MANAGEMENT OF THE DUODENUM DURING RESECTION OF PRIMARY RETROPERITONEAL SARCOMA: SURGICAL AND ONCOLOGICAL OUTCOMES FROM A MULTICENTER STUDY
Bibliographic record
Abstract
Objective: Duodenal management is critical in multivisceral resection for primary retroperitoneal sarcoma (RPS).This study evaluated how surgical duodenal management affects oncologic and surgical outcomes.Methods: Consecutive adults (18 years) patients with primary localized RPS undergoing curative-intent surgery (2010-2020) at three referral centers were included.Patients were stratified into three groups: simple dissection (no repair), difficult dissection (duodenal repair with stitches/sutures), and duodenal resection (wedge, segmental, or pancreatoduodenectomy).Primary endpoints were crude cumulative incidence (CCI) of local recurrence (LR) and postoperative morbidity (Clavien-Dindo 3).Secondary endpoints were overall survival (OS) and disease-free survival (DFS).Univariate and multivariable analyses were performed; Sarculator was used for nomogram scoring.Results: Among the 1,027 patients included, 864 (84%) underwent simple dissection, 91 (9%) had difficult dissection, and 72 (7%) underwent duodenal resection.At a median follow-up of 83.4 months, 5-year CCI of LR was 0.27 (95% CI 0.24 -0.30) for simple dissection, 0.47 (95% CI 0.35 -0.58) for difficult dissection, and 0.40 (95% CI 0.28 -0.52) for duodenal resection (p < 0.001).Local recurrence at the duodenum occurred in 2.2% of simple, 9.9% of difficult dissection, and 5.5% of resection cases (p< 0.001).Univariate analysis showed significant differences in severe postoperative complications among groups (p 0.028).At univariate analysis, OS was similar across groups (p=0.19), while DFS was significantly better with simple dissection (p < 0.001).Difficult dissection (HR 1.50; 95% CI 1.14-1.98;p = 0.004) and resection (HR 1.75; 95% CI 1.30-2.35;p < 0.001) were associated with shorter DFS compared to simple dissection.These associations remained significant in the multivariable model adjusted for Sarculator. Conclusion:In cases of simple duodenal dissection, surgical margins are safe, with minimal risk of LR near the duodenum.When the tumor is adherent to the duodenum, the risk of abdominal recurrence is higher, and the decision between performing a difficult dissection or a wedge resection should be guided not by concerns over postoperative complications, but by the opportunity to achieve adequate surgical margins.
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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 | 0.000 | 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 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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".