1. Lessons Learnt The demise of thoracic surgery (Part II)
Mr Eric Lim
MB ChB, MSc (Biostatistics), MD, FRCS (C-Th)
Consultant Thoracic Surgeon
Academic Division of Thoracic Surgery
Royal Brompton Hospital, London, United Kingdom
Clinical Reader in Thoracic Surgery
National Heart and Lung Institute
Imperial College, London, United Kingdom

2. Disclosures Consultancy / Advisory Board
Strategen, Abbott Molecular, Glaxo Smith Klein, Pfizer, Norvatis, Covidien, Ethicon
Educational presentations / speaker
Roche, Imedex, Glaxo Smith Klein, Lily, Pfizer, Medela, Boehringer Ingelheim
Travel, accommodation and course fees
Covidien, Medela
Research funding
ScreenCell®, Meleda
Other
Founder of Informative Genomics (blood based molecular diagnostics laboratory)
Director of the BUPA Cromwell Lung Cancer Screening Programme
Chief Investigator for MARS 2 – surgery versus no surgery for mesothelioma
Chief Investigator for VIOLET – VATS versus thoracotomy for lung cancer

3. The demise of thoracic surgery (Part I)
We are witnessing unprecedented acceleration in advances in competing radiotherapy technology backed by:
Industry (multi-billion dollar companies)
UK government
Exponential growth
International research consortia
RCT evidence of superior survival (Chang et al) in early stage lung cancer
To ensure the survival of our speciality, we need to take on (head to head) clinical trials of surgery versus radiotherapy

4. UK thoracic surgery research agenda
UK Thoracic Surgery Research Collaborative established in 2010
Consortia of research active thoracic surgery centres
Set up an infrastructure for grant funded thoracic surgery research
Surgeons
experience in trial participation
education in trial conduct (ability to randomise)
Thoracic surgery centres
financial support
dedicated thoracic surgery research nurses

12. Screening / eligibility

13. Eligible / consent

15. Lessons learnt Successfully recruiting thoracic surgery trial
Friends rather than colleagues
Sense of community
Research facilities, nurses and training support (finance) critical to success
Sense of fairness is important
New funding model by number recruited
Group authorship (VIOLET Trialists - not Lim et al)

16. Future directions
VIOLET and MARS 2 (in application stages to HTA) will reinforce funding and resources for thoracic surgery clinical trials in the UK
In line with our research agenda to establish trial ready thoracic surgery community in the UK with the next aim to tackle important issues in thoracic oncology (surgery versus radiotherapy trials in early and advanced disease)
Critical to ensure the survival of our speciality

17. Assessment (HTA) programme (project number 13/04/03).
Meeting Room 1, Tuesday 14 March 11:30 Innovate or Perish The Demise of Thoracic Surgery (Part III)
VIOLET is funded by the National Institute for Health Research Health Technology
Assessment (HTA) programme (project number 13/04/03).
Department of Health Disclaimer: The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health.