***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 
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    Input: Laparoscopy-assisted colectomy istechnically feasible , but objective evidence of its benefits remainsscarce . This study was done to evaluate the outcomes and operativestress of laparoscopy-assisted colectomy versus the traditional open method in the management of sigmoid complex polyps that can not besafely or adequately removed by colonofibroscopy . Between January 1997 and December 1999 , a total of 42 patients were equally r and omizedto the laparoscopy group and the laparotomy group by the blockedr and omization method . Three patients r and omized to the laparoscopygroup did not complete the trial ; therefore 18 patients treated bylaparoscopy-assisted sigmoidectomy and the other 21 treated by the open method were prospect ively evaluated . These two groups of patients werewell matched in age , gender , symptoms , tumor location , localization method , tumor size , morphology , histopathology , and the accuracy of the clinical diagnosis . Two st and ardized surgical strategies , thelateral-to-medial and medial-to-lateral dissection sequences , wereperformed in 14 and 4 patients of the laparoscopy group , respectively , according to whether their tumors were located above or below 20 cmabove the anal verge . After evaluating the surgical outcomes , we foundthat the laparoscopy group was significantly better than the laparotomygroup in regard to parameters that included severity of postoperativepain , wound size , postoperative complication rate , and the duration ofpostoperative ileus , hospitalization , and disability . There was nosignificant difference in the operating times for these two groups . However , the costs of the laparoscopy group were significantly higher . To evaluate the surgical stress , we measured the serum C-reactiveprotein ( CRP ) level , erythrocyte sedimentation rate ( ESR ) , totallymphocyte count , and CD4+/CD8 + ratio 24 hoursbefore and after surgery . We found that the postoperative serum CRPlevel and the ESR were significantly less elevated and the totallymphocyte counts and CD4+/CD8 + ratio weresignificantly less depressed in the laparoscopy group than in thelaparotomy group . We thus concluded that laparoscopy-assistedsigmoidectomy can be safely performed with shorter convalescence and less operative stress but at a higher cost . We strongly recommended theuse of this technique in the management of sigmoid complex polyps ifthe patient 's economic status permits CONTEXT Laparoscopic-assisted colectomy ( LAC ) has emerged as the preferred minimally invasive surgical strategy for diseases of the colon . The safety and efficacy of LAC for colon cancer are unknown , and the nature and magnitude of any quality -of-life ( QOL ) benefit result ing from LAC for colon cancer is also unknown . OBJECTIVE To compare short-term QOL outcomes after LAC vs open colectomy for colon cancer . DESIGN , SETTING , AND PARTICIPANTS Multicenter , r and omized controlled trial ( Clinical Outcomes of Surgical Therapy [ COST ] ) . Between September 1994 and February 1999 , 37 of 48 centers provided data for the QOL component of the trial for 449 consecutive patients with clinical ly resectable colon cancer . MAIN OUTCOME MEASURES Scores on the Symptoms Distress Scale ( SDS ) , Quality of Life Index , and a single-item global rating scale at 2 days , 2 weeks , and 2 months postoperative ; duration of postoperative in-hospital analgesic use ; and length of stay . RESULTS Of 449 patients , 428 provided QOL data . In an intention-to-treat analysis comparing SDS pain intensity , SDS summary , QOL Index summary , and global rating scale scores at each time point , the only statistically significant difference observed between groups was the global rating scale score for 2 weeks postsurgery . The mean ( median ) global rating scale scores for 2 weeks postsurgery were 76.9 ( 80 ) for LAC vs 74.4 ( 75 ) for open colectomy ( P = .009 ) . While in the hospital , patients assigned to LAC required fewer days of both parenteral analgesics compared with patients assigned to open colectomy ( mean [ median ] , 3.2 [ 3 ] vs 4.0 [ 4 ] days ; P<.001 ) and oral analgesics ( mean [ median ] , 1.9 [ 1 ] vs 2.2 [ 2 ] days ; P = .03 ) . CONCLUSION Only minimal short-term QOL benefits were found with LAC for colon cancer compared with st and ard open colectomy . Until ongoing trials establish that LAC is as effective as open colectomy in preventing recurrence and death from colon cancer , this procedure should not be offered to patients with colon cancer Background : The magnitude of surgical trauma after laparoscopic and open colonic resection was evaluated by examining postoperative serum values of interleukin-6 ( IL-6 ) , IL-10 , C-reactive protein ( CRP ) , and granulocyte elastase ( GE ) for further evidence of the benefit realized with minimally invasive approaches in colonic surgery . Methods : Altogether , 42 patients with Crohn 's disease ( n = 20 ) or colon carcinomas/adenomas ( n = 22 ) were matched by age , gender , body mass index ( BMI ) , and Crohn 's Disease Activity Index for either a laparoscopic ( n = 21 ) or an open colonic resection ( n = 21 ) . In both groups the postoperative serum levels of IL-6 , IL-10 , C-RP , and granulocyte elastase  were determined , as indicators of surgical stress . Results : Laparoscopic and open colonic resection caused a significant increase in serum IL-6 , IL-10 , CRP , and granulocyle elastase levels . The comparison between laparoscopic and open colonic resections , however , showed significantly lower serum IL-6 , IL-10 , CRP , and granulocyte elastase levels after laparoscopic colonic resection , which was most evident for IL-6 and granulocyte elastase . Conclusions : Our study demonstrated that IL-6 and granulocyte elastase may be appropriated particularly to monitor surgical stress . By using these parameters , we found a significant reduction in surgical trauma after laparoscopic surgery , was compared with the open procedure . This supports the clinical findings of a clear benefit for patients undergoing laparoscopic colonic surgery Background : A shorter duration of postoperative ileus and earlier oral alimentation of patients may be a clinical ly relevant benefit of laparoscopic compared with conventional colorectal resection . Patients / Methods : A total of 60 patients were r and omised to either laparoscopic ( n=30 ) or conventional ( n=30 ) resection of colorectal tumours . Major endpoints were the postoperative time to the first bowel movement and the time until oral feeding without parenteral alimentation was tolerated . Minor endpoints were the postoperative interval to the first peristalsis and first passage of flatus , the distribution of radio-opaque markers in abdominal radiographs on day 3 and day 5 and the incidence of postoperative vomiting . Results : Age , gender , ASA-classification and type of resection were comparable in thetwo groups . Peristalsis was first noticed 26±9 h after laparoscopic and 38±17 h after conventional colorectal resection ( P<0.01 ) . First flatus occurred 50±19 h after laparoscopic and 79±21 h after conventional surgery ( P<0.01 ) . The incidence of postoperative vomiting was similar in both groups . Three days after surgery radio-opaque markers were found more often in the right colon ( P<0.01 ) and less often in the small intestine ( P<0.05 ) in laparoscopic compared with conventional patients . Five days after laparoscopic surgery , more markers had reached the left colon ( P<0.05 ) . The first bowel movement occurred 70±32 h after laparoscopic and 91±22 h after conventional resection ( P<0.01 ) . Oral feeding without additional parenteral alimentation was tolerated 3.3±0.7 days after laparoscopic and 5.0±1.5 days after conventional surgery ( P<0.01 ) . Conclusion : The shorter duration of postoperative ileus allows earlier restoration of oral feeding after laparoscopic compared with conventional colorectal resection and therefore increases quality of life immediately after resection of colorectal tumours BACKGROUND Minimally invasive , laparoscopically assisted surgery was first considered in 1990 for patients undergoing colectomy for cancer . Concern that this approach would compromise survival by failing to achieve a proper oncologic resection or adequate staging or by altering patterns of recurrence ( based on frequent reports of tumor recurrences within surgical wounds ) prompted a controlled trial evaluation . METHODS We conducted a noninferiority trial at 48 institutions and r and omly assigned 872 patients with adenocarcinoma of the colon to undergo open or laparoscopically assisted colectomy performed by credentialed surgeons . The median follow-up was 4.4 years . The primary end point was the time to tumor recurrence . RESULTS At three years , the rates of recurrence were similar in the two groups--16 percent among patients in the group that underwent laparoscopically assisted surgery and 18 percent among patients in the open-colectomy group ( two-sided P=0.32 ; hazard ratio for recurrence , 0.86 ; 95 percent confidence interval , 0.63 to 1.17 ) . Recurrence rates in surgical wounds were less than 1 percent in both groups ( P=0.50 ) . The overall survival rate at three years was also very similar in the two groups ( 86 percent in the laparoscopic-surgery group and 85 percent in the open-colectomy group ; P=0.51 ; hazard ratio for death in the laparoscopic-surgery group , 0.91 ; 95 percent confidence interval , 0.68 to 1.21 ) , with no significant difference between groups in the time to recurrence or overall survival for patients with any stage of cancer . Perioperative recovery was faster in the laparoscopic-surgery group than in the open-colectomy group , as reflected by a shorter median hospital stay ( five days vs. six days , P<0.001 ) and briefer use of parenteral narcotics ( three days vs. four days , P<0.001 ) and oral analgesics ( one day vs. two days , P=0.02 ) . The rates of intraoperative complications , 30-day postoperative mortality , complications at discharge and 60 days , hospital readmission , and reoperation were very similar between groups . CONCLUSIONS In this multi-institutional study , the rates of recurrent cancer were similar after laparoscopically assisted colectomy and open colectomy , suggesting that the laparoscopic approach is an acceptable alternative to open surgery for colon cancer INTRODUCTION : Surgeons have been reluctant to apply laparoscopic techniques to Crohn 's disease surgery because of concerns with evaluating and excising inflamed tissue using laparoscopic methods Additionally in Crohn 's disease surgery , laparoscopic techniques have not been demonstrated to have clear advantages over conventional ones . METHOD : We conducted a prospect i ve , r and omized trial in one surgical department comparing laparoscopic vs. conventional techniques in 60 patients ( 25 males ) , median age 34.4 ( range 10–60.1 ) years , undergoing elective ileocolic resection for refractory Crohn 's disease . Postoperatively , all patients underwent measurement of pulomnary function tests every 12 hours , and were treated identically on a highly controlled protocol with regard to analgesic administration , feeding , and postoperative care . RESULTS : Of the 31 patients assigned to laparoscopic and 29 to the conventional group , all had isolated Crohn 's disease of the terminal ileum plus or minus the cecum .  Median length of the incision was 5 cm in the laparoscopic group and 12 cm in the conventional group . Overall recovery of 80 percent of forced expiratory volume ( one second ) and forcec vital capacity was a median of 2.5 days for laparoscopic and 3.5 days for conventional ( P=0.03 ) . There was no difference in the amount of morphine equivalents used between groups postoperatively . Flatus and first bowel movement returned a median of 3 and 4 days , respectively , after conventional roscopicvs . 3.3 and 4 days , respectively , after conventional surgery ( P=0.21 ) . Median length of stay was five ( range , 4–30 ) days for laparoscopic , and six ( range , 4–18 ) days for conventional surgery .  Major complications occurred in one patient in each group . Minor complications occurred in four laparoscopic and eight conventional patients ( P<0.05 ) . There were no deaths . Two laparoscopic patients were converted to conventional as a result of adhesions or inflammation . All patients recovered well and there were no clinical resurrences in the follow-up period ( median , 20 ; range , 12–45 months ) . CONCLUSIONS : Within a single insititution , single surgical team , prospect i ve , r and omized trial , laparoscopic techniques offered a faster recovery of pulomary function , fewer complications , and shorter length of stay compared with conventional surgery for selected patients undergoing ileocolic resection for Crohn 's disease UNLABELLED We compared the effects of a laparoscopic ( n = 23 )  versus laparotomic  ( n = 21 ) technique for major abdominal surgery on temperature control in 44 patients undergoing colorectal surgery during a combined epidural/general anesthesia .  A thoracic epidural block up 
    Output:
    
Operative time was longer in laparoscopic surgery , but intraoperative blood was less than in conventional surgery .
Intensity of postoperative pain and duration of postoperative ileus was shorter after laparoscopic colorectal resection and pulmonary function was improved after a laparoscopic approach .
Total morbidity and local ( surgical ) morbidity was decreased in the laparoscopic groups .
General morbidity and mortality was not different between both groups .
Until the 30th postoperative day , quality of life was better in laparoscopic patients .
Postoperative hospital stay was less in laparoscopic patients .
Under traditional perioperative treatment , laparoscopic colonic resections show clinical ly relevant advantages in selected patients .