Alaa El-Hussuna

Zahra Tabatabaei, Jon Sporring, Mark Bremholm Ellebæk et al.

Anastomotic leak remains one of the most serious complications following colorectal cancer surgery, substantially affecting patient outcomes, recovery trajectories, and healthcare costs. Despite advances in imaging technology, current preoperative assessment relies only on clinical assessment, a process that is subjective, error-prone, and highly dependent on individual expertise. To date, no validated CT-based method exists to predict anastomotic leak risk prior to surgery. This protocol paper outlines a comprehensive framework for developing and validating an AI-driven system for preoperative risk assessment using pre- and post-contrast CT imaging. The study describes the stages of data collection, ethical handling, and preprocessing of patient data in accordance with GDPR, image preprocessing, and the exploration of deep learning architectures designed to generate clinically interpretable outputs. Two integrated tools constitute the main deliverables of this workflow: 1) a risk assessment module, which quantifies the likelihood of leakage by analyzing vascular and tissue features in CT scans, and 2) a Content-Based Medical Image Retrieval (CBMIR) module, which identifies and displays similar historical cases to support evidence-based surgical decision making. The protocol paper requires close collaboration between hospitals and universities; this protocol demonstrates that such a system is technically feasible and clinically implementable within existing healthcare infrastructures. By following the proposed methodological stages and regulatory principles, other institutions can reproduce this workflow to develop analogous decision-support tools. Ultimately, this interdisciplinary framework aims to enhance surgical planning, reduce leak incidence, and contribute to a broader paradigm shift toward explainable, data-driven precision surgery.

Dan Liu, Samer El Kababji, Nicholas Mitsakakis et al.

Small datasets are common in health research. However, the generalization performance of machine learning models is suboptimal when the training datasets are small. To address this, data augmentation is one solution. Augmentation increases sample size and is seen as a form of regularization that increases the diversity of small datasets, leading them to perform better on unseen data. We found that augmentation improves prognostic performance for datasets that: have fewer observations, with smaller baseline AUC, have higher cardinality categorical variables, and have more balanced outcome variables. No specific generative model consistently outperformed the others. We developed a decision support model that can be used to inform analysts if augmentation would be useful. For seven small application datasets, augmenting the existing data results in an increase in AUC between 4.31% (AUC from 0.71 to 0.75) and 43.23% (AUC from 0.51 to 0.73), with an average 15.55% relative improvement, demonstrating the nontrivial impact of augmentation on small datasets (p=0.0078). Augmentation AUC was higher than resampling only AUC (p=0.016). The diversity of augmented datasets was higher than the diversity of resampled datasets (p=0.046).