***TASK***
the task is to simplify the input abstract of a biomedical literature

***INPUT***
the input is the abstract of a biomedical literature

***OUTPUT***
the output is the simplified abstract for the input abstract of a biomedical literature

***DOCUMENTATION***

***EXAMPLES***

Input: We included 16 studies with a total of 1146 participants in the meta-analysis. Only one study including 52 participants had a low risk of bias and low applicability concern in the patient selection domain. The median pre-test probability of unresectable disease after CT scanning across studies was 41.4% (that is 41 out of 100 participants who had resectable cancer after CT scan were found to have unresectable disease on laparotomy). The summary sensitivity of diagnostic laparoscopy was 64.4% (95% confidence interval (CI) 50.1% to 76.6%). Assuming a pre-test probability of 41.4%, the post-test probability of unresectable disease for participants with a negative test result was 0.20 (95% CI 0.15 to 0.27). This indicates that if a person is said to have resectable disease after diagnostic laparoscopy and CT scan, there is a 20% probability that their cancer will be unresectable compared to a 41% probability for those receiving CT alone. A subgroup analysis of people with pancreatic cancer gave a summary sensitivity of 67.9% (95% CI 41.1% to 86.5%). The post-test probability of unresectable disease after being considered resectable on both CT and diagnostic laparoscopy was 18% compared to 40.0% for those receiving CT alone. Diagnostic laparoscopy may decrease the rate of unnecessary laparotomy in people with pancreatic and periampullary cancer found to have resectable disease on CT scan. On average, using diagnostic laparoscopy with biopsy and histopathological confirmation of suspicious lesions prior to laparotomy would avoid 21 unnecessary laparotomies in 100 people in whom resection of cancer with curative intent is planned.
Output:

We performed a thorough literature search to identify studies published up to 15 May 2016. We identified 16 studies reporting information on 1146 people with pancreatic or periampullary cancers which were considered to be eligible for potentially curative surgery based on CT scan staging. These studies evaluated diagnostic laparoscopy and compared results of the procedure with the eventual diagnosis by the surgeon that the cancer was not resectable during major abdominal operation or examination under microscope. All of the studies were of unclear or low methodological quality in one or more aspects, which may undermine the validity of our findings. Of those people with what CT suggests seems to be a potentially surgically curable cancer, the percentage in whom more extensive cancer was found on further staging with diagnostic laparoscopy or laparotomy ranged between 17% and 82% across studies. The median percentage of people in whom cancer spread was not detected by CT scan was 41%. Adding staging laparoscopy to CT scan might decrease the number of people with unremovable disease undergoing unnecessary major operations to 20% compared to those who undergo unnecessary major operation after CT scan alone (41%). This means that using diagnostic laparoscopy could halve the rate of unnecessary major open operations in people undergoing major surgery for potentially surgically curable pancreatic cancer.