Surgical Treatment Strategies in Chronic Pancreatitis
Bibliographic record
Abstract
OBJECTIVE: To research the optimal surgical strategy for chronic pancreatitis. DATA SOURCES: PubMed, EMBASE, Science Citation Index, SpringerLink, and secondary sources from inception through December 31, 2011, with no restrictions on languages or regions. STUDY SELECTION: All controlled experimental (randomized and nonrandomized) studies in which duodenum-preserving pancreatic head resection was compared with pancreaticoduodenectomy in chronic pancreatitis. DATA EXTRACTION: Data were extracted independently and in duplicate by 2 reviewers; discrepancies were resolved by discussion. DATA SYNTHESIS: A total of 1007 patients from 15 studies were included in the meta-analysis. The relative risks for postoperative pain relief and postoperative morbidity in the Beger procedure were 1.29 (95% CI, 1.03-1.61; P = .03) and 0.55 (0.21-1.39; P = .20), respectively, compared with pancreaticoduodenectomy. These results are just the opposite in the Frey procedure, in which a significantly better outcome was shown in postoperative morbidity compared with resection (relative risk, 0.60; 95% CI, 0.46-0.78; P < .01) but not in postoperative pain relief (1.03; 0.90-1.17; P = .67). In terms of quality of life, pancreatic exocrine function, and delayed gastric emptying, the results also favored duodenum-preserving strategies. CONCLUSIONS: For the duodenum-preserving strategy of the Beger procedure, complete pain relief is achieved in most patients, but there is no evidence that it has a better result in postoperative morbidity. For the Frey procedure, a significantly lower postoperative morbidity is demonstrated, but complete pain relief is not provided in most cases. Thus, compared with conventional pancreaticoduodenectomy, both new strategies should be recommended on the basis of the patients' appropriate individual preferences.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.029 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".