***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 Esophageal resection is associated with a high incidence of postoperative pneumonia . Respiratory complications account for almost half of the readmissions to the critical care unit . Postoperative complications can result in prolonged hospital stay and consequently increase healthcare costs . In cardiac surgery a preoperative inspiratory muscle training program has shown to prevent postoperative pneumonia and reduce length of hospital stay . While in some surgical centers inspiratory muscle training is already used in the preoperative phase in patients undergoing esophageal resection , the added value of this intervention on the reduction of pulmonary complications has not yet been investigated in large surgical population s other than cardiac surgery in a r and omized and controlled study design . Methods / Design The effect of a preoperative inspiratory muscle training program on the incidence of postoperative pneumonia in patients undergoing esophageal resection will be studied in a single blind multicenter r and omized controlled trial ( the PREPARE study ) . In total 248 patients ( age > 18 years ) undergoing esophageal resection for esophageal cancer will be included in this study . They are r and omized to either usual care or usual care with an additional inspiratory muscle training intervention according to a high-intensity protocol which is performed with a tapered flow resistive inspiratory loading device . Patients have to complete 30 dynamic inspiratory efforts twice daily for 7 days a week until surgery with a minimum of 2 weeks . The starting training load will be aim ed to be 60 % of maximal inspiratory pressure and will be increased based on the rate of perceived exertion . The main study endpoint is the incidence of postoperative pneumonia . Secondary objectives are to evaluate the effect of preoperative inspiratory muscle training on length of hospital stay , duration of mechanical ventilation , incidence of other postoperative ( pulmonary ) complications , quality of life , and on postoperative respiratory muscle function and lung function . Discussion The PREPARE study is the first multicenter r and omized controlled trial to evaluate the hypothesis that preoperative inspiratory muscle training leads to decreased pulmonary complications in patients undergoing esophageal resection . Trial registration NCT01893008 Background Poor nutrition in the first months after oesophago-gastric resection is a contributing factor to the reduced quality of life seen in these patients . The aim of this pilot and feasibility study was to ascertain the feasibility of conducting a multi-centre r and omised controlled trial to evaluate routine home enteral nutrition in these patients . Methods Patients undergoing oesophagectomy or total gastrectomy were r and omised to either six weeks of home feeding through a jejunostomy ( intervention ) , or treatment as usual ( control ) . Intervention comprised overnight feeding , providing 50 % of energy and protein requirements , in addition to usual oral intake . Primary outcome measures were recruitment and retention rates at six weeks and six months . Nutritional intake , nutritional parameters , quality of life and healthcare costs were also collected . Interviews were conducted with a sample of participants , to ascertain patient and carer experiences . Results Fifty-four of 112 ( 48 % ) eligible patients participated in the study over the 20 months . Study retention at six weeks was 41/54 patients ( 76 % ) and at six months was 36/54 ( 67 % ) . At six weeks , participants in the control group had lost on average 3.9 kg more than participants in the intervention group ( 95 % confidence interval [ CI ] 1.6 to 6.2 ) . These differences remained evident at three months ( mean difference 2.5 kg , 95 % CI −0.5 to 5.6 ) and at six months ( mean difference 2.5 kg , 95 % CI −1.2 to 6.1 ) . The mean values observed in the intervention group for mid arm circumference , mid arm muscle circumference , triceps skin fold thickness and right h and grip strength were greater than for the control group at all post hospital discharge time points . The economic evaluation suggested that it was feasible to collect re source use and EQ-5D data for a full cost-effectiveness analysis . Thematic analysis of 15 interviews identified three main themes related to the intervention and the trial : 1 ) a positive experience , 2 ) the reasons for taking part , and 3 ) uncertainty of the study process . Conclusions This study demonstrated that home enteral feeding by jejunostomy was feasible , safe and acceptable to patients and their carers . Whether home enteral feeding as ’ usual practice ’ is a cost-effective therapy would require confirmation in an appropriately powered , multi-centre study .Trial registration UK Clinical Research Network ID 12447 ( main trial , first registered 30 May 2012 ) ; UK Clinical Research Network ID 13361 ( qualitative sub study , first registered 30 May 2012 ) ; Clinical Trials.gov NCT01870817 ( first registered 28 May 2013 BACKGROUND Patients requiring surgery for locally advanced rectal cancer often additionally undergo neoadjuvant chemoradiotherapy ( NACRT ) , of which the effects on physical fitness are unknown . The aim of this feasibility and pilot study was to investigate the effects of NACRT and a 6 week structured responsive exercise training programme ( SRETP ) on oxygen uptake [ Formula : see text ] at lactate threshold ( [ Formula : see text ] ) in such patients . METHODS We prospect ively studied 39 consecutive subjects ( 27 males ) with T3 - 4/N+ resection margin threatened rectal cancer who completed st and ardized NACRT .  Subjects underwent cardiopulmonary exercise testing at baseline ( pre-NACRT ) , at week 0 ( post-NACRT ) , and week 6 ( post-SRETP ) . Twenty-two subjects undertook a 6 week SRETP on a training bike ( three sessions per week ) between week 0 and week 6 ( exercise group ) . These were compared with 17 contemporaneous non-r and omized subjects ( control group ) . Changes in [ Formula : see text ] at [ Formula : see text ] over time and between the groups were compared using a compound symmetry covariance linear mixed model . RESULTS Of 39 recruited subjects , 22 out of 22 ( exercise ) and 13 out of 17 ( control ) completed the study . There were differences between the exercise and control groups at baseline [ age , ASA score physical status , World Health Organisation performance status , and Colorectal Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity ( CR-POSSUM ) predicted mortality ] . In all subjects , [ Formula : see text ] at [ Formula : see text ] significantly reduced between baseline and week 0 [ -1.9 ml kg(-1 ) min(-1 ) ; 95 % confidence interval ( CI ) -1.3 , -2.6 ; P<0.0001 ] . In the exercise group , [ Formula : see text ] at [ Formula : see text ] significantly improved between week 0 and week 6 ( + 2.1 ml kg(-1 ) min(-1 ) ; 95 % CI + 1.3 , + 2.9 ; P<0.0001 ) , whereas the control group values were unchanged ( -0.7 ml kg(-1 ) min(-1 ) ; 95 % CI -1.66 , + 0.37 ; P=0.204 ) . CONCLUSIONS NACRT before rectal cancer surgery reduces physical fitness . A structured exercise intervention is feasible post-NACRT and returns fitness to baseline levels within 6 weeks . CLINICAL TRIAL REGISTRATION NCT 01325909 Purpose Physical , nutritional and quality -of-life compromises are known sequelae of oesophageal cancer ( OC ) treatment . Inflammation and oxidative stress may be relevant to adverse consequences . Multimodal rehabilitation involving exercise and diet prescription may attenuate some of the negative consequences and optimise survivorship , and this was assessed in this feasibility study in OC patients at least 1 year post-oesophagectomy . Methods The 12-week programme included supervised and home-based exercise , dietetic counselling to ensure energy balance and multidisciplinary education . Baseline and post-intervention assessment s examined aerobic fitness , physical activity and body composition . Serum interleukin (IL)-1β , tumour necrosis factor (TNF)-α , IL-6 and IL-8 were measured via multiplex arrays . Lactate secretion , lipid peroxidation ( 4-HNE ) and oxidative stress ( 8-iso-PGF2α ) were measured by enzyme-linked immunosorbent assay ( ELISA ) . Results Twelve patients ( mean ( SD ) age 64(1.29 ) years ) participated . IL-8 reduced significantly from pre- to post-intervention ( percentage change −11.25 % ( 95 % CI −20.98 to −1.51 % ) , p = 0.03 ) , and there was a non-significant trend towards lower expression patterns of other inflammatory mediators . At baseline , inflammatory status correlated inversely with sedentary behaviour ( IL-6 rho = −0.74 , IL-8 rho = −0.59 , TNF-α rho = −0.69 ; p < 0.05 ) . While energy metabolism did not change , post-intervention lactate concentration correlated strongly and inversely with aerobic fitness ( rho = −0.68 , p = 0.02 ) . Body composition was maintained throughout the intervention . Conclusions Results suggest that multimodal rehabilitation following OC treatment reduced inflammatory status without compromising body composition . Findings will be further examined in a larger r and omised controlled trial Background Sarcopenia is a decrease in both muscle mass and strength . It remains unclear whether sarcopenia is associated with morbidity after gastric cancer surgery . This study evaluated the impact of sarcopenia on the morbidity of gastric cancer surgery . Methods A total of 293 gastric cancer patients who underwent curative surgery between May 2011 and June 2013 were retrospectively examined . Patients with performance status 3 or 4 were excluded .  Preoperative lean body mass ( LBM ) was evaluated by bioelectrical impedance analysis and expressed as LBM index .  Preoperative muscle function was measured by h and grip strength ( HGS ) . The cutoff values were the gender-specific lowest 20 % . Grade 2 or higher morbidities , as retrospectively evaluated by the Clavien – Dindo classification , were obtained from the patient record . The risk factors for morbidity were examined by univariate and multivariate analyses . Results Morbidity was observed in 39 patients ( 13.3 % ) , including 7 with pancreatic leakage , 12 with anastomotic leakage , and 4 with intraabdominal abscesses , but no mortality was observed . The univariate analysis showed that male gender , total gastrectomy , splenectomy , and a low HGS were significant risk factors for morbidity . A low LBM was not a significant risk factor . A low HGS , male gender , and total gastrectomy remained significant in the multivariate analysis . Conclusions A low h and grip strength was a significant risk factor for morbidity after gastric cancer surgery . The importance of the h and grip strength as a risk factor should be examined in future prospect i ve studies Background Neoadjuvant therapy for cancer of the esophagus or gastroesophageal (GE)-junction is well established . The pros and cons of chemoradiotherapy and chemotherapy are debated . Chemoradiotherapy might impair cardiac function eliciting postoperative morbidity . The aim of this pilot study was to describe acute changes in left ventricular function following chemoradiotherapy or chemotherapy . Methods Patients with esophageal and (GE)-junction cancer enrolled at our center into a multicenter trial comparing neoadjuvant chemoradiotherapy and chemotherapy were eligible . Patients were r and omized to receive cisplatin and 5-fluorouracil with or without the addition of 40 Gy radiotherapy prior to surgery .  Left ventricular function was evaluated using echocardiography and plasma N-Terminal Pro-B-Type Natriuretic Peptide ( NT-proBNP ) before and after neoadjuvant treatment . The primary outcome measure was left ventricular global strain ( GS ) . Clinical effects were assessed using repeated exercise tests . Linear mixed models were used to analyze the effects of treatment group , and the interaction between groups . Results 40 patients participated ( chemoradiotherapy , n = 17 ; chemotherapy , n = 23 ) . In the chemoradiotherapy group there was no change in left ventricular global strain but mitral annular plane systolic excursion ( MAPSE ) of the ventricular septum , early diastolic filling velocity ( E-velocity ) , and the ratio of early to late ventricular filling velocities ( E/A ratio ) decreased significantly ( p = 0.02 , p = 0.01 , and p = 0.03 , respectively ) . No changes were observed in the chemotherapy group . There was a trend towards an interaction effect for MAPSE sept and E ( p = 0.09 and p = 0.09 ) . NT-proBNP increased following chemoradiotherapy ( p = 0.05 ) but not after chemotherapy ( p > 0.99 ) , and there was a trend towards an interaction effect ( p = 0.07 ) . Working capacity decreased following neoadjuvant treatment ( chemoradiotherapy p = 0.001 , chemotherapy p = 0.03 ) and was more pronounced after chemoradiotherapy with a trend towards an interaction effect ( p = 0.10 ) . Conclusions Neoadjuvant chemoradiotherapy but not chemotherapy before surgery for cancer of the esophagus or GE-junction seems to induce an acute negative effect on both systolic and diastolic left vent 
    Output:
    
Significant reductions in physical function occur in patients undergoing neoadjuvant treatment and in the first 3 months post-resection .
Lower pre-operative exercise capacity is associated with an increased risk of post-operative pulmonary complications ( PPCs ) .
Conclusions Chemotherapy , chemoradiation and surgery lead to reduced physical function in patients with oesophageal and gastric cancer .
Implication s for Cancer SurvivorsCurative treatment for oesophago-gastric cancer can negatively impact on physical function .
Rehabilitation programmes have considerable potential to enhance physical function across the oesophago-gastric cancer journey