• Researchers have found that video-assisted thoracoscopic surgery (VATS) is superior to more invasive open lobectomy surgery for people with early non-small cell lung cancer (NSCLC).
• In an update to an ongoing study, United Kingdom-based researchers found that people who underwent VATS had less pain, fewer complications, and shorter hospital stays than those who had open lobectomies.
• Despite the differences in recovery after surgery, the researchers found no significant effect on overall survival.

Video-assisted thoracoscopic surgery for people with early-stage non-small cell lung cancer was found to lower complications, cost less, and result in less pain and shorter hospital stays when compared to an open lobectomy, according to a recent update to an ongoing study. VATS is a minimally invasive surgery that uses a small camera, known as a thoracoscope, and surgical instruments inserted in the chest through a small incision. An open lobectomy involves opening the chest wall to remove the lung lobe affected by cancer. Dr. Eric Kian Saik Lim and his colleagues presented their findings at the 2021 American Society of Clinical Oncology annual meeting.

The ongoing study is called VIOLET, which stands for “(VI)deo assisted thoracoscopic lobectomy versus conventional (O)pen (L)ob(EcT)omy for lung cancer.” VIOLET is a randomized clinical trial being conducted at nine sites across the U.K. to compare VATS to open lobectomy. The overall goals of the study are to compare the two methods in terms of effectiveness and cost-effectiveness.

Researchers have noted a lack of evidence on this subject, because previous studies have been too small or nonrandomized. To address this need, the VIOLET study was designed as a large, multicenter trial that involves hundreds of participants and surgeons to determine the differences between the two surgeries.

In the VIOLET study, 503 people diagnosed with NSCLC or thought to have NSCLC were randomly chosen to undergo VATS or open lobectomy. People in the VATS group reported less pain and took less pain medication compared to the open lobectomy group. The VATS group also recovered more quickly and had fewer complications, as well as less risk for serious adverse events after leaving the hospital. Overall, people who underwent VATS were discharged one day earlier than those who had an open lobectomy.

Readmission rates to the hospital in the first year after surgery were lower in the VATS group than in the open lobectomy group, at 29 percent compared to 35.9 percent, respectively. However, the study found that having VATS or an open lobectomy had no effect on the overall survival rate.

Dr. Lim stated, “Patients who were randomized to VATS had a higher quality of life … and also lower overall hospital costs out to one year when taking into account the costs of surgery, complications, hospital stay, and readmissions.”

Lim also noted that, “Post-discharge complications in favor of VATS were driven by lower blood, heart, and gastrointestinal complications.”