***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: 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 purpose of this study was to evaluate laparoscopy-assisted distal gastrectomy ( LADG ) compared to open distal gastrectomy ( ODG ) in the treatment of early gastric cancer with respect to survival , surgical outcomes , complications , and quality of life ( QOL ) . Methods One hundred sixty-four patients with cT1N0M0 and cT1N1M0 distal gastric cancer were r and omly assigned to either the LADG group or the ODG group . The primary end point was the 5-year disease-free survival ( DFS ) rate . Complications were classified using the accordion severity classification of postoperative complications scheme . QOL was measured using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-STO22 preoperatively and postoperatively during regular follow-up visits . This trial is registered at Clinical Trials.gov ( NCT00546468 ) . Results The median ( range ) follow-up period was 74.3 ( 24.8–90.8 ) months . The LADG and ODG groups showed similar survival [ 5-year DFS rate : 98.8 % vs. 97.6 % , respectively ( P = 0.514 ) , 5-year overall survival ( OS ) rate : 97.6 vs. 96.3 % , respectively ( P = 0.721 ) ] or overall complication rate ( 29.3 vs. 42.7 % , respectively ; P = 0.073 ) . Mild complications were significantly less frequent in the LADG group than in the ODG group ( 23.2 vs. 41.5 % ; P = 0.012 ) . The rates of moderate , severe , and long-term complications ( i.e. , 31 days to 5 years after surgery ) did not differ significantly between groups . No clinical ly meaningful differences were detected between the two groups in long-term QOL . Conclusion LADG showed similar DFS and OS compared to ODG in treating early gastric cancer . Marginal benefits in mild complications were observed with LADG . LADG did not show advantages over ODG regarding other complications and long-term QOL BACKGROUND Laparoscopic surgery as an alternative to open surgery in patients with rectal cancer has not yet been shown to be oncologically safe . The aim in the COlorectal cancer Laparoscopic or Open Resection ( COLOR II ) trial was to compare laparoscopic and open surgery in patients with rectal cancer . METHODS A non-inferiority phase 3 trial was undertaken at 30 centres and hospitals in eight countries . Patients ( aged ≥18 years ) with rectal cancer within 15 cm from the anal verge without evidence of distant metastases were r and omly assigned to either laparoscopic or open surgery in a 2:1 ratio , stratified by centre , location of tumour , and preoperative radiotherapy . The study was not masked . Secondary ( short-term ) outcomes -including operative findings , complications , mortality , and results at pathological examination-are reported here . Analysis was by modified intention to treat , excluding those patients with post-r and omisation exclusion criteria and for whom data were not available . This study is registered with Clinical Trials.gov , number NCT00297791 . FINDINGS The study was undertaken between Jan 20 , 2004 , and May 4 , 2010 . 1103 patients were r and omly assigned to the laparoscopic ( n=739 ) and open surgery groups ( n=364 ) , and 1044 were eligible for analyses ( 699 and 345 , respectively ) . Patients in the laparoscopic surgery group lost less blood than did those in the open surgery group ( median 200 mL [ IQR 100 - 400 ] vs 400 mL [ 200 - 700 ] , p<0·0001 ) ; however , laparoscopic procedures took longer ( 240 min [ 184 - 300 ] vs 188 min [ 150 - 240 ] ; p<0·0001 ) . In the laparoscopic surgery group , bowel function returned sooner ( 2·0 days [ 1·0 - 3·0 ] vs 3·0 days [ 2·0 - 4·0 ] ; p<0·0001 ) and hospital stay was shorter ( 8·0 days [ 6·0 - 13·0 ] vs 9·0 days [ 7·0 - 14·0 ] ; p=0·036 ) . Macroscopically , completeness of the resection was not different between groups ( 589 [ 88 % ] of 666 vs 303 [ 92 % ] of 331 ; p=0·250 ) . Positive circumferential resection margin ( < 2 mm ) was noted in 56 ( 10 % ) of 588 patients in the laparoscopic surgery group and 30 ( 10 % ) of 300 in the open surgery group ( p=0·850 ) . Median tumour distance to distal resection margin did not differ significantly between the groups ( 3·0 cm [ IQR 2·0 - 4·8 ] vs 3·0 cm [ 1·8 - 5·0 ] , respectively ; p=0·676 ) . In the laparoscopic and open surgery  groups , morbidity ( 278 [ 40 % ] of 697 vs 128 [ 37 % ] of 345 , respectively ; p=0·424 ) and mortality ( eight [ 1 % ] of 699 vs six [ 2 % ] of 345 , respectively ; p=0·409 ) within 28 days after surgery were similar . INTERPRETATION In selected patients with rectal cancer treated by skilled surgeons , laparoscopic surgery result ed in similar safety , resection margins , and completeness of resection to that of open surgery , and recovery was improved after laparoscopic surgery . Results for the primary endpoint-locoregional recurrence-are expected by the end of 2013 . FUNDING Ethicon Endo-Surgery Europe , Swedish Cancer Foundation , West Gothia Region , Sahlgrenska University Hospital Introduction Total mesorectal excision ( TME ) is an essential component of surgical management of rectal cancer . Both open and laparoscopic TME have been proven to be oncologically safe . However , it remains a challenge to achieve complete TME with clear circumferential resections margin ( CRM ) with the conventional transabdominal approach , particularly in mid and low rectal tumours . Transanal TME ( TaTME ) was developed to improve oncological and functional outcomes of patients with mid and low rectal cancer . Methods An international , multicentre , superiority , r and omised trial was design ed to compare TaTME and conventional laparoscopic TME as the surgical treatment of mid and low rectal carcinomas . The primary endpoint is involved CRM . Secondary endpoints include completeness of mesorectum , residual mesorectum , morbidity and mortality , local recurrence , disease-free and overall survival , percentage of sphincter-saving procedures , functional outcome and quality of life . A Quality Assurance Protocol including central ised MRI review , histopathology re-evaluation , st and ardisation of surgical techniques , and monitoring and assessment of surgical quality will be conducted . Discussion The difference in involvement of CRM between the two treatment strategies is thought to be in favour of the TaTME . TaTME is therefore expected to be superior to laparoscopic TME in terms of oncological outcomes in case of mid and low rectal carcinomas Background Laparoscopy-assisted distal gastrectomy ( LADG ) is generally considered superior to open distal gastrectomy ( ODG ) with regard to postoperative quality -of-life . Differences in postoperative pain may exist due to recent pain control techniques including epidural anesthesia . There is little evidence for this difference . In this article we report the results of our r and omized single-blind study in LADG versus ODG . The aim of the present study was to evaluate differences in postoperative physical activity between LADG and ODG . Methods Forty patients with early gastric cancer ( stage IA and IB ) were registered in this r and omized study . For strict evaluation , patients were not told about the type of operation until postoperative day 7 . Postoperative physical activity was evaluated objective ly by Active Tracer , which records the cumulative acceleration over a 24 h period to investigate differences in postoperative recovery . Question naire and visual analog scale score related to postoperative pain were also investigated . Results Significant differences were observed with a more favorable outcome noted in the LADG group with respect to intraoperative blood loss ( P < 0.001 ) , total amount of pain rescue ( P < 0.001 ) , wound size ( P < 0.001 ) , postoperative hospital stay ( P < 0.001 ) , and inflammatory parameters ( C-reactive protein , SaO2 , and duration of febrile period ) ( P < 0.001 ) . Cumulative physical recovery to 70 % of the preoperative level was significantly shorter ( by 3 days , P < 0.001 ) in the LADG group . Conclusions Comparison of LADG and ODG for patients with early gastric cancer showed favorable outcome and earlier recovery of physical activity in the LADG group BACKGROUND Compared with open resection , laparoscopic resection of rectal cancers is associated with improved short-term outcomes , but high-level evidence showing similar long-term outcomes is scarce . We aim ed to compare survival outcomes of laparoscopic surgery with open surgery for patients with mid-rectal or low-rectal cancer . METHODS The Comparison of Open versus laparoscopic surgery for mid or low REctal cancer After Neoadjuvant chemoradiotherapy ( COREAN ) trial was an open-label , non-inferiority , r and omised controlled trial done between April 4 , 2006 , and Aug 26 , 2009 , at three centres in Korea . Patients ( aged 18 - 80 years ) with cT3N0 - 2M0 mid-rectal or low-rectal cancer who had received preoperative chemoradiotherapy  were r and omly assigned ( 1:1 ) to receive either open or laparoscopic surgery . R and omisation was stratified by sex and preoperative chemotherapy regimen . Investigators were masked to the r and omisation sequence ; patients and clinicians were not masked to the treatment assignments . The primary endpoint was 3 year disease-free survival , with a non-inferiority margin of 15 % . Analysis was by intention to treat . This trial is registered with Clinical Trials.gov , number NCT00470951 . FINDINGS We r and omly assigned 340 patients to receive either open surgery ( n=170 ) or laparoscopic surgery ( n=170 ) . 3 year disease-free survival was 72·5 % ( 95 % CI 65·0 - 78·6 ) for the open surgery group and 79·2 % ( 72·3 - 84·6 ) for the laparoscopic surgery group , with a difference that was lower than the prespecified non-inferiority margin ( -6·7 % , 95 % CI -15·8 to 2·4 ; p<0·0001 ) . 25 ( 15 % ) patients died in the open group and 20 
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Conclusions Crossover in trials was associated with an increase in 30-day mortality , anastomotic leak rate , and early complications within the MIS group based on intention-to-treat analysis , although our analysis did not assess causation .