Swiss Society of Surgery
Bibliographic record
Abstract
Objective: Partial pancreato-duodenectomy (PD) is the standard treatment for tumors of the pancreatic head.Preservation of the pylorus has been widely accepted as standard procedure.Delayed gastric emptying (DGE) is a common complication causing impaired oral intake, prolonged hospital stay and postponed further treatment.Recently, pylorus resection with preservation of the stomach has been shown to reduce the incidence of DGE.The aim of this study was to investigate the effect of pylorus resection on postoperative DGE in PD.Methods: Patients undergoing PD for any indication were randomized to either PD with pylorus preservation (PP) or PD with pylorus resection and complete stomach preservation (PR).The primary endpoint was DGE within 30 days according to the ISGPS definition.Furthermore, a multivariate analysis correcting for body-mass-index (BMI) and age was performed.Secondary endpoints were operative time, blood loss, postoperative complications, mortality, length of hospital stay and quality of life (QoL).Results: 188 patients were recruited from February 2013 to June 2016.95 patients were randomized to PP and 93 patients to PR.There were no baseline imbalances between the groups.Overall 53 of 188 patients (28.2%) developed a DGE (Grades: A 15.5%; B 8.8%; C 3.3%).In the PP group, 24 of 95 patients (25.3%) and in the PR group 29 of 93 patients (31.2%) developed a DGE (odds ratio 1.534; 95% confidence interval 0.788 to 2.987; p=0.2079).None of the secondary endpoints differed significantly between the groups.However, higher BMI was a significant risk factor for DGE severity.Conclusion: In this randomized controlled trial, pylorus resection during PD did not impact the incidence or severity of DGE.The development of DGE seems to be multifactorial and may not be attributed to pyloric dysfunction alone.Pylorus preservation should therefore remain the standard of care in PD.
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.559 | 0.440 |
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".