***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: OBJECTIVE The aim of this study was to compare , in a series of 159 women the feasibility , safety and morbidity of  total laparoscopic hysterectomy ( LPS ) and abdominal hysterectomy with lymphadenectomy ( LPT ) for early-stage endometrial cancer and to assess disease-free survival and recurrence rate . METHODS 159 patients with clinical stage I endometrial cancer were enrolled in a prospect i ve r and omized trial and treated with LPS or LPT approach . The para-aortic lymphadenectomy was performed in all cases with positive pelvic lymph nodes discovered at frozen section evaluation , in patients with poorly differentiated tumors with myometrial invasion greater than 50 % ( ICG3 ) , and non-endometrioid carcinomas . RESULTS The mean operative time was 136 min+/-31 ( 95 % CI 118 - 181 ) in the LPS group and 123 min+/-29 ( 95 % CI 111 - 198 ) in the LPT group ( P<0.01 ) . The mean blood loss was 50 ml+/-12 in the LPS group ( 95 % CI 20 - 90 ) and 145 ml+/-35 in the LPT group ( 95 % CI 60 - 255 ) ( P<0.01 ) . The mean length of hospital stay was 5.1+/-1.2 in the LPT group ( 95 % CI 1 - 7 ) and 2.1+/-0.5 in the LPS group ( 95 % CI 1 - 5 ) ( P<0.01 ) . CONCLUSIONS Laparoscopy is a suitable procedure for the treatment of patients with early endometrial cancer and may offer the potential benefits of decreased discomfort with decreased convalescence time without compromising the degree of oncological radicality required ; however , it does not seem to modify the disease-free survival and the overall survival , although multicenter r and omized trials and long-term follow-up are required to evaluate the overall oncologic outcomes of this procedure e15583 Background : Total abdominal hysterectomy and bilateral salpingo-oophorectomy is st and ard treatment for early stage endometrial cancer ( EC ) .  Pelvic lymphadenectomy had never been fully evaluated in early endometrial cancer until the ASTEC trial . The primary objective was to determine the benefit or otherwise of lymphadenectomy on overall survival ( OS ) . Primary analyses showed no evidence of an OS benefit with a hazard ratio ( HR ) of 1.16 ( 95%CI 0.87 - 1.54 ; p=0.31 ) in favour of st and ard surgery . A secondary objective was to investigate whether type of incision affects outcome . METHODS Patients with histologically proven EC were r and omised to receive no lymphadenectomy ( No LN ) or lymphadenectomy ( LN ) . The protocol recommended a vertical incision but transverse incisions could be used if appropriate . The up date d analysis was planned when 110 deaths were observed in each incision group to detect a 10 % difference in 5-year OS with 5 % significance level and 90 % power . RESULTS Between 07/1998 and 04/2005 , 1408 patients ( 704 No LN , 704 LN ) were r and omised . 1286 patients had open ( vs laparoscopic ) surgery , of these 672 ( 52 % ) , 522 ( 40 % ) and 92 ( 7 % ) had vertical , Pfannenstiel and other transverse incisions respectively . More patients in the LN arm had a vertical incision ( 386 ) compared to the no LN arm ( 287 ) . With a median follow-up of 60 months , 251 ( 18 % ) patients ( 115 No LN , 136 LN ) had died with a HR of 1.22 ( 95%CI 0.95 - 1.56 ) , p=0.12 in favour of st and ard surgery . 128 ( 19 % ) and 102 ( 17 % ) deaths were reported in vertical and Pfannenstiel/other transverse groups . There was no evidence of an interaction between type of incision and surgical r and omisation for OS ( p=0.74 ) . CONCLUSIONS Long term follow-up supports previous findings , with no evidence of a benefit from lymphadenectomy and no evidence that type of surgical incision influences OS Abstract Objectives Identifying all published reports of r and omized controlled trials ( RCTs ) is an important aim , but it requires extensive manual effort to separate RCTs from non- RCTs , even using current machine learning ( ML ) approaches . We aim ed to make this process more efficient via a hybrid approach using both crowdsourcing and ML . Methods We trained a classifier to discriminate between citations that describe RCTs and those that do not . We then adopted a simple strategy of automatically excluding citations deemed very unlikely to be RCTs by the classifier and deferring to crowdworkers otherwise . Results Combining ML and crowdsourcing provides a highly sensitive RCT identification strategy ( our estimates suggest 95%–99 % recall ) with substantially less effort ( we observed a reduction of around 60%–80 % ) than relying on manual screening alone . Conclusions Hybrid crowd-ML strategies warrant further exploration for biomedical curation/annotation tasks OBJECTIVE The purpose of this study was to explore in greater depth the outcomes of the Italian r and omized trial investigating the role of pelvic lymphadenectomy in clinical early stage endometrial cancer . In the attempt to identify the patients with poorer prognosis , the impact of age and body mass index were also thoroughly investigated by cancer-specific survival ( CSS ) analyses . STUDY DESIGN Survival outcomes of trial patients were analyzed in relation to age ( ≤65 years and > 65 years ) in the 2 arms  ( lymphadenectomy and no lymphadenectomy ) and in the whole population of the trial . RESULTS Univariate and multivariable analyses of CSS and overall survival ( OS ) of patients showed that age > 65 years is a strong independent poor prognostic factor ( 5-y OS 92.1 % and 78.4 % in ≤65 years and > 65 years patients , respectively , P < .0001 ; 5-y CSS 93.8 % and 83.5 % in ≤65 years and > 65 years patients , respectively , P = .003 ) . Among women ≤65 years , node negative patients had 94.4 % 5-y OS and 96.3 % 5-y CSS vs 74.3 % 5-y OS and 74.3 % 5-y CSS for node positive patients ( P = .009 and P = .002 , respectively ) , while among women > 65 y , node negative patients had 75.7 % 5-y OS and 83.6 % 5-y CSS vs 74.1 % 5-y OS and 83.3 % 5-y CSS for node positive patients ( P = .55 and P = .58 , respectively ) . Univariate and multivariable survival analyses in the whole trial population showed that older age , and higher tumor grade and stage were significantly associated to a worse prognosis . CONCLUSION Older women faced an intrinsic poorer survival whether or not they underwent lymphadenectomy , and , unexpectedly , irrespective of the presence of nodal metastasis . Only in older patients was obesity ( body mass index > 30 ) significantly associated with scarce prognosis BACKGROUND Hysterectomy and bilateral salpingo-oophorectomy ( BSO ) is the st and ard surgery for stage I endometrial cancer . Systematic pelvic lymphadenectomy has been used to establish whether there is extra-uterine disease and as a therapeutic procedure ; however , r and omised trials need to be done to assess therapeutic efficacy . The ASTEC surgical trial investigated whether pelvic lymphadenectomy could improve survival of women with endometrial cancer . METHODS From 85 centres in four countries , 1408 women with histologically proven endometrial carcinoma thought preoperatively to be confined to the corpus were r and omly allocated by a minimisation method to st and ard surgery ( hysterectomy and BSO , peritoneal washings , and palpation of para-aortic nodes ; n=704 ) or st and ard surgery plus lymphadenectomy ( n=704 ) . The primary outcome measure was overall survival . To control for postsurgical treatment , women with early-stage disease at intermediate or high risk of recurrence were r and omised ( independent of lymph-node status ) into the ASTEC radiotherapy trial . Analysis was by intention to treat . This study is registered , number IS RCT N 16571884 . FINDINGS After a median follow-up of 37 months ( IQR 24 - 58 ) , 191 women ( 88 st and ard surgery group , 103 lymphadenectomy group ) had died , with a hazard ratio ( HR ) of 1.16 ( 95 % CI 0.87 - 1.54 ; p=0.31 ) in favour of st and ard surgery and an absolute difference in 5-year overall survival of 1 % ( 95 % CI -4 to 6 ) . 251 women died or had recurrent disease ( 107 st and ard surgery group , 144 lymphadenectomy group ) , with an HR of 1.35 ( 1.06 - 1.73 ; p=0.017 ) in favour of st and ard surgery and an absolute difference in 5-year recurrence-free survival of 6 % ( 1 - 12 ) . With adjustment for baseline characteristics and pathology details , the HR for overall survival was 1.04 ( 0.74 - 1.45 ; p=0.83 ) and for recurrence-free survival was 1.25 ( 0.93 - 1.66 ; p=0.14 ) . INTERPRETATION Our results show no evidence of benefit in terms of overall or recurrence-free survival for pelvic lymphadenectomy in women with early endometrial cancer . Pelvic lymphadenectomy can not be recommended as routine procedure for therapeutic purpose s outside of clinical trials Background The grading of recommendation , assessment , development and evaluation ( GRADE ) approach is widely implemented in health technology assessment and guideline development organisations throughout the world . GRADE provides a transparent approach to reaching judgements about the quality of evidence on the effects of a health care intervention , but is complex and therefore challenging to apply in a consistent manner . Methods We developed a checklist to guide the research er to extract the data required to make a GRADE assessment . We applied the checklist to 29 meta-analyses of r and omised controlled trials on the effectiveness of health care interventions . Two review ers used the checklist for each paper and used these data to rate the quality of evidence for a particular outcome . Results For most ( 70 % ) checklist items , there was good agreement between review ers . The main problems were for items relating to indirectness where considerable judgement is required . Conclusions There was consistent agreement between review ers on most items in the checklist . The use of this checklist may be an aid to improving the consistency and reproducibility of GRADE assessment s , particularly for inexperienced users or in rapid review s without the re sources to conduct assessment s by two research ers independently BACKGROUND Pelvic lymph nodes are the most common site of extrauterine tumor spread in early-stage endometrial cancer , but the clinical impact of lymphadenectomy has not been addressed in r and omized studies . We conducted a r and omized clinical trial to determine whether the addition of pelvic systematic lymphadenectomy to st and ard hysterectomy with bilateral salpingo-oophorectomy improves overall and disease-free survival . METHODS From October 1 , 1996 , through March 31 , 2006 , 514 eligible patients with preoperative International Federation of Gynecology and Obstetrics stage I endometrial carcinoma were r and omly assigned to undergo pelvic systematic lymphadenectomy ( n = 264 ) or no lymphadenectomy ( n = 250 ) . Patients ' clinical data , pathological tumor characteristics , and operative and early postoperative data were recorded at discharge from hospital . Late postoperative complications , adjuvant therapy , and follow-up data were collected 6 months after surgery . Survival was analyzed by use of the log-rank test and a Cox multivariable regression analysis . All statistical tests were two-sided . RESULTS The median number of lymph nodes removed was 30 ( interquartile range = 22 - 42 ) in the pelvic systematic lymphadenectomy arm and 0 ( interquartile range = 0 - 0 ) in the no-lymphadenectomy arm ( P < .001 ) . Both early and late postoperative complications occurred statistically significantly more frequently in patients who had received pelvic systematic lymphadenectomy ( 81 patients in the lymphadenectomy arm and 34 patients in the no-lymphadenectomy arm , P = .001 ) . Pelvic systematic lymphadenectomy improved surgical staging as statistically significantly more patients with lymph node metastases were found in the lymphadenectomy arm than in the no-lymphadenectomy arm ( 13.3 % vs 3.2 % , difference = 10.1 % , 95 % confidence interval [ CI ] = 5.3 % to 14.9 % , P < .001 ) . At a 
    Output:
    
Furthermore , the Cochrane review and meta- analysis of RCTs of routine adjuvant radiotherapy to treat possible lymph node metastases in women with early-stage endometrial cancer found no survival advantage .
Results of the meta- analysis remained unchanged from the previous versions of this review and indicated no differences in overall and recurrence-free survival between women who underwent lymphadenectomy  and those who did not undergo lymphadenectomy  ( pooled hazard ratio ( HR ) 1.07 , 95 % confidence interval ( CI ) 0.81 to 1.43 ; HR 1.23 , 95 % CI 0.96 to 1.58 for overall and recurrence-free survival , respectively ) ( 1851 participants , two studies ; moderate- quality evidence ) .We found no difference in risk of direct surgical morbidity between women who underwent lymphadenectomy and those who did not undergo lymphadenectomy .
This review found no evidence that lymphadenectomy decreases risk of death or disease recurrence compared with no lymphadenectomy in women with presumed stage I disease .
Evidence on serious adverse events suggests that women who undergo lymphadenectomy are more likely to experience surgery-related systemic morbidity or lymphoedema/lymphocyst formation .
Currently , no RCT evidence shows the impact of lymphadenectomy in women with higher-stage disease and in those at high risk of disease recurrence