacent to coal ash impoundments exhibit significantly higher cancer incidence rates compared to more distant counties, even after adjusting for potential confounders. Incidence rates for both total cancer and lung cancer were significantly associated with smoking, drinking, and physical inactivity, corroborating prior research on these behavioral risk factors. The lung cancer model further revealed significant positive associations between cancer incidence and PM₂.₅, arsenic concentrations, and airborne cancer risk scores, highlighting specific environmental risk factors for the disease. These findings strengthen the evidence linking coal ash exposure to adverse health outcomes and underscore the urgent need for robust enforcement and compliance measures to protect communities from coal ash contamination.

Background A textbook outcome is a composite score of individual metrics that report an ideal outcome for a given surgery. The objectives of this study were to develop and validate a textbook outcome definition for distal pancreatectomy. Methods PubMed, Embase, and Web of Science databases were searched until October 1, 2024 for this systematic review, and studies that evaluated textbook outcome for distal pancreatectomy were selected. Textbook outcome metrics were chosen by data strength and validated by reviewing our institution's distal pancreatectomy database from 1999 to 2024. Univariate and multivariate analyses evaluated the association of 180-day mortality with clinical factors, textbook outcome definition, and iterations of the definition. Cumulative incidence method estimated time to adjuvant therapy in patients with adenocarcinoma based on textbook outcome achievement. Results The systematic review included 10 studies. A textbook outcome was defined as no readmission or death within 90 days, length of stay <75th percentile, no Clavien-Dindo complication grade ≥III, and a negative margin. In our institution's database, textbook outcome frequency was 46.3% (n = 157/339). A textbook outcome was not associated with 180-day mortality; a major complication parameter was associated with 180-day mortality in multivariate analysis (odds ratio 0.04, P = .009). In patients with adenocarcinoma, time to adjuvant therapy was significantly shorter in patients with a textbook outcome (mean 1.47 months vs. 2.56 months, P < .001). Conclusion We present a definition for textbook outcome for distal pancreatectomy based on systematic review; the only parameter affecting 180-day mortality was a major complication. All parameters affected time to adjuvant therapy in adenocarcinoma. The definition of textbook outcome is not universally applicable and should be evaluated based on disease type.

Early detection of treatment resistance and progression in metastatic melanoma may improve outcomes, but current surveillance relies on intermittent radiographic imaging that may lag behind dynamic tumor biology. Circulating tumor DNA (ctDNA), a minimally invasive and increasingly validated biomarker, enables real-time disease monitoring. Longitudinal (kinetic) changes in ctDNA over time have been proposed to provide greater insight into disease activity than isolated measurements; however, few studies have evaluated the prognostic significance of longitudinal ctDNA kinetics across extended timepoints. We aimed to assess the relationship between ctDNA concentration, ctDNA longitudinal kinetics, and future radiographic progression in patients receiving systemic therapy. We quantified BRAF V600E/V600K, or NRAS Q61 ctDNA using droplet digital polymerase chain reaction from longitudinal plasma samples from patients with metastatic cutaneous melanoma. A multivariate Cox proportional hazards model using a time-to-event framework was fit, treating each patient as contributing multiple 100-day landmark intervals. Predictors of future progression included percent variant allele frequency at each follow-up assessment and Δ

To examine the development, performance, and potential integration of three commercially available gene expression profiling (GEP) assays for primary melanoma into clinical practice through a comparative and evidence-based lens. Recent prospective data has shown the ability for GEP assays to provide additional objective data in stratifying risk of sentinel node positivity for primary melanoma. GEP assays have emerged for patients with melanoma to better define individual metastatic risk based on tumor-intrinsic biology and refine decisions around SLNB, surveillance, and adjuvant therapy. While prospective evidence is currently insufficient to show the associated prognostic value of these tests improves clinical outcomes in all patients with melanoma over clinicopathologic variables alone, these assays may serve as a useful and objective adjunct in clinical decision-making promoting personalized care.

BACKGROUND:Radiation therapy prevents locoregional recurrence and improves outcomes in patients with positive lymph nodes undergoing mastectomy. Axillary lymph node dissection combined with radiation has not provided additional survival benefit. We evaluated the efficacy of postmastectomy radiation therapy and the effect of extent of axillary surgery. METHODS:Women with pT1-T2 breast cancer undergoing mastectomy with 1-2 positive lymph nodes were identified within the National Cancer Database from 2012 to 2021. Propensity-weighted Kaplan-Meier survival and Cox proportional hazards models were constructed to compare overall survival between groups. RESULTS:A total of 71,776 patients met inclusion criteria, with 39,319 (55%) receiving postmastectomy radiation therapy. Most patients had T1c (36%) or T2 (51%) disease and 1 positive lymph node (75%). A little over half (56%) underwent axillary lymph node dissection. Patients receiving postmastectomy radiation therapy were younger; had fewer comorbidities; and were more likely to have T2 disease, have 2 positive lymph nodes (33% vs 19%, P < .001), and undergo sentinel lymph node biopsy (49% vs 40%, P < .001). Ten-year OS probabilities were higher for patients receiving postmastectomy radiation therapy compared with patients who did not. Adding axillary lymph node dissection did not show an overall survival benefit. These differences persisted in a propensity-weighted Cox model adjusting for significant prognostic factors, where postmastectomy radiation therapy was associated with a 26% reduction in risk of death (hazard ratio 0.74 [95% confidence interval 0.70-0.78]), but the addition of axillary lymph node dissection was not (odds ratio 0.98 [0.92-1.03]) CONCLUSION: Data from the National Cancer Database support omission of further axillary surgery in patients with early-stage breast cancer with 1 to 2 positive lymph nodes undergoing postmastectomy radiation therapy and confirm the benefit of postmastectomy radiation therapy shown in most prospective studies.

BackgroundBiopsy is the only definitive method for diagnosing pancreatic ductal adenocarcinoma(PDAC) in the preoperative setting. With the increasing use of neoadjuvant therapy, alternative diagnostic modalities would aid in cases where fine-needle aspiration(FNA) is inconclusive or challenging. We hypothesized that radiomic signatures generated from computed tomography(CT) scans can help diagnose PDAC with high fidelity and radiologic/radiomics features have utility in predicting clinical outcomes.MethodsPatients with PDAC who underwent oncologic pancreatectomy from 2017-2019 were selected. Preoperative CT scans were reviewed by two body radiologists and two pancreatic surgeons. Tumors were segmented using two radiomics software platforms(Platform A&B).ResultsTwenty-five patients were included (n = 20 PDAC,n = 5 pancreatic neuroendocrine tumors(pNET)). Neoadjuvant chemotherapy was administered in 80% of PDAC patients, and 60% underwent pancreaticoduodenectomy. Platform A extracted 455 independent radiomics features and Platform B extracted 2078 radiomics features corresponding to shape, texture, filter, and intensity. One principal component from the shape feature group showed significant discrimination between PDAC and pNET, within both Platform A and B(area under the curve(AUC) = 0.81,p = 0.038 and AUC=0.89,p = 0.017, respectively). Additionally, a gray-level co-occurrence matrix sum entropy feature identified with Platform B differentiated malignant pancreatic tissue from normal parenchyma and PDAC from normal gland(p < 0.05).ConclusionRadiologic/radiomic features are reliable tools for PDAC diagnosis and associate with clinical outcomes. An improved understanding of PDAC radiomics may have implications for prognosis, margin status, and treatment response assessments.

BACKGROUND:Controversy exists regarding the overutilization of sentinel lymph node biopsy for nonulcerated T1b melanomas. We previously proposed an algorithm based on mitotic rate, age, and Breslow thickness that suggested that over half of nonulcerated T1b patients could forgo sentinel lymph node biopsy. We sought to validate this model and compare it with the Melanoma Institute Australia's nomogram. METHODS:The 2022 National Cancer Database Public Use File was used to identify clinically node-negative melanoma patients with nonulcerated T1b melanomas staged by sentinel lymph node biopsy from 2016 to 2022. The sentinel lymph node positivity rates for our previously described low-risk groups (mitotic rate = 0 mm2 or mitotic rate ≥1/mm2 + thickness <1.0 + age >56) were calculated. The Melanoma Institute Australia's nomogram was used to calculate predicted sentinel lymph node positivity for patients with pathologically complete records. RESULTS:We identified 18,957 patients with nonulcerated T1b melanomas who underwent sentinel lymph node biopsy. A mitotic rate of <1/mm2 had a low risk of a positive sentinel lymph node (3.9%; 95% confidence interval, 3.5-4.4%). The other previously proposed low-risk group had a sentinel lymph node-positive rate exceeding the >5% threshold (5.7%; 5.0-6.4%). Using a mitotic rate <1/mm2 as a criterion, 38% of T1b nonulcerated patients could avoid sentinel lymph node biopsy. More patients would avoid sentinel lymph node biopsy with our algorithm versus the Melanoma Institute Australia's nomogram (39% vs 28%). For those with mitotic rate = 0, age cutoffs of ≤42 (sentinel lymph node + rate 7.0%, 5.2-9.1%) or ≤56 (sentinel lymph node + rate 5.4%, 4.3-6.6%) identified younger patients for whom sentinel lymph node biopsy should be considered. CONCLUSION:One-third of patients with nonulcerated T1b melanomas have a low predicted risk of a positive sentinel lymph node. When parameters are not available to calculate the Melanoma Institute Australia's nomogram, mitotic rate in conjunction with age is a suitable decision aid for recommending sentinel lymph node biopsy.

BACKGROUND:Patients with cancer in rural areas often encounter significant barriers to accessing cancer care. This study evaluated whether Medicare-aged patients can safely undergo lung and colon cancer surgery at their local rural hospital, limiting travel burden. STUDY DESIGN:Surveillance, Epidemiology, and End Results-Medicare files were used to identify patients with stage I to III colon and lung cancers. Patients residing in ZIP codes outside metropolitan statistical areas were defined as rural; facilities were similarly categorized. Rural patients undergoing elective colon or lung cancer surgery at rural vs urban facilities were compared. Unadjusted and risk-adjusted complication and mortality rates were compared using multivariate logistic regression. Driving distances between patients' residences and surgery facilities were calculated on the basis of ZIP codes. RESULTS:A total of 10,383 rural patients with colon cancer and 6,006 rural patients with lung cancer were identified. There were no clinically significant differences between rural and urban treatment groups in either colon or lung cohorts in terms of demographics or cancer stage; their comorbidity risks were similar. Mortality and complication rates were comparable across urban and rural facilities. Travel distance was significantly greater for patients treated at urban facilities than for those treated at rural facilities for patients with colon cancer (49 vs 16 miles, p < 0.001) and lung cancer (61 vs 35 miles, p < 0.001). CONCLUSIONS:Rural patients can achieve comparable short-term surgical outcomes for lung and colon cancer when treated at local rural facilities, thereby decreasing the travel burden of treatment at higher-volume urban facilities.

Abstract Purpose: Circulating tumor DNA (ctDNA) is a promising biomarker for real-time monitoring of treatment response and recurrence, but current sequencing-based assays are limited by cost, TAT, performance on difficult regions, and sampling frequency. Universal Signal Encoding PCR (USE-PCR) is a highly multiplexed digital PCR chemistry that enables >30 tumor-informed targets to be measured per reaction. We evaluated its performance in a longitudinal melanoma cohort with dense serial sampling. Methods: Tumor/ctDNA sequencing identified subject-specific variants, including challenging GC-rich loci such as TERT c.-124C>T. Multiplexed, tumor-specific USE-PCR panels were designed using Apollo, an automated cloud-based workflow. Panels flexibly incorporated additional targets and were compatible with low-shedding ctDNA. Plasma cfDNA and matching PBMC samples were collected from 8 melanoma subjects at high density (up to 20 timepoints per patient over ∼2 years). Plasma ctDNA VAF trajectories, corrected for PBMC, were quantified on a commercial dPCR platform and compared with clinical course and treatment events. Analytical validation included sensitivity, precision, linearity, specificity, cross-platform performance, and robustness with low DNA input (<10 ng). Results: USE-PCR detected distinct molecular phenotypes including clear treatment response (rapid VAF decline), molecular recurrence (0→5%→15% VAF within ∼80 days), stable disease (VAF ∼0), and mixed responses with target-specific fluctuations often preceding clinical progression or therapy change. An average of four variants were measurable per subject. Sampling at ∼20-day intervals uncovered rapid, low-level shifts in ctDNA, including subclonal SNVs at <0.2% VAF, not achievable with quarterly surveillance. Detection was reliable down to 80 ppm with ≤14 SNV targets, strong precision (CV <15%), and linearity over 4 logs. The platform was robust on GC-rich and historically difficult NGS targets, including the TERT promoter, maintained performance with low cfDNA input (<10 ng), and allowed seamless addition of new variants (e.g. BRAF V600E/K, NRAS Q61) for longitudinal monitoring. Conclusions: USE-PCR is a rapid (median TAT < 6 hrs), low-cost, and highly scalable platform for tumor-informed ctDNA monitoring, enabling high multiplexing, compatibility with difficult genomic loci, and frequent sampling suitable for real-time clinical management. High-density longitudinal data reveal molecular patterns aligned with disease activity supporting USE-PCR for dynamic treatment response assessment and recurrence monitoring. Processing of a larger cohort is in progress to enable prospective clinical validation. Citation Format: Hunter Miller, Annalara Fischer, Melissa Hall, Michael E. Egger, Kavitha Yaddanapudi, Lucien Jacky, John Alvarado, Aaron Aguiar, Nathaniel Clark, Paul Belitz, Jeremy Myslinski, Jerrod Schwartz, Paul Flook, Mark Linder. Longitudinal ctDNA monitoring in melanoma using highly multiplexed USE-PCR incorporating bespoke targets enables real-time detection of treatment response and recurrence [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 3844.

Previous studies have used national data to assess readmission risk factors for patients with burn injury. This study sought to identify risk factors for readmission amongst unhoused burn patients. The 2022 Nationwide Readmissions Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, was used for this study. Patients with International Classification of Diseases Version 10 codes for burn or corrosive injury between January 1, 2022, to November 30, 2022, were included in analysis. Readmission was defined as a subsequent encounter within 30 days with a diagnosis of burn. 18 607 encounters were identified as index admissions, 1130 (6.1%) were unhoused. 8.6% of unhoused patients (n = 97) were readmitted with a diagnosis of burn injury compared to 5.2% (n = 908) of housed patients (P < .001). Risk factors for readmission for unhoused patients included a third-degree burn (OR 2.4, [1.4-4.2], P < .001), leaving against medical advice (OR 4.1, [2.6-6.6], P < .001), burn of the trunk (OR 1.9, [1.2-3.0], P < .001), burn of the upper extremity (OR 1.9, [1.2-3.0], P < .001), and burn of the lower extremity (OR 1.6, [1.0-2.6], P = .004). Despite higher rates of diagnoses such as schizophrenia, bipolar disorder, alcohol abuse, and/or substance abuse in the unhoused population, these factors did not increase risk for readmission. Unhoused burn patients were at higher risk of readmission than housed patients, even when adjusting for other risk factors for readmission. Severity of injury, location of injury, and leaving against medical advice were associated with readmission amongst unhoused patients. Leaving against medical advice was a potentially modifiable risk factor identified for readmission risk mitigation in this study.

Background: Ambient air pollution is a modifiable determinant of lung cancer survival, affecting early-stage Non-Small Cell Lung Cancer (NSCLC) incidence and mortality. Methods: This retrospective cohort study examined the association between all-cause mortality and exposure to air pollution among stage 1A NSCLC-treated patients from the U.S. National Cancer Registry from 1988 to 2015. The Cox hazard model and Kaplan–Meier survival plots were provided. Air pollutants were included separately and together in the models, accounting for spatiotemporal weather variability affecting air pollution exposure levels pre and post lung cancer diagnosis. Results: NO2 (above the median sample mean = 25.66 ppb; 12.97 ppb below median), SO2 (above median sample mean = 3.98 ppb; 1.81 ppb below median), and CO (above median sample mean = 1010.84 ppb; 447.91 ppb below median) air pollutant levels and weather conditions were calculated for county-day units. The median months of survival for those exposed to above-median NO2 were 27 months (SD = 17.61 months), while the median was 30 months (SD = 15.93 months) for those exposed to below-median levels. Multipollutant analyses indicated that an average monthly NO2 increase of 1 part per billion (ppb) in the county of NSCLC diagnosis was associated with increases of 4%, 6%, and 9% in the all-cause mortality rate one, three, and five years after diagnosis, respectively; an equivalent increase in SO2 was associated with increases of 16%, 17%, and 17%; and an increase in CO was associated with increases of 53%, 51%, and 42% Conclusion: It is vital to implement environmental policies that control emissions to reduce preventable deaths in stage 1A NSCLC patients with adenocarcinoma or squamous cell carcinoma histology types who reside in metropolitan areas.

INTRODUCTION:Adjuvant immunotherapy is approved for patients with Stage IIB melanoma but carries risks and costs. The aim of this study was to identify high-risk stage IIB patients to help inform adjuvant immunotherapy decisions. METHODS:The NCDB was queried to identify patients with stage IIB melanoma. Cox proportional hazards models identified risk factors for overall survival (OS). Conditional inference survival trees were used to create distinct risk groups. These groups were validated for melanoma-specific survival using SEER database. RESULTS:12,610 patients were identified in the NCDB with Stage IIB melanoma. Three groups were identified with significant differences in OS: age <54, age ≥54 with MR ​≤ ​3/mm2, and age ≥54 with MR ​> ​3/mm2. Among the 7599 patients with Stage IIB melanoma in the SEER database, the cumulative incidence of melanoma-specific death at 5 years was significantly different between these groups (12 ​% vs 15 ​% vs 20 ​%). CONCLUSIONS:Distinct melanoma-specific survival can be identified in stage IIB melanoma patients based on age and mitotic rate. These groups can be considered to inform decision-making for adjuvant therapy.

BACKGROUND:The definition of T1b cutaneous melanoma was changed in the 8th edition of the American Joint Committee on Cancer (AJCC) staging system based on survival differences but not risk of sentinel lymph node (SLN) metastases. We sought to evaluate changes in SLNB use and rates of positive SLNB in response to updated staging criteria, and to evaluate the incidence of high-risk features in T1a melanoma in whom SLNB is now recommended. STUDY DESIGN:The 2021 National Cancer Database Melanoma Participant User File was used to obtain SLNB use and positivity rates in T1 (thin) melanoma (thickness 1.0 mm or less) from 2012 to 2021. Rates were compared between AJCC 7th (2012 to 2017) and 8th editions (2018 to 2021). Factors associated with SLNB use in nonulcerated T1 melanoma were evaluated. The presence of high-risk features in T1a melanoma was identified and SLN positivity rates were reviewed. RESULTS:A total of 136,966 cases were included with 76,485 (55.8%) cases diagnosed under the AJCC 7th edition era (2021 to 2017). The overall proportion of patients with thin melanoma undergoing SLNB was relatively stable over the time periods, roughly 30%. In the AJCC 8th edition era, the overall SLNB positivity rate slightly increased from 4.5% to 6.6% (p < 0.001). There was increased SLNB use in melanoma with a thickness of 0.8 to 1.0 mm (T1b: odds ratio 2.53 [95% CI 2.31 to 2.78]) and decreased use when the thickness was less than 0.8 mm (T1a: odds ratio 0.80 [0.76 to 0.85]). The rate of SLNB positivity increased in both thickness groups over time. CONCLUSIONS:After implementation of the AJCC 8th edition staging criteria, surgeons have become more selective in SLNB use with a resulting increase in SLNB positivity rate. Fewer SLNBs in T1a and more SLNBs in nonulcerated T1b are being performed.

The journal retracts the article, "Actively Targeted Nanodelivery of Echinomycin Induces Autophagy-Mediated Death in Chemoresistant Pancreatic Cancer In Vivo" [...].

Importance:Contemporary guidelines recommend sentinel lymph node biopsy (SLNB) for patients with melanoma with predicted risk of SLN metastasis greater than 10% and consideration of SLNB when the risk is 5% to 10%. A gene expression profile (GEP)-based test that can accurately identify patients with a low risk of SLN metastasis would refine selection for SLNB. Objective:To establish the predictive capability of the combined clinicopathological factors and GEP (CP-GEP) test to identify patients with primary cutaneous melanoma who can safely forgo SLNB and to investigate the prognostic value of CP-GEP regarding the outcome in patients with cutaneous melanoma after a negative SLNB (not reported herein). Design, Setting, and Participants:This prognostic study was conducted from September 2021 to June 2024 at 9 academic medical centers with experienced melanoma surgeons. Included were patients with biopsy-proven invasive cutaneous melanoma with T1 to T3 tumors and clinically negative regional LNs. All patients were deemed candidates for SLNB using standard clinical criteria. GEP was performed on formalin-fixed, paraffin-embedded tissue from the primary melanoma biopsy. Analyses were performed from December 2024 to August 2025. Intervention:CP-GEP testing to determine risk of having a positive SLNB in patients with T1 to T3 cutaneous melanoma who were considered appropriate candidates for the procedure based on standard clinical parameters. Main Outcomes and Measures:CP-GEP results were reported as low risk or high risk; the primary outcome measure was negative predictive value (NPV) in low-risk cases. Analyses included NPV assessment by tumor (T) subcategory, primary site, and age. Results:A total of 1761 patients (median [IQR] age, 64 [53-72] years; 997 male [56.6%]) underwent SLNB (310 [17.6%] SLN positive) and had a successful CP-GEP test; GEP was successful in 97.7% of samples. A total of 651 patients (37.0%) were considered low risk by CP-GEP. Among low-risk cases, 46 (7.1%) were SLN positive, and NPV was 92.9% (95% CI, 90.7%-94.8%). High-risk cases had a 23.8% (264 of 1110) SLN-positive rate. The percentage of cases with low-risk CP-GEP declined with increasing T category (T1 = 346 of 507 [68.2%]; T2 = 295 of 897 [32.9%]; T3 = 10 of 357 [2.8%]). CP-GEP results were consistent in discriminating SLN-positive rates across primary sites, histologic subtypes, and mitotic count categories. In 2 large subsets, clinical stage IB (n = 1187) and patients 65 years and older (n = 832), 6.5% (95% CI, 4.6%-8.8%) of low-risk clinical stage IB cases and 6.6% (95% CI, 4.2%-9.7%) of all low-risk cases in patients 65 years and older were SLN positive vs 18.3% (95% CI, 15.3%-21.6%) and 20.3% (95% CI, 16.8%-24.2%) for high-risk cases, respectively. Conclusions and Relevance:In this multicenter, prospective, blinded, prognostic study, the CP-GEP test reliably identified patients with melanoma with less than 10% SLN metastasis risk. SLN metastasis rates were approximately 3-fold greater for high-risk vs low-risk CP-GEP cases. In appropriately selected patients, the CP-GEP test may add value for shared patient-surgeon decision-making.

BACKGROUND:Adequate postoperative pain control is essential after mastectomy. This study compares the influence of 2 regional analgesia techniques on length of stay and opioid use to systemic analgesia alone. METHODS:Patients treated with mastectomy from 2014 to 2020 were stratified according to perioperative analgesic modality (systemic analgesia versus thoracic epidural anesthesia or erector spinae plane block). Demographic, tumor, and treatment characteristics were compared. Outcome variables included postoperative anesthesia unit and hospital length of stay, postoperative day 1 and 2 discharge rates, and inpatient opioid use (in oral milligram morphine equivalents). RESULTS:Of 316 patients, 171 received systemic analgesia, 72 thoracic epidural anesthesia, and 73 erector spinae plane block. On univariate analysis, there were significant differences in age, neoadjuvant chemotherapy, bilateral surgery, immediate reconstruction, and Her2 positivity rates. Thoracic epidural anesthesia had the longest hospital length of stay, and erector spinae plane block the shortest, compared with systemic analgesia (52.1 vs 28 vs 30.6 hours, P < .0001). Postoperative day 1 discharge was more likely with erector spinae plane block than systemic analgesia and less likely with thoracic epidural anesthesia (89% vs 68.4% vs 30.6%, P < .0001). Erector spinae plane block required significantly less milligram morphine equivalents than thoracic epidural anesthesia or systemic analgesia on postoperative day 1 (10 vs 18.75 vs 20 milligram morphine equivalents, P < .0009), but no differences on postoperative day 2 (23.5 vs 20 vs 25 milligram morphine equivalents, P = .84). Total hospital opioid use was significantly lower for erector spinae plane block than thoracic epidural anesthesia or systemic analgesia (24 vs 32.3 vs 32 milligram morphine equivalents, P = .024). On multivariate analysis, thoracic epidural anesthesia was associated with significantly longer length of stay, whereas neither thoracic epidural anesthesia nor erector spinae plane block was associated with decreased opioid use. CONCLUSION:Regional analgesia is not significantly associated with decreased opioid use or hospital length of stay.