VATS in-hospital outcomes may better those of open lobectomy
medwireNews: Video-assisted thoracic surgery (VATS) lobectomy is associated with less pain, fewer in-hospital complications, and shorter hospital stays compared with open lobectomy for early-stage lung cancer, data from the VIOLET study indicate.
The findings, presented at the IASLC World Conference on Lung Cancer 2019 in Barcelona, Spain, also show that these results can be achieved without compromising early oncologic outcomes or increasing the risk for serious adverse events in the early postoperative period.
Eric Lim (Royal Brompton Hospital, London, UK) explained that although VATS is currently the most popular technique used for lung cancer resection in the UK, there are limited data comparing early oncologic outcomes after VATS with those after other types of surgery.
To address this, Lim and colleagues set up the VIOLET trial with the aim of comparing clinical efficacy, safety, and oncologic outcomes of VATS with those of open surgery in patients with lung cancer.
In total, 503 participants (mean age 69 years, 49.5% men) with known or suspected primary lung cancer (stage cT1–3, N0–1, and M0) from nine UK thoracic surgery centers were randomly assigned to receive VATS (one to four ports; n=247) or open surgery (n=256).
WATCH | Eric Lim describes the findings of the VIOLET trial (1:57)
Of these, 89.5% in the VATS group and 90.6% in the open surgery group ultimately underwent lobectomy, with a conversion rate from VATS to open surgery of 5.7%, mainly due to plural adhesions and bleeding (1.6% each). The overall in-hospital mortality rate was 1.4%.
Lim told delegates that, on day 1 post-surgery, patients in both the VATS and open surgery groups reported a median visual analog pain score of 4. On day 2, the median score had fallen to 3 in the VATS group but remained at 4 in the open group.
In addition, significantly fewer patients who received VATS experienced in-hospital complications compared with those who received open surgery, at 32.8% versus 44.3%, and the median length of hospital was significantly shorter with VATS than with open surgery, at 4 versus 5 days.
Lim and co-researchers also found that there was no difference between the two groups in the rates of serious adverse events (8.1 vs 7.8%), complete resection (98.8 vs 97.4%), and lymph node upstaging from cN0/1 to pN2 disease (6.2 vs 4.8%).
By Laura Cowen
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