Important outcomes for transanal total mesorectal excision in a Canadian population after using transanal minimally invasive surgery (flexible) or transanal endoscopic microsurgery (rigid) platforms
Bibliographic record
Abstract
Background: There are no clinical studies comparing the short-term oncologic outcomes of transanal total mesorectal excision (TaTME) after using the flexible transanal minimally invasive surgery (TAMIS) vs. rigid transanal endoscopic microsurgery (TEM) platforms. The purpose of the study was to compare outcomes of TaTME surgery in a Canadian population when using a flexible vs. a rigid platform for patients with rectal neoplasia. Methods: This is a retrospective, observational study utilizing prospectively collected data from two institutions. Inverse probability of treatment weights (IPTW) analysis was used to facilitate accurate estimation of treatment effects on outcome measures. The study was conducted at two high volume rectal cancer surgery centers in Canada. Only patients with rectal neoplasia who received TaTME were included, using either the flexible (TAMIS) or rigid (TEMS) platform. Results: The total cohort consisted of 223 patients (116 with the rigid and 107 with the flexible platform). Two sets of patients 109 vs. 99 were eligible for inclusion. The incidence of complete/near complete specimens was 98.9% for TAMIS vs. 91.5% for TEMS. Oncological outcomes are comparable for both platforms when considering specimen completeness and negative margins (98.9% vs. 95.6%). A subgroup analysis demonstrated no difference between the two devices beyond proficiency (40 cases). Limitations include a relatively small number of cases and difficult generalizability since only 2 specialized centers participated in this project. Differences in patient selection and surgeon technique cannot be excluded. Conclusions: Both flexible (TAMIS) and rigid (TEMS) platforms are safe and suitable options for TaTME. Surgical and oncological outcomes are equivalent once proficiency level is reached.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| 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".