***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Combined pancreatic and liver resection for hepato-pancreatico-biliary disease is generally considered contraindicated since it is thought to provide little if any survival benefit with high risk of morbidity . Our goal was to review our experience with combined pancreatic and liver resections to better define characteristics that increase risk for perioperative complications after combined resections . METHODS A review of prospect ively collected IRB approved hepato-pancreatico-biliary data base was performed from October 2002 to April 2012 . RESULTS Twenty-one cases were identified including all histologies . Perioperative outcomes were examined and the overall mean length of stay was 12.1 days ( range : 6 - 26 days ) and no perioperative mortalities ( < 90 days ) were observed . With respect to morbidity 43 % of patients experienced any grade of complication , 29 % were Grade 3 with no Grade 4 or 5 complications noted . We found a statistically indicated association between BMI > 25 and risk of Grade 3 complications ( P = 0.149 ) . The median survival following operation was 11 months ( range : 3 - 148 months ) . CONCLUSION Combined pancreas and liver resection for metastatic disease should only be considered in highly selected patients . Tumor histology as well as BMI > 25 ( overweight and obese patients ) should be considered in the decision making process in an effort to minimize surgical morbidity while potentially improving survival Background Obesity has previously been shown to correlate with higher stage and decreased survival in pancreatic cancer . The aim of this study was to determine the impact of obesity on operative outcomes , recurrence , and overall survival . Methods A review of our 1345 patient prospect i ve hepatopancreaticobiliary data base was performed to identify patients undergoing pancreatic resection from January 1991 to August 2008 for adenocarcinoma . Obesity was defined as a body mass index ( BMI ) > 30 kg/m2 . Data was analyzed using Wilcoxon , t test , and chi-square methods . Survival was analyzed using log-rank analysis . Postoperative complications were assessed using a 5-point scale . P < .05 was considered significant . Results Of 306 patients undergoing pancreatic resection for pancreatic adenocarcinoma examined , 68 were defined as obese . There was no significant difference seen in length of stay , operative time , tumor size , or node status . Obese patients had a higher operative blood loss ( median 650 vs. 400 mL , P = .0008 ) . Obese patients were more likely to suffer postoperative complications ( 67.6 % vs. 50.4 % , P = .01 ) . There was no significant difference seen in disease-free survival or overall survival ( 22.1 months for obese vs. 25.6 months for nonobese , P = .5 ; 19.8 months for obese vs. 23.5 months for nonobese , P = .46 ) . Conclusion Obese patients had a higher rate and greater severity of postoperative complications , with increased operative blood loss . However , obese patients did not demonstrate any significant difference in specific oncologic factors or survival . These data suggest an equivalent biologic effect of obesity on pancreatic cancer survival Introduction Obesity adds to the technical difficulty of colorectal surgery and is a risk factor for postoperative complications . We hypothesized that obese patients have increased morbidity and poor oncologic outcomes after proctectomy for rectal adenocarcinoma . Methods Adult patients undergoing total mesorectal excision ( TME ) for rectal adenocarcinoma at a tertiary referral center were retrospectively identified from a prospect ively maintained data base . Operative characteristics , postoperative complication rates , and oncologic outcomes were compared in patients with BMI ≥ 30 kg/m2 and BMI < 30 kg/m2 . Results Between 1997 and 2009 , 254 patients underwent proctectomy for rectal adenocarcinoma , of whom 27 % were obese . There were no significant differences in demographics , comorbidities or preoperative oncologic characteristics between obese and nonobese groups . Patients with BMI ≥ 30 kg/m2 had longer operative times ( p = 0.04 ) and higher intraoperative blood loss ( p < 0.001 ) but comparable postoperative complication rates ( p = 0.80 ) , number of lymph nodes retrieved ( p = 0.57 ) , margin-negative resections ( p = 0.44 ) , and disease-free survival ( p = 0.11 ) . Obese patients had longer overall survival ( p = 0.05 ) . Tumor stage was the only variable associated with disease-free ( p < 0.001 ) and overall survival ( p < 0.001 ) . Conclusion Despite increased technical difficulty of resection , obesity does not increase the risk of postoperative morbidity or adversely affect oncologic outcomes after total mesorectal excision of rectal adenocarcinoma Abstract ᅟThe long-term role of laparoscopy in the treatment of rectal cancer is still controversial . The aim of the present study was to evaluate the safety , the feasibility , the perioperative outcome , and the long-term results of laparoscopic total mesorectal excision ( TME ) for extraperitoneal rectal cancer considering a single center series . Methods Data about 186 unselected consecutive patients that underwent laparoscopic TME for middle and low rectal cancer between January 2001 and December 2011 were prospect ively recorded and were included in the present study . Results Distribution of TNM stage was 5 % T1 , 37 % T2 , 52.5 % T3 , and 6 % T4 . Fifty-one percent of patients have lymph node metastases . The average duration of surgery was 234 min . Fourteen patients required conversion ( 7.5 % ) . A complete microscopic excision was achieved in 169 patients ( 91 % ) . The mean hospital stay was 9 days . The overall postoperative morbidity rate was 24 % . Surgical-related complications were reported in 19 % . Overall mortality was 0.5 % . Sex , tumor level , and the presence of a stoma were the only statistically significant independent risk factors for anastomotic leakage . Median follow-up was 71 months . The 5-year overall survival rate was 77 % , with 89 % for stage 1 , 81 % for stage 2 , 43 % for stage 3 , and 10 % for stage 4 . The 5-year disease-free survival rate was 66 % . The 10-year survival rate was 54 % . Nine patients ( 4.8 % ) experienced a pelvic recurrence . Late metastases developed in 31 patients ( 17.2 % ) . Conclusions The study confirms the oncological safety of laparoscopic TME in a long follow-up period Abstract Background : The extent of st and ard lymph node dissection ( D1 , D2 , or D3 ) in gastric cancer patients is still controversial . Several prospect i ve European trials attained contradictory results . A generally increased body mass index ( BMI ) of the European patients was assumed to be one of the major causes for postoperative morbidity . Methods : We evaluated the effect of BMI on the quality of routine D2 lymph node dissection and on postoperative morbidity in patients with gastric cancer who underwent a potentially curative total gastrectomy . A total of 199 consecutive gastric cancer patients who underwent a total gastrectomy and a routine D2 lymph node dissection between 1992 and 2001 were included in the study . According to BMI , they were assigned to three groups : group A , with BMI < 25 kg/m2 ( normal body weight ) ; group B , with BMI of 25 to 30 kg/m2 ( overweight ) ; and group C , with BMI > 30 kg/m2 ( obesity ) . Parameters such as complete histopathological staging , intraoperative blood loss , length of operation , and surgical and nonsurgical morbidity were recorded and correlated within the different groups . Results : No significant differences were found with regard to the number of examined lymph nodes , blood loss , length of operation , surgical complications , or length of stay in the intensive care unit . Conclusions : In contrast to comparable Japanese studies , our analysis reveals that even for overweight patients , a st and ard D2 lymph node dissection is justified without significantly increased morbidity Surgical site infection ( SSI ) is one of the most frequent postoperative complications among patients undergoing elective colorectal surgery .  A multisite , prospect i ve cohort study was conducted to investigate whether the thickness of subcutaneous fat ( TSF ) influences the occurrence of SSI in patients undergoing colorectal surgery . Participants included patients scheduled to receive colorectal laparotomy for colorectal cancer and who were under the care of a wound ostomy continence nurse at 17 participating general hospitals in Japan . Patients were not eligible to participate if they had undergone emergency surgery , reoperation , or laparoscopic surgery .  Demographic , wound , and surgical data and American Society of Anesthesiologists ( ASA ) scale scores were collected and assessed , along with nutritional status , TSF , body mass index , and risk factors for SSI ( ie , length of surgery and wound classification ) . The incidence of SSI and nutritional conditions was assessed weekly for 30 days after surgery . Of the 155 participants ( mean age 68.9 ± 10.8 years , 53 [ 34.2 % ] of whom were women ) , 90 ( 58.1 % ) underwent rectal surgery , and the remaining 65 underwent colon surgery .  Seventy-two ( 72 , 46.5 % ) of the 155 patients underwent colostomy surgery ; 24 ( 15.5 % ) developed a SSI . The mean onset of SSI was 7.3 ± 2.9 days after surgery and commonly observed in the stoma group when the ASA score was 3 or higher ( P = 0.02 ) . Patients who developed SSI resumed oral dietary intake later than those without SSI ( 7.4 days versus 4.6 days , P = 0.02 ) . Multivariate analysis indicated TSF > 15 mm ( P = 0.01 ) , Alb level < 3.5 g/dL at postoperative days 14 ( P = 0.03 ) and 21 ( P = 0.02 ) , and total protein level < 6.8 g/dL at postoperative day 7 ( P = 0.02 ) were statistically significantly correlated with SSI occurrence . These results suggest preoperative TSF and preoperative and postoperative serum albumin levels are independent risk factors for SSI in patients undergoing colorectal surgery , confirming current recommendations to maximize the preoperative nutritional status of patients in order to prevent major complications . The results also confirm obesity/TSF should be assessed preoperatively to ascertain the risk of SSI in patients undergoing colorectal surgery Introduction : We postulated that the risk of venous thromboembolic disease ( VTE ) may persist after discharge and tested this hypothesis in patients undergoing colorectal resection for cancer . Methods : The American College of Surgeons National Surgery Quality Improvement Program data base was queried for patients undergoing colorectal resections for cancer from 2005 to 2009 . The outcome analyzed was a 30-day deep vein thrombosis ( DVT ) and /or pulmonary embolism ( PE ) . Multivariable forward stepwise regression was used to identify independent predictors of VTE . Results : The data base contained 21 943 colorectal cancer resections . The 30-day DVT rate was 1.4 % ( 306 of 21 943 ) , 29 % ( 89 of 306 ) were diagnosed post-discharge . The 30-day PE rate was 0.8 % ( 180 of 21 943 ) , 33 % ( 60 of 180 ) was diagnosed post-discharge , the combined DVT/PE rate was 2.0 % ( 446 of 21 943 ) . The median time to diagnosis of VTE was 9 days ( interquartile range 4 - 16 ) after surgery . Post-discharge VTE rates in patients with length of stay ( LOS ) less than 1 week ( 0.6 % ) were similar to patients with LOS greater than 1 week ( 0.7 % , Fisher exact P not significant ) . Independent risk factors for post-discharge VTE were preoperative steroid use for chronic condition ( odds ratio [ OR ] 2.90 , 95 % confidence interval [ CI ] 1.51 - 5.57 , P = .001 ) and preoperative systemic inflammatory response syndrome ( OR 2.26 , 95 % CI 1.24 - 4.10 , P = .008 ) . Conclusions : Diagnosis of almost one third of postoperative VTE in this patient population occurred after discharge . The duration of the prothrombotic stimulus of surgery is not well defined , and patients with malignancy are at high risk of VTE ; thromboprophylaxis after discharge should be considered for these patients Abstract PD morbidity and readmission pose a substantial clinical and economic burden to the healthcare system . Comprehensive PD complications and readmission data are essential for developing initiatives to improve patient care . No previous studies have extensively investigated PD complications after gastr 
    Output:
    
In this review obesity was frequently found to have no effect on peri-operative and oncologic outcomes