Trends of colorectal cancer surgery in 2022
Notice bibliographique
Résumé
Trends of colorectal cancer surgery in 20222022 was a great year for high-quality submissions to BJS Open in the field of colorectal cancer (CRC) surgery.Layfield and associates 1 documented how changes in treatments delivered by the multidisciplinary team (MDT) over 14 years, demonstrating how implementation of CRC management based on the latest gold standards, significantly improved survival and reduced mortality in a high-volume UK institution.Of note, concerning older patients, they demonstrated the changing pattern in MDT decisions with a decreased rate of surgical intervention.Despite this reduction in surgery and oncological therapies, the survival benefit was also seen among patients aged 80 years or more, which may reflect the 'inclusion of patients who would previously have undergone surgery but lived a little longer without it' or had fatal complications after major procedures.Regarding management, in their analysis of 41 800 patients from Denmark and Yorkshire (UK), Taylor and co-authors 2 reported the application of specific policies in Denmark at a national level that resulted in a reduction in left-sided emergency resections and an increase in stenting.This resulted in conversion of potential emergency into elective resections and reduced 30-day postoperative mortality.The debate on management leads to other important topics: cost-effectiveness and correction of modifiable preoperative risk factors with protocols implemented at institutional level.In particular, a large Canadian study 3 , analysing circular stapler anastomotic rings specimens from nearly 490 CRC resections, confirmed that their routine pathologic evaluation is not useful, as no patients had cancer in the ring specimen, 5.1 per cent had benign pathological findings and patients' management was never affected by this result.Also, in another registry study including nearly 6200 patients from Sweden 4 , authors documented that the routine use of rectal washout during anterior resection did not impact the 3-year oncological outcomes, even if a reduction in local recurrence risk after the 5-year follow-up was observed.In another large Danish study 5 , authors investigated the effect of screening for modifiable high-risk factors combined with targeted interventions in CRC surgery.These consisted of a screening for anaemia, low functional capacity, and nutritional status and their implementation (iron supplementation, pre-habilitation, nutritional supplements, and consultation with a dietician) for a minimum of 4 weeks before surgery.Even when analyses were balanced for age, sex, smoking habits, stage of disease, ASA score, surgical approach, and surgical procedure, the intervention was associated with a 10.9 per cent absolute risk reduction of a complicated postoperative course, primarily due to a reduction in severe complications, highlighting what and how it's worth to correct.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,003 | 0,004 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».