ASCO 2021: Video-Assisted Thoracoscopy Versus Open Lobectomy for Early-Stage Lung Cancer
Posted: Monday, June 14, 2021
In the VIOLET randomized controlled trial, video-assisted thoracoscopic surgery (VATS) in the treatment of early-stage lung cancer was associated with less pain, fewer in-hospital complications, a shorter hospital stay, and no difference in survival when compared with an open lobectomy. In fact, according to Eric Kian Saik Lim, MD, MBBS, of the Royal Brompton and Harefield Hospitals, London, there appeared to be no difference in disease-free or overall survival up to 1 year. These findings were presented during the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 8504).
This multicenter study enrolled 503 patients with known or suspected lung cancer across the United Kingdom. Patients were randomly assigned to receive VATS or open lobectomy. Patients who underwent VATS had less pain than those who were assigned to open surgery, with a mean difference in visual analog pain scale of –0.54. Patients in the VATS group also utilized fewer analgesic medications than the open lobectomy group. This remained true after hospital discharge, as patients in the VATS group had less overall pain, chest pain, and an 18% relative risk reduction in incisional pain. Additionally, according to the investigators, those in the VATS group had better physical functioning at 5 weeks as well as a reported improvement in global health status after hospital discharge.
While patients were still in the hospital, those in the VATS arm had fewer complications (relative risk = 0.74) than those in the open-procedure group, and no significant difference in serious adverse events was reported (relative risk = 0.98). Further, the median hospital stay was 4 days among the VATS group and 5 days among the open group. Readmission rates were 29.0% for the VATS group and 35.9% for the open-lobectomy group.
The recurrence rate at 1 year was similar between the two groups (7.7% with VATS, 8.1% with open surgery). Overall survival and progression-free survival were likewise not significantly different between the groups, the investigators noted.
Disclosure: For a full list of authors’ disclosures, visit coi.asco.org.