Is laparoscopic resection in select T4 colorectal lesions comparable to open resection for achieving adequate margins?
Bibliographic record
Abstract
e14527 Background: Laparoscopic resection has been considered a relative contraindication for T4 colonic and rectal lesions due to concern over inadequate margins. The objective of this study is to compare planned laparoscopic and open resections of T4 lesions with respect to the positive margin rate. Methods: Data was obtained from the American College of Surgeons National Surgical Quality Improvement Program participant use file to perform a retrospective cohort analysis. The study population consisted of patients that underwent a colorectal resection for a primary T4 lesion during 2011 and 2012. Patients were excluded if they had evidence of metastatic disease. A multiple logistic regression analysis was performed to determine the adjusted odds ratio (OR) of positive margins based on surgical approach (i.e. laparoscopic vs. open). Results: The sub-selected population consisted of 304 and 478 patients in the laparoscopic and open group, respectively. There were no statistical differences between the two groups with respect to demographic and clinical variables including age, sex, body mass index, number of emergency cases, and patients with coagulopathy. However, a significantly higher proportion of patients received neoadjuvant therapy in the open group (p <0.01). The laparoscopic group had 66 (22.68%) cases with positive margins and the open group had 126 (27.9%). Among patients with a planned laparoscopic approach, 77 (25%) required conversion to an open procedure with 19 (25%) cases resulting in positive margins. No statistical difference was found between planned laparoscopic and open resections with respect to positive margin status (OR 0.76, p = 0.13, 95% CI [0.54-1.08]). In addition, no significant clinical predictors for positive margin status were identified. Conclusions: Using this large national surgical database, select patients with T4 lesions that underwent planned laparoscopic colorectal resections did not have a significantly higher positive margin rate compared to patients with open operations. Experienced laparoscopic surgeons are able to selectively perform adequate resections for T4 colorectal lesions.
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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 | 0.002 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 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".