The following article features coverage from the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting. Click here to read more of Cancer Therapy Advisor‘s conference coverage.

Video-assisted thoracoscopic surgery (VATS) was associated with better physical function, less pain, and fewer complications, compared with open surgery, in patients with early-stage lung cancer, according to results of the VIOLET study.

These results were presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting by Eric Kian Saik Lim, MD, of Royal Brompton Hospital in London. 

VIOLET is a multicenter study that included 503 patients with known or suspected lung cancer who were randomly assigned to VATS or open surgery. Dr Kim presented results on the study’s primary endpoint — physical function at 5 weeks — and results out to 1 year.

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Physical function was significantly better in the VATS arm than in the open surgery arm. There was a 4.65-point improvement in physical function with VATS at 5 weeks and a 4.22-point improvement with VATS overall (P = .009 for both).

Dr Lim noted that physical function did not return to baseline for either treatment arm. He said this is likely a reflection of lung function lost due to lobectomy.

In-hospital pain was a median of 1 point lower at day 2 for patients assigned to VATS. This was achieved despite 10% less analgesic consumption compared with open surgery, Dr Lim said. 

On average, patients experienced pain for 3 months after surgery. However, patients in the VATS arm experienced much lower levels of pain compared with patients in the open surgery arm, Dr Lim reported.

Overall, in-hospital safety was improved with VATS over open surgery. VATS patients had significantly fewer adverse events — 32.8% and 44.3%, respectively (P <.001) — but not serious adverse events — 8.1% and 8.2%, respectively (P =.948) — while in hospital.

The lower rates of in-hospital complications with VATS were driven by fewer infections and kidney complications.

After discharge, rates of serious adverse events were 30.7% in the VATS arm and 37.8% in the open surgery arm (P =.053). Rates of hospital readmission were 29.0% and 35.9%, respectively (P value not reported).

The reduction in post-discharge complications with VATS was driven by lower blood, heart, and gastrointestinal complications. The main reasons for readmission across both arms were infections, medical procedures, and shortness of breath.

Among patients who required adjuvant treatment because of lymph node disease, there was no significant difference in the time to uptake of adjuvant treatment between the arms (P =.716).

Recurrence with clinical follow-up and CT at 1 year was also similar between the two arms, and there was no significant difference in progression-free survival (P =.262) or overall survival (P =.283) between the arms.

Dr Lim said most individual components of quality of life scales were consistently in favor of VATS.

In addition, patients randomized to VATS had lower overall hospital costs out to 1 year, when taking into account costs of surgery, complications, hospital stay, and readmissions. The mean total costs were £10,832 for VATS and £13,567 for open surgery.

Disclosures: This research was supported by the UK National Institute of Healthcare Research. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Read more of Cancer Therapy Advisor’s coverage of the 2021 ASCO Annual Meeting by visiting the conference page.


Lim EKS, Batchelor TJP, Dunning  J, et al. Video-assisted thoracoscopic versus open lobectomy in patients with early-stage lung cancer: One-year results from a randomized controlled trial (VIOLET). J Clin Oncol. 2021;39:(suppl 15; abstr 8504). doi:10.1200/JCO.2021.39.15_suppl.8504