Artificial intelligence-powered clinical decision making within gastrointestinal surgery: A systematic review.

BACKGROUND: Clinical decision-making in gastrointestinal surgery is complex due to the unpredictability of tumoral behavior and postoperative complications. Artificial intelligence (AI) could aid in clinical decision-making by predicting these surgical outcomes. The current status of AI-based clinical decision-making within gastrointestinal surgery is unknown in recent literature. This review aims to provide an overview of AI models used for clinical decision-making within gastrointestinal surgery. METHODS: A systematic literature search was performed in databases PubMed, EMBASE, Cochrane, and Web of Science. To be eligible for inclusion, studies needed to use AI models for clinical decision-making involving patients undergoing gastrointestinal surgery. Studies reporting on reviews, children, and study abstracts were excluded. The Probast risk of bias tool was used to evaluate the methodological quality of AI methods. RESULTS: Out of 1073 studies, 10 articles were eligible for inclusion. AI models have been used to make clinical decisions between surgical procedures, selection of chemotherapy, selection of postoperative follow up programs, and implementation of a temporary ileostomy. Most studies have used a Random Forest or Gradient Boosting model with AUCs up to 0.97. All studies involved a retrospective study design, in which external validation was performed in one study. CONCLUSIONS: This review shows that AI models have the potentiality to select the most optimal treatments for patients undergoing gastrointestinal surgery. Clinical benefits could be gained if AI models were used for clinical decision-making. However, prospective studies and randomized controlled trials will reveal the definitive role of AI models in clinical decision-making.

ChatGPT in surgery: a revolutionary innovation?

ChatGPT has brought about a new era of digital health, as this model has become prominent and been rapidly developing since its release. ChatGPT may be able to facilitate improvements in surgery as well; however, the influence of ChatGPT on surgery is largely unknown at present. Therefore, the present study reports on the current applications of ChatGPT in the field of surgery, evaluating its workflow, practical implementations, limitations, and future perspectives. A literature search was performed using the PubMed and Embase databases. The initial search was performed from its inception until July 2023. This study revealed that ChatGPT has promising capabilities in areas of surgical research, education, training, and practice. In daily practice, surgeons and surgical residents can be aided in performing logistics and administrative tasks, and patients can be more efficiently informed about the details of their condition. However, priority should be given to establishing proper policies and protocols to ensure the safe and reliable use of this model.

Mobile applications in gastrointestinal surgery: a systematic review.

BACKGROUND: Mobile applications can facilitate or improve gastrointestinal surgical care by benefiting patients, healthcare providers, or both. The extent to which applications are currently in use in gastrointestinal surgical care is largely unknown, as reported in literature. This systematic review was conducted to provide an overview of the available gastrointestinal surgical applications and evaluate their prospects for surgical care provision. METHODS: The PubMed, EMBASE and Cochrane databases were searched for articles up to October 6th 2022. Articles were considered eligible if they assessed or described mobile applications used in a gastrointestinal surgery setting for healthcare purposes. Two authors independently evaluated selected studies and extracted data for analysis. Descriptive data analysis was conducted. The revised Cochrane risk of bias (RoB-2) tool and ROBINS-I assessment tool were used to determine the methodological quality of studies. RESULTS: Thirty-eight articles describing twenty-nine applications were included. The applications were classified into seven categories: monitoring, weight loss, postoperative recovery, education, communication, prognosis, and clinical decision-making. Most applications were reported for colorectal surgery, half of which focused on monitoring. Overall, a low-quality evidence was found. Most applications have only been evaluated on their usability or feasibility but not on the proposed clinical benefits. Studies with high quality evidence were identified in the areas of colorectal (2), hepatopancreatobiliary (1) and bariatric surgery (1), reporting significantly positive outcomes in terms of postoperative recovery, complications and weight loss. CONCLUSIONS: The interest for applications and their use in gastrointestinal surgery is increasing. From our study, it appears that most studies using applications fail to report adequate clinical evaluation, and do not provide evidence on the effectiveness or safety of applications. Clinical evaluation of objective outcomes is much needed to evaluate the efficacy, quality and safety of applications being used as a medical device across user groups and settings.

Machine learning applications in upper gastrointestinal cancer surgery: a systematic review.

BACKGROUND: Machine learning (ML) has seen an increase in application, and is an important element of a digital evolution. The role of ML within upper gastrointestinal surgery for malignancies has not been evaluated properly in the literature. Therefore, this systematic review aims to provide a comprehensive overview of ML applications within upper gastrointestinal surgery for malignancies. METHODS: A systematic search was performed in PubMed, EMBASE, Cochrane, and Web of Science. Studies were only included when they described machine learning in upper gastrointestinal surgery for malignancies. The Cochrane risk-of-bias tool was used to determine the methodological quality of studies. The accuracy and area under the curve were evaluated, representing the predictive performances of ML models. RESULTS: From a total of 1821 articles, 27 studies met the inclusion criteria. Most studies received a moderate risk-of-bias score. The majority of these studies focused on neural networks (n = 9), multiple machine learning (n = 8), and random forests (n = 3). Remaining studies involved radiomics (n = 3), support vector machines (n = 3), and decision trees (n = 1). Purposes of ML included predominantly prediction of metastasis, detection of risk factors, prediction of survival, and prediction of postoperative complications. Other purposes were predictions of TNM staging, chemotherapy response, tumor resectability, and optimal therapy. CONCLUSIONS: Machine Learning algorithms seem to contribute to the prediction of postoperative complications and the course of disease after upper gastrointestinal surgery for malignancies. However, due to the retrospective character of ML studies, these results require trials or prospective studies to validate this application of ML.

Machine Learning Algorithms for Predicting Surgical Outcomes after Colorectal Surgery: A Systematic Review.

BACKGROUND: Machine learning (ML) has been introduced in various fields of healthcare. In colorectal surgery, the role of ML has yet to be reported. In this systematic review, an overview of machine learning models predicting surgical outcomes after colorectal surgery is provided. METHODS: Databases PubMed, EMBASE, Cochrane, and Web of Science were searched for studies using machine learning models for patients undergoing colorectal surgery. To be eligible for inclusion, studies needed to apply machine learning models for patients undergoing colorectal surgery. Absence of machine learning or colorectal surgery or studies reporting on reviews, children, study abstracts were excluded. The Probast risk of bias tool was used to evaluate the methodological quality of machine learning models. RESULTS: A total of 1821 studies were analysed, resulting in the inclusion of 31 articles. A vast proportion of ML algorithms have been used to predict the course of disease and response to neoadjuvant chemoradiotherapy. Radiomics have been applied most frequently, along with predictive accuracies up to 91%. However, most studies included a retrospective study design without external validation or calibration. CONCLUSIONS: Machine learning models have shown promising potential in predicting surgical outcomes after colorectal surgery. However, large-scale data is warranted to bridge the gap between calibration and external validation. Clinical implementation is needed to demonstrate the contribution of ML within daily practice.

Artificial Intelligence in Bariatric Surgery: Current Status and Future Perspectives.

BACKGROUND: Machine learning (ML) has been successful in several fields of healthcare, however the use of ML within bariatric surgery seems to be limited. In this systematic review, an overview of ML applications within bariatric surgery is provided. METHODS: The databases PubMed, EMBASE, Cochrane, and Web of Science were searched for articles describing ML in bariatric surgery. The Cochrane risk of bias tool and the PROBAST tool were used to evaluate the methodological quality of included studies. RESULTS: The majority of applied ML algorithms predicted postoperative complications and weight loss with accuracies up to 98%. CONCLUSIONS: In conclusion, ML algorithms have shown promising capabilities in the prediction of surgical outcomes after bariatric surgery. Nevertheless, the clinical introduction of ML is dependent upon the external validation of ML.