Xiaoying Lou Receives Presentation Award at ECTSS Annual Meeting

November 2018

Xiaoying Lou, MD, PGY-4 cardiothoracic surgery integrated resident, won the Best Thoracic Surgery Oral Presentation Award at the 2018 Annual Meeting of the Eastern Cardiothoracic Surgical Society (ECTSS).

The abstract was titled "Safety and feasibility of thoracoscopic lung resection for non-small cell lung cancer in octogenarians," and was concerned with the fact that patients in their 80s comprise an increasing proportion of patients presenting with non-small cell lung cancer (NSCLC). Under the guidance and mentorship of Emory cardiothoracic surgeon Onkar Khullar, MD, Dr. Lou specifically examined post-operative morbidity and mortality and long term survival in octogenarians undergoing thoracoscopic anatomic lung resection for NSCLC compared with two younger cohorts, 60-69 years of age and 70-79.

The study team, which also included Emory cardiothoracic surgeons Drs. Manu Sancheti, Jeffrey Javidfar, Allan Pickens, Seth Force, and Felix Fernandez, and Emory medical student Andrew Sanders, conducted a retrospective review of 738 patients that presented with operable stage I or II NSCLC and underwent video-assisted thoracic surgery (VATS) between 2009-2018, culled from Emory's patient data repository for the Society of Thoracic Surgeons General Thoracic Surgery Database. Results were compared between patients aged 60-79 (n=668) and 80-89 (n=71). Long-term survival among octogenarians was further assessed using Kaplan-Meier analysis.

The mean age of each cohort was 82.6±2.5 and 69.1±5.1 years. There were no significant differences in post-operative length of stay or baseline co-morbidities, though the younger cohort was more likely to have T3/T4 cancer. However, a greater proportion of octogenarians required admission to the intensive care unit and discharge to extended care facilities. Among postoperative complications, only renal failure was more likely in the older cohort.

While in-hospital mortality was equivalent in both groups, thirty-day mortality was significantly higher among octogenarians (5.6 percent versus 1.5 percent, p=0.04). Overall survival among octogenarians at one, three, and five years was 86.8 percent, 50.3 percent, and 37.8 percent, respectively. On univariate analysis of baseline demographic variables, only the presence of stroke was a significant independent predictor of mortality (HR 2.98).

Dr. Lou and her co-authors agreed that the results showed that thoracoscopic anatomic resection could be performed with favorable early post-operative outcomes in carefully selected octogenarians with NSCLC, and that age alone should not exclude them from this therapy.

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