Evaluating Respiratory Complications Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy With Subphrenic Peritonectomy Versus Full Thickness Diaphragm Resection
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Patients with diaphragm tumor deposits undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) require subphrenic peritonectomy (SPP) or full-thickness diaphragm resection (FTR) to achieve complete cytoreduction. The incidence and severity of respiratory complications from these techniques are not well characterized. We compared the rate of respiratory complications between SPP and FTR and identified predictive factors. METHODS: CRS/HIPEC patients between 2013 and 2022 were screened. Those who underwent SPP and FTR were evaluated. The primary endpoint was incidence of respiratory complications. Multivariable logistic regression identified risk factors for respiratory complications. RESULTS: Among 208 CRS/HIPEC procedures, 100 involved the diaphragm. Respiratory complications occurred in 16/81 (19.8%) of SPP and 6/19 (31.6%) of FTR cases; a difference that was not statistically significant (OR 2.26, 95% CI 0.63-8.11, p = 0.211). All respiratory complications following FTR were classified as major (Clavien-Dindo ≥ 3, p = 0.013). Bilateral diaphragm involvement was associated with increased risk of respiratory complications (OR 12.3, 95% CI 2.62-57.8, p = 0.001), while age, gender, smoking, and PCI score were not. CONCLUSION: FTR may allow complete cytoreduction in CRS/HIPEC without increased incidence of respiratory morbidity, however FTR is associated with more severe complications. Bilateral diaphragm involvement, regardless of resection type, is predictive of respiratory complications.
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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) | 0.001 | 0.000 |
| 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 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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".