Short-term clinical effects of robot-assisted esophagectomy with thoracic duct resection
Bibliographic record
Abstract
Background: Whether extended robot-assisted esophagectomy with thoracic duct resection (RAE-TDR) has a favorable effect on esophageal cancer patients is not yet known.This study sought to analyze the safety and efficiency of RAE-TDR.Methods: From January 2019 to July 2020, 73 thoracic duct (TD)-resected and 127 TD-preserved consecutive patients who received standard RAE McKeown surgery were enrolled in this study.The perioperative-related indicators of recurrence-free survival (RFS) and overall survival (OS) at 1-year were compared between the 2 groups.Results: In relation to morbidity, the Clavien-Dindo (CD) classifications for grades greater than or equal to II-III were similar between the 2 groups (P>0.05).The number of retrieved total lymph nodes (LNs) and mediastinal nodes were significantly higher in the TD-resected group than in the TD-preserved group (total lymph nodes: 29.0±11.1 vs. 25.1±8.5,P=0.006; mediastinal nodes: 19.5±8.0 vs. 16.1±5.5,P=0.002).Additionally, more metastatic TD-related LNs were harvested in cT3-4 patients (2.3±3.7 vs. 1.7±2.8;P=0.21).The rates of LN recurrence and local recurrence were similar between the 2 groups (LN recurrence: 6.8% vs. 7.1%, P>0.99; local recurrence: 1.4% vs. 2.4%, P>0.99).The OS and RFS at 1-year were equivalent regardless of the TD procedure at each stage (P>0.05).However, the rate of hematogenous metastasis in the TD-resected group was significantly elevated (17.8% vs. 7.9%; P=0.034).Conclusions: RAE-TDR may help to improve total and metastatic LN harvest, especially in patients with advanced esophageal squamous cell carcinoma (ESCC) without increasing the intra-and post-operative adverse events.However, RAE-TDR did not lead to a decrease in the local recurrence rate within the short-term follow-up period.Whether the increase in distant metastasis rate in the TD-resected group was associated with relevant immune system damage is unclear.Thus, nonselective RAE-TDR is not routinely recommended.
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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) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".