Extent of resection for curable colorectal cancer in young patients: A 27-year experience at a tertiary care centre
Bibliographic record
Abstract
e15059 Background: Patients diagnosed with colorectal cancer (CRC) under the age of 50 have an increased lifetime risk of developing metachronous primary tumours. Some familial GI cancer experts have recommended that younger patients with curable CRC undergo definitive subtotal colectomy at initial presentation. We sought to determine the compliance with these recommendations at our institution, the factors predictive of subtotal/total colectomy, and the influence of resection extent on survival. Methods: A case- control study utilised a prospective CRC database at Mount Sinai Hospital, Toronto. All patients under 50 who underwent initial resection of CRC with curative intent from 1979–2007 were included. Patients 50 or over were identified as controls. Type of resection was classified as complete (total/subtotal colectomy, proctocolectomy) or segmental. Results: From the database of over 1400 CRC cases, 201 patients were under age 50. 1182 controls were identified. The young patients had significantly higher rates of identifiable risk factors for CRC (IBD, FAP/HNPCC, family history of cancer) and were significantly more likely to undergo complete resection (23.38% vs 6.01%, OR 4.78). Interestingly, rectum was the primary site in 54.73% of young patients. Factors contributing to complete resection were site of disease (colon), IBD, and family history of CRC (Table). Four patients (2.6%) who underwent segmental resection developed metachronous disease at a median of 66.38 months post resection. No significant change in practice was noted over time. Conclusions: The majority of young patients with curable CRC underwent segmental resection only. Factors predictive of a complete resection included IBD, family history of CRC, and colonic primary site. Overall survival was not influenced by extent of resection. The authors support this pragmatic approach while more sophisticated estimates of tumor biology are being developed to guide the decision for more extensive prophylactic resection. [Table: see text] No significant financial relationships to disclose.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".