Treatment of Early Lung Cancer With Video-Assisted Surgery

Surgical resection is a standard of care for early lung cancer. However, the most frequent surgical approach, open surgical resection, is associated with a high degree of morbidity and risk of complications. Video-assisted thoracic surgery (VATS), sometimes called ‘keyhole surgery’, is an alternative approach to surgery for lung cancer, but it is currently underutilized, particularly in the United States. At the 2019 World Conference on Lung Cancer, Eric Lim, MD (Royal Brompton Hospital, London, United Kingdom), presented results from the VIOLET trial (Abstract PL02.06 ), a parallel group study comparing VATS to open resection in 503 patients with early-stage lung cancer treated in thoracic cancer centers across the United Kingdom.

Compared to open resection, VATS was associated with improved postsurgical outcomes and comparable oncologic outcomes. On day 2 after surgery, patients undergoing VATS had a median pain score of 3 on visual analogue scales, compared to 4 for patients undergoing open surgery. In-hospital complications were lower in patients undergoing VATS (32.8% vs 44.3%; P = .008), and the length of hospital stay was shorter in the VATS group (4 days vs 5 days; P = .008). Rates of serious adverse events were similar between the two modalities (8.1% vs 7.8%).
The median number of lymph node stations harvested was 5 in each group, though the rate of surgical upstaging was higher in patients undergoing VATS compared to open surgery (6.2% vs 4.8%). The rate of complete resection was identical between the two treatment groups.

The investigators concluded that VATS is equally as effective as open surgery in the treatment of early lung cancer, and is associated with lower rates of treatment-related complications, including lower postoperative pain and shorter hospital stays. These are the first randomized clinical trial data supporting the use of VATS over open surgery in treatment of early lung cancer.

Read more about this study on Medscape News .
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