# VIOLET

Source: https://onco.cc/trials/violet/  
OnCo record `violet` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The UK trial that settled how a lung should be removed: keyhole surgery leaves people functioning better at five weeks and causes fewer serious problems after discharge, with the same survival.

## Summary

VIOLET randomised 503 people with early-stage non-small-cell lung cancer to video-assisted thoracoscopic lobectomy or open lobectomy. At five weeks, median physical function on the EORTC quality-of-life questionnaire was 73 after keyhole surgery against 67 after open surgery, a mean difference of 4.65 points (95 percent confidence interval 1.69 to 7.61). Serious adverse events after discharge occurred in 30.7 percent of the keyhole group against 37.8 percent of the open group (risk ratio 0.81, 0.66 to 1.00). At 52 weeks there was no difference in progression-free survival (hazard ratio 0.74) or overall survival (0.67).

The result matters more now than when it was published: three quarters of English lung resections are done by keyhole or robot, and the National Lung Cancer Audit reports that the number of resections is rising steeply as screening finds more early cancers.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-25
- Also known as: Video-assisted thoracoscopic lobectomy versus conventional Open Lobectomy for lung cancer; ISRCTN13472721
- Tags: uk; surgery; lung
- Registry id: ISRCTN13472721
- Phase: 3
- Setting: Video-assisted thoracoscopic lobectomy against open lobectomy in cT1a to T2b, N0 to N1, M0 non-small-cell lung cancer, recruiting July 2015 to March 2019
- Sponsor: Royal Brompton and Harefield NHS Foundation Trust, funded by the NIHR Health Technology Assessment Programme
- Enrolled: 503
- Result: Physical function at five weeks 4.65 points better after keyhole surgery; serious adverse events after discharge 30.7 against 37.8 percent; no difference in progression-free or overall survival at a year.

## Sources

- NEJM Evidence 2022: https://europepmc.org/article/MED/38319202
- ISRCTN13472721: https://www.isrctn.com/ISRCTN13472721

## Connected records

- cancers: [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Resectable stage I to III non-small-cell lung cancer](https://onco.cc/cancers/resectable-nsclc/)
- fronts: [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- institutions: [Guy's and St Thomas' NHS Foundation Trust / King's Health Partners Cancer Centre](https://onco.cc/institutions/guys-st-thomas/), [The Christie NHS Foundation Trust](https://onco.cc/institutions/the-christie/), [University Hospitals Birmingham / University of Birmingham Cancer Research Centre](https://onco.cc/institutions/birmingham-cancer-centre/)
- terms: [Lobectomy](https://onco.cc/terms/lobectomy/)

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JSON: https://onco.cc/api/v1/entities/violet.json