Swiss Society of Surgery
Bibliographic record
Abstract
Objective: CRS/HIPEC has become a treatment of choice for many patients with peritoneal metastasis originating from appendix or colorectal tumors, leading to improved survival rates. However, the pathophysiology behind HIPEC is only poorly understood, and there is an ongoing discussion which protocol to use for HIPEC: a mitomycin C based protocol currently preferred by many surgeons in the US, or the oxaliplatin based protocol developed by FRENCH groups. Here, we describe for the first-time dramatic changes in the postoperative systemic inflammatory reaction, highly different among treatment protocols. Methods: 164 patients after CRS/HIPEC were included in a prospective database. HIPEC was performed according the US protocol (90 min at 42 C with mitomycin C/doxorubicin) or the FRENCH protocol (30 min at 43 C with oxaliplatin). White blood cells (WBC), C-reactive protein (CRP), body temperature, thrombocytes were serially analyzed. In (n = 61) patients, serial blood samples were assessed for procalcitonin (PCT), Interleukin-6 (IL-6), pancreatic stone protein (PSP), and bacterial components (16 s rDNA). Results: In patients treated with the US protocol, a significant secondary CRP increase (p = 0.039) was observed in the second postoperative week, even after uncomplicated CRS/HIPEC, highlighting an ongoing inflammatory process (Figure This increase did not correlate with infectious complications, and hence, postoperative CRP levels did not contribute to clinical decision making. To test our hypothesis of intestinal translocation after HIPEC with the US protocol, patients with an uncomplicated course were further explored, and compared to patients after HIPEC with oxaliplatin (FRENCH). After HIPEC with the US protocol, but not after the HIPEC with the FRENCH protocol, a massive increase of PSP (p = 0.014) (Figure Finally, elevated 16 s rDNA levels (p = 0.022) in the serum (Figure Conclusion: HIPEC with the US protocol induces a systemic inflammatory response secondary to intestinal bacterial translocation. These dramatic changes, not observed after HIPEC with oxaliplatin, are an important and novel finding in the still poorly understood pathophysiology of HIPEC. Beilage 1347.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.006 | 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 teacher head, 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".