Bibliographic record
Abstract
Central MessageThoracic surgeons have pushed the technical boundaries of our specialty with multiple success stories, but careful selection and long-term outcomes should still be our guiding principles.See Article page 323. Thoracic surgeons have pushed the technical boundaries of our specialty with multiple success stories, but careful selection and long-term outcomes should still be our guiding principles. See Article page 323. In this issue of JTCVS Techniques, Galvaing and colleagues1Galvaing G. Sassi S. Dagenais F. Conti M. Triple-sleeve lobectomy for non–small cell lung cancer: lessons from a case.J Thorac Cardiovasc Surg Tech. 2020; 4: 323-325Google Scholar present a challenging but gratifying case of triple-sleeve right upper lobectomy, where reconstruction of the bronchus, pulmonary artery, and vena cava was necessary for the success of resection. The patient, a 66-year-old woman, had refused chemotherapy and was not a surgical candidate for a pneumonectomy. Although the caval resection and reconstruction was not planned, it was rapidly executed due to the appearance of superior vena cava syndrome intraoperatively. The patient lived 4 years after the initial resection—a true feat without chemotherapy—and died from a cause not related to lung cancer. The report is rich in technical lessons learned from this case, the likes of which only 4 others have been reported. One cannot help but wonder why that is. Certainly, it would not be because of the paucity of T4 lung tumors. Could it be because many of these patients are receiving a pneumonectomy? Or is it because such operations have been tried and were not successful? So how do we measure the success of such cases? The most valuable lesson that I learned from this case is not technical. It is that the feasibility of these cases is measured by a large number of critical steps—patient selection, surgeon selection, investigations, execution, and postoperative care. However, the success of these cases is measured only by one critical metric—survival. The authors waited 4 years to publish this report and only did so after it was determined that this patient will never have lung cancer recurrence. In other words, the technical lessons from this case are only worth sharing if the operation was beneficial to the patient. We continue to push the technical boundaries of our specialty with multiple success stories, but we should never lose focus of why we do what we do. We don't do it because we can. We do it because it saves a life, for more than 90 days. Sometimes, the difference is not clearly obvious. Triple-sleeve lobectomy for non–small cell lung cancer: Lessons from a caseJTCVS TechniquesVol. 4PreviewThe combination of a bronchial and arterial (double) sleeve lobectomy associated with the prosthetic replacement of the superior vena cava (SVC) has rarely been reported. Herein, we report such a case and highlight operative technique and pitfalls. Full-Text PDF Open Access
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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 | 0.006 | 0.065 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.005 | 0.008 |
| Scholarly communication | 0.008 | 0.011 |
| Open science | 0.005 | 0.005 |
| Research integrity | 0.050 | 0.063 |
| Insufficient payload (model declined to judge) | 0.049 | 0.027 |
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".