***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: Background Fast-track protocol s are followed by an enhanced recovery , early return to bowel function and to complete nutrition , and a reduced hospital stay . Our study was design ed to implement fast-track protocol in our university hospital . Methods The 96 consecutive patients with colorectal neoplasm included in the study were r and omized in two equal groups : group 1 ( FT ) included patients undergoing colorectal surgery in a fast-track protocol , and group 2 ( C ) included patients undergoing colorectal surgery with a conventional care protocol .  As with other fast-track protocol s , our protocol included carbohydrate fluids load before operation , early mobilization and oral feeding , regular prokinetics , and multimodal postoperative analgesia .  Time to restoration of bowel function , to complete mobilization and feeding , length of hospital stay , and incidence of complications and readmissions were monitored . Results Time to mobilization , restoring of bowel function , and complete oral feeding were significantly shorter with fast-track protocol ( p = 0.001 , p = 0.042 , and p = 0.01 , respectively ) . Hospital stay also was shorter in the fast-track group ( p = 0.001 ) . The incidence of complications did not significantly differ with the study groups . Conclusions In our study , fast-track protocol result ed in a shorter time to mobilization , complete feeding , and discharge from hospital . Fast-track protocol did not increase the incidence of complications . However , we consider that our data require further confirmation with powered multicenter national studies INTRODUCTION The aim of this study is to present the " fast-track " experience in children who underwent colon resection .  MATERIAL S AND METHODS Forty-six children who underwent laparoscopic colon resection  were prospect ively included in the study . Anomalies of colon innervation and inflammatory bowel disease represented the main surgical indications . RESULTS Left colon/sigmoid resection was performed in 37 , total colon resection was done in 5 , and right colon resection in 4 children . Total colon resection was always associated to ileostomy . Anastomosis was performed in 41 cases . Patients were postoperatively monitored for pain , return to normal activity , feeding , bowel movements , and complications . Stool passage and oral feeding were started on postoperative day 1 , and all patients were discharged before postoperative day 4 . One child was readmitted the day after discharge because of an anastomotic leak . No other major complications were recorded . DISCUSSION Minimally invasive surgery is safe and effective in pediatric colonic surgery and allows a fast recovery time ( fast-track ) Fast-track surgery describes innovative treatment concepts ensuring a faster convalescence phase . The aim of this study was to allow hospital discharge 3 days after surgery without additional complications in patients receiving LRPE for localized prostate cancer . Twenty-five patients each were r and omized in the study groups to verify if a fast-track regimen could be transferred into clinical routine . The perioperative data , early complications , hospital stay as well as readmission rate were analyzed . The mean postoperative stay was 3.6 days in the fast-track group versus 6.7 days in the conventional group . The overall complications were significantly less in the fast-track procedure . The readmission rate was low and not significant . Patients receiving an LRPE benefit from a suitable fast-track concept . The postoperative hospital stay could be shortened nearly by half with a significantly decreased overall complication rate . Thus , fast-track concepts might contribute to saving re sources in the long term . However , more evidence based on larger prospect i ve trials is needed to achieve optimal quality of life for patients perioperatively Bilateral  simultaneous total knee replacement ( TKR )  has been considered by some to be associated with increased morbidity and mortality . Our study analysed the outcome of 150 consecutive , but selected , bilateral simultaneous TKRs  and compared them with that of 271 unilateral TKRs in a st and ardised fast-track setting . The procedures were performed between 2003 and 2009 . Apart from staying longer in hospital ( mean 4.7 days ( 2 to 16 ) versus 3.3 days ( 1 to 25 ) ) and requiring more blood transfusions , the outcome at three months and two years was similar or better in the bilateral  simultaneous TKR  group in regard to morbidity , mortality , satisfaction , the range of movement , pain , the use of a walking aid and the ability to return to work and to perform activities of daily living .  Bilateral simultaneous TKR can therefore be performed as a fast-track procedure with excellent results Objective It has been demonstrated that colon operation combined with fast-track ( FT ) surgery and laparoscopic technique can shorten the length of hospital stay , accelerate recovery of intestinal function , and reduce the occurrence of post-operative complications . However , there are no reports regarding the combined effects of FT colon operation and laparoscopic technique on humoral inflammatory cellular immunity . Methods This was a prospect i ve , controlled study . One hundred sixty-three colon cancer patients underwent the traditional protocol and open operation ( traditional open group , n = 42 ) , the traditional protocol and laparoscopic operation ( traditional laparoscopic group , n = 40 ) , the FT protocol and open operation ( FT open group , n = 41 ) , or the FT protocol and laparoscopic operation ( FT laparoscopic group , n = 40 ) .  Blood sample s were taken prior to operation as well as on days 1 , 3 , and 5 after operation . The number of lymphocyte sub population s was determined by flow cytometry , and serum interleukin-6 and C-reactive protein levels were measured . Post-operative hospital stay , post-operative morbidity , readmission rate , and in-hospital mortality were recorded . Results Compared with open operation , laparoscopic colon operation effectively inhibited the release of post-operative inflammatory factors and yielded good protection via post-operative cell immunity . FT surgery had a better protective role with respect to the post-operative immune system compared with traditional peri-operative care . Inflammatory reactions , based on interleukin-6 and C-reactive protein levels , were less intense following FT laparoscopic operation compared to FT open operation ; however , there were no differences in specific immunity ( CD3 + and CD4 + counts , and the CD4+/CD8 + ratio ) during these two types of surgical procedures . Post-operative hospital stay in patients r and omized to the FT laparoscopic group was significantly shorter than in the other three treatment groups ( P < 0.01 ) . Post-operative complications in patients who underwent FT laparoscopic treatment were less than in the other three treatment groups ( P < 0.05 ) . There were no significant differences between the four treatment groups regarding readmission rate and in-hospital mortality . Conclusions The laparoscopic technique and FT surgery rehabilitation program effectively inhibited release of post-operative inflammatory factors with a reduction in peri-operative trauma and stress , which together played a protective role on the post-operative immune system . Combining two treatment measures during colon operation produced better protective effects via the immune system . The beneficial clinical effects support that the better-preserved post-operative immune system may also contribute to the improvement of post-operative results in FT laparoscopic patients Background Fast-track surgery has been shown to enhance postoperative recovery in several surgical fields . This study aim ed to evaluate the safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy . Methods The present study was design ed as a single-center , r and omized , unblinded , parallel-group trial . Patients were eligible if they had gastric cancer for which laparoscopic distal gastrectomy was indicated . The fast-track surgery protocol included intensive preoperative education , a short duration of fasting , a preoperative carbohydrate load , early postoperative ambulation , early feeding , and sufficient pain control using local anesthetics perfused via a local anesthesia pump device , with limited use of opioids . The primary endpoint was the duration of possible and actual postoperative hospital stay . Results We r and omized 47 patients into a fast-track group ( n = 22 ) and a conventional pathway group ( n = 22 ) , with three patients withdrawn . The possible and actual postoperative hospital stays were shorter in the fast-track group than in the conventional group ( 4.68 ± 0.65 vs. 7.05 ± 0.65 ; P < 0.001 and 5.36 ± 1.46 vs. 7.95 ± 1.98 ; P < 0.001 ) . The time to first flatus and pain intensity were not different between groups ; however , a greater frequency of additional pain control was needed in the conventional group ( 3.64 ± 3.66 vs. 1.64 ± 1.33 ; P = 0.023 ) . The fast-track group was superior to the conventional group in several factors of the European Organization for Research and Treatment of Cancer Quality of Life Question naire , including : fatigue , appetite loss , financial problems , and anxiety . The complication and readmission rates were similar between groups . Conclusions Fast-track surgery could enhance postoperative recovery , improve immediate postoperative quality of life , and be safely applied in laparoscopic distal gastrectomy The rate of postoperative recovery is determined by pain , stress-induced organ dysfunction , and limitations in conventional postoperative care . We attempted to provide " stress-free " colonic resection for neoplastic disease in eight elderly high-risk patients by a combination of laparoscopically assisted surgery , epidural analgesia , and early oral nutrition and mobilisation .  Effective pain relief allowed early mobilisation , and hospital stay was reduced to 2 days without nausea , vomiting , or ileus . Postoperative fatigue and impairment in functional activity were avoided . Major advances in postoperative recovery can be achieved by early aggressive perioperative care in elderly high-risk patients undergoing colonic surgery Background Nasogastric decompression has been routinely used in most major abdominal operations to prevent the consequences of postoperative ileus . The aim of the present study was to assess the necessity for routine prophylactic nasogastric or nasojejunal decompression after gastrectomy . Methods A prospect i ve r and omized trial included 84 patients undergoing elective partial or total gastrectomy . The patients were r and omized to a group with a  postoperative nasogastric or nasojejunal tube ( Tube Group , n = 43 ) or to a  group without a tube ( No-tube Group , n = 41 ) . Gastrointestinal function , postoperative course , and complications were assessed . Results No significant differences in postoperative mortality or morbidity , especially fistula or intra-abdominal sepsis , were observed between the groups . Passage of flatus ( P < 0.01 ) and start of oral intake ( P < 0.01 ) were significantly delayed in the Tube Group . Duration of postoperative perfusion ( P = 0.02 ) and length of hospital stay ( P = 0.03 ) were also significantly longer in the Tube Group . Rates of nausea and vomiting were similar in the two groups . Moderate to severe discomfort caused by the tube was observed in 72 % of patients in the Tube Group . Insertion of a  nasogastric or nasojejunal tube  was necessary in 5 patients in the No-tube Group ( 12 % ) . Conclusions Routine prophylactic postoperative nasogastric decompression is unnecessary after elective gastrectomy Background Fast-track surgery is a new , promising comprehensive program for surgical patients and is beneficial to recovery . Prospect i ve r and omized , controlled clinical trials involving fast-track surgery for gastric cancer are lacking . Patient and methods Ninety-two patients with gastric cancer were r and omly divided into a fast-track surgery group ( n = 45 ) and conventional surgery group ( n = 47 ) . We compared outcomes ( duration of postoperative stay in hospital , fever , and flatus , complications , and medical costs ) ; postoperative serum levels of tumor necrosis factor-α , interleukin-6 , and C-reactive protein ; and resting energy expenditure between two groups . Results Compared with the conventional surgery group , the fast-track surgery group had no more complications ( P > 0.05 ) with a significantly shorter duration of fever , flatus , and hospital stay , and less medical costs as well as a higher quality of life score on hospital discharge ( all P < 0.05 ) . With a significantly lower resting energy expenditure ( days 1 and 3 ) postoperatively ( P < 0.05 ) , the fast-track surgery group showed a lower serum level of tumor necrosis factor-α ( days 1 and 3 ) , interleukin-6 ( days 1 and 3 ) , and C-reactive protein ( days 1 , 3 , and 7 ) than the conventional surgery group ( all P < 0.05 ) . Conclusions Fast-track surgery can lessen postoperative stress reactions and accelerate rehabilitation for patients with gastric cancer Objective The aim of this study was to evaluate the safety and effectiveness of fast-track surgery combined with laparoscopy-assisted radical distal gastrectomy for gastric cancer . Methods Eighty-eight eligible patients were r and omly assigned into four groups : ( 1 ) fast-track surgery ( FTS ) + laparoscopy-assisted radical distal gastrectomy ( LADG ) , treated with LADG and FTS treatment ; ( 2 ) LADG , treated with LADG and traditional treatment ; ( 3 ) FTS + open distal grastectomy ( ODG ) , treated with ODG and FTS treatment ; and ( 4 ) ODG , treated with ODG and traditional treatment . The clinical parameters and serum indicators were compared . Results Compared with the ODG group , 
    Output:
    
Conclusions Based on current evidence , the FTS protocol was feasible for gastric cancer patients who underwent gastrectomy ( distal subtotal gastrectomy , proximal subtotal gastrectomy , or radical total gastrectomy ) via open or laparoscopic surgery .