***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: Bladder and sexual dysfunction are recognized complications of mesorectal resection . Their incidence following laparoscopic surgery is unknown OBJECTIVE The aims of this study were to evaluate the safety and efficacy of laparoscopic abdominoperineal resection compared to conventional approach for surgical treatment of patients with distal rectal cancer presenting with incomplete response after chemoradiation . METHOD Twenty eight patients with distal rectal adenocarcinoma were r and omized to undergo surgical treatment by laparoscopic abdominoperineal resection or conventional approach and evaluated prospect ively . Thirteen underwent laparoscopic abdominoperineal resection  and 15  conventional approach . RESULTS There was no significant difference ( p<0,05 ) between the two studied groups regarding : gender , age , body mass index , patients with previous abdominal surgeries , intra and post operative complications , need for blood transfusion , hospital stay after surgery , length of resected segment and pathological staging . Mean operation time was 228 minutes for the laparoscopic abdominoperineal resection versus 284 minutes for the conventional approach ( p=0.04 ) . Mean anesthesia duration was shorter ( p=0.03 ) for laparoscopic abdominoperineal resection when compared to conventional approach : 304 and 362 minutes , respectively . There was no need for conversion to open approach in this series . After a mean follow-up of 47.2 months and with the exclusion of two patients in the conventional abdominoperineal resection who presented with unsuspected synchronic metastasis during surgery , local recurrence was observed in two patients in the conventional group and in none in the laparoscopic group . CONCLUSIONS We conclude that laparoscopic abdominoperineal resection is feasible , similar to conventional approach concerning surgery duration , intra operative morbidity , blood requirements and post operative morbidity . Larger number of cases and an extended follow-up are required to adequate evaluation of oncological results for patients undergoing laparoscopic abdominoperineal resection after chemoradiation for radical treatment of distal rectal cancer PURPOSE : Traumatic manipulation of cancer specimens during  laparoscopic colectomy  may increase exfoliation of malignant cells into the peritoneal cavity , causing an early occurrence of peritoneal carcinomatosis or port-sites recurrence . Because of this concern , the routine use of intraperitoneal chemotherapy after laparoscopic colectomy for cancer was suggested recently . We assessed if laparoscopicvs . conventional surgery increases exfoliated malignant cells in the peritoneal cavity during resection of colorectal cancer . METHODS : In a prospect i ve , r and omized fashion , 38 colorectal cancer patients undergoing an elective , curative operation were assigned to either a conventional or laparoscopic procedure between June 1996 and May 1997 . In either group ( n=19 ) , after the abdominal cavity was entered , saline was instilled into the peritoneal cavity , and the fluid was collected ( Specimen 1 ) . During surgery , all irrigating fluids were collected ( Specimen 2 ) . Both specimens were assessed for malignancy using four techniques : filtration process ( ThinPrep ® ) , smear , cell block , and immunochemistry using Ber-EP4 . The change in the amount of tumor cells in both specimens was compared between surgical groups . A pilot study was performed to vali date the proposed cytologic method . RESULTS : In the pilot study of 20 consecutive patients with colorectal cancer , postresectional peritoneal cytology was positive in six patients , including two Stage II ( T3,N0,M0 ) patients . The pilot study also vali date d that our semiquantitative scoring system can be reliably used to assess the amount of free peritoneal cancer cells . In the main study , 16 right colectomies , 3 extended right colectomies , 17 proctosigmoidectomies , and 1 left colectomy were performed . The T and N stages were T1 ( n=13 ) , T2 ( n=5 ) , T3 ( n=8 ) , T4 ( n=11 ) ; N0 ( n=22 ) , N1 ( n=8 ) , N2 ( n=7 ) . Malignant cells were not detected in any Specimens 1 or , more importantly , in Specimens 2 in either surgical group . CONCLUSION : When performed according to strict oncologic surgical principles , laparoscopic techniques in curative colorectal cancer surgery did not have an increased risk of intraperitoneal cancer cell spillage , compared with conventional techniques . We hope that these results can decrease some of the concerns about tumors cell spillage and seeding during laparoscopy Background and aims Evidence demonstrating improved short-term outcomes with laparoscopic surgery compared with open surgery for colorectal cancer is accumulating . In addition , programmes optimising peri-operative care for major abdominal surgery are becoming widespread . Evaluating laparoscopic surgery and enhanced recovery programmes usually focuses on short-term recovery . The aim of this study was to compare recovery after laparoscopic and open surgery for colorectal cancer up to 1 year post-operatively , using a combination of self-report and observer data . Patients / Methods From January 2002 to March 2004 , 62 patients were r and omised ( 2:1 ) to receive laparoscopic ( n = 43 ) or open surgery ( n = 19 ) within an enhanced recovery programme .  Functional outcomes up to 1 year were assessed using interview-administered question naires . Results / Findings Question naire and health-related quality of life data were obtained in over 85 % of patients . Patients undergoing laparoscopic surgery  felt fully recovered and resumed driving more quickly than those having open surgery ( p = 0.016 and p = 0.048 respectively ) . Fifty-eight percent of patients having open surgery felt fully recovered by 12 months versus 88 % of laparoscopic patients .Interpretation/ Conclusion Within an enhanced recovery programme , patients undergoing laparoscopic surgery  recovered more quickly than after open resection . Both approaches however , were associated with slow recovery despite a relatively short hospital stay Purpose This study was design ed to evaluate the impact of  laparoscopic rectal resection  on short-term postoperative morbidity and costs . Methods A total of 168 patients with rectal cancer were r and omly assigned to laparoscopic ( n = 83 ) or open ( n = 85 ) resection . Outcome parameters were : postoperative morbidity , length of hospital stay , quality of life , long-term survival , and local recurrences . The mean follow-up period was 53.6 months . Cost-benefit analysis was based on hospital costs . Results Operative time was 53 minutes longer in the laparoscopic group ( P < 0.0001 ) . Postoperative morbidity rate was 28.9 percent in the laparoscopic vs. 40 percent in the open group ( P = 0.18 ) . The mean length of hospital stay was 10 ( 4.9 ) days in the laparoscopic group and 13.6 ( 10 ) days in the open group ( P = 0.004 ) . Local recurrence rate and five-year survival were similar in both groups ; however , the limited number of patients does not allow firm conclusions . Quality of life was better in the laparoscopic group only in the first year after surgery ( P < 0.0001 ) . The additional charge in the laparoscopic group was $ 1,748 per patient r and omized ( $ 1,194 the result of surgical instruments and $ 554 the result of longer operative time ) . The saving in the laparoscopic group was $ 1,396 per patient r and omized ( $ 647 the result of shorter length of hospital stay and $ 749 the result of the lower cost of postoperative complications ) . The net balance result ed in $ 351 extra cost per patient r and omly allocated to the laparoscopic group . Conclusions Short-term postoperative morbidity was similar in the two groups . Laparoscopic resection reduced length of hospital stay , improved first-year quality of life , and slightly increased hospital costs A r and omized controlled trial was started in Japan to evaluate whether laparoscopic surgery is the optimal treatment for colorectal cancer . Patients with T3 or deeper carcinoma in the colorectum without transverse and descending colons are pre-operatively r and omized to either open or laparoscopic colorectal resection .  Surgeons in 24 specialized institutions will recruit 818 patients . The primary end-point is overall survival . Secondary end-points are relapse-free survival , short-term clinical outcome , adverse events , the proportion of conversion from laparoscopic surgery to open surgery , and the proportion of completion of laparoscopic surgery Laparoscopic surgery is believed to produce an attenuated metabolic stress response and to have a less dampening effect on the immune response than open surgery . To date , the effect has not been studied in a r and omized clinical trial of colorectal cancer PURPOSE : The aim of this study was to compare the safety and efficacy of laparoscopic abdominoperineal resection and open abdominoperineal resection for cancer . METHODS : Records of 194 patients who underwent laparoscopic abdominoperineal resection ( 42 patients ) or open abdominoperineal resection ( 152 patients ) at three institutions between 1991 and 1997 were review ed . Follow-up was through office charts , American College of Surgeons cancer registry , or telephone contact . Tumors included ( laparoscopic abdominoperineal resection and open abdominoperineal resection , respectively ) adenocarcinoma ( 86 and 92 percent ) , squamous ( 12 and 7 percent ) , and gastrointestinal stromal ( 2 and 1.4 percent ) types ; Stages I ( 17 and 26 percent ) , II ( 24 and 33 percent ) , III ( 43 and 32 percent ) , and IV ( 14 and 9 percent ) ; and those with invasion of pelvic structures ( 14 and 16 percent ) . RESULTS : Laparoscopic abdominoperineal resection was converted to open abdominoperineal resection in 21 percent because of vessel injury ( 33 percent ) , poor exposure ( 22 percent ) , adhesions ( 22 percent ) , inguinal hernia ( 11 percent ) , or radiation fibrosis ( 11 percent ) . Perineal infections occurred more often in the laparoscopic abdominoperineal resection group ( 24vs . 8 percent;P=0.02 ) . Late stoma complications were similar . Mean hospital stay was shorter after laparoscopic abdominoperineal resection ( 7vs . 12 days ) . Radial margins were positive in 12 percent of laparoscopic abdominoperineal resection and 12.5 percent of open abdominoperineal resection specimens . Tumor recurrence was similar for both local ( 19 and 14 percent ) and distant ( 38 and 26 percent ) recurrence . Survival rates were similar by Kaplan-Meier curves , with median follow-up of 19 and 24 months , respectively ( P=0.22 ; log rank ) . CONCLUSION : Laparoscopic abdominoperineal resection can be performed safely and results in a shorter hospital stay . A r and omized , prospect i ve trial is needed to determine the long-term outcome of cancer treatment The short-term clinical results of the CLASICC trial indicated that clinical outcomes were similar between laparoscopic and open approaches . This study presents the short-term ( 3 month ) cost analysis undertaken on a subset of patients entered into the CLASICC trial ( 682 of 794 patients ) . As expected the costs associated with the operation were higher in the 452 patients r and omised to laparoscopic surgery ( lap ) compared with the 230 r and omised to open procedure ( open ) , £ 1703 vs £ 1386 . This was partially offset by the other hospital ( nontheatre ) costs , which were lower in the lap group ( £ 2930 vs £ 3176 ) . The average cost to individuals for reoperations was higher in the lap group ( £ 762 vs £ 553 ) . Overall costs were slightly higher in the lap group ( £ 6899 vs £ 6631 ) , with mean difference of £ 268 ( 95%CI −689 to 1457 ) . Sensitivity analysis made little difference to these results . The cost of rectal surgery was higher than for colon , for lap ( £ 8259 vs £ 5586 ) and open procedures ( £ 7820 vs £ 5503 ) . The short-term cost analysis for the CLASICC trial indicates that the costs of either laparoscopic or open procedure were similar , lap surgery costing marginally more on average than open surgery Background : Laparoscopic resection of the rectum is still under scrutiny for its adequacy of oncological clearance . Aim : To assess lymph node yield after laparoscopic total mesorectal excision ( TME ) for rectal cancer as compared to the open approach . Methods : 74 patients with middle and low rectal cancer were prospect ively r and omized in two groups . Group A included 39 patients who had an open TME ( 35 with low anterior resection of the rectum ( LARR ) and 4 with abdominoperineal resection of the rectum ( APR ) ) .  In group B , there were 34 patients who had a laparoscopic TME ( 27 with LARR and 7 with APR ) . 10 of the LARR patients in group A and 14 of the LAR 
    Output:
    
There is evidence that LTME results in less blood loss , quicker return to normal diet , less pain , less narcotic use and less immune response .
It seems likely that LTME is associated with longer operative time and higher costs .
Based on evidence mainly from non-r and omized studies , LTME appears to have clinical ly measurable short-term advantages in patients with primary resectable rectal cancer .