***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: The contention that the R2 radical gastrectomy for localized and potentially curable gastric carcinoma may be superior to gastrectomy without lymphadenectomy ( R1 ) was assessed by r and omized trial . Five years after commencement 403 patients have been evaluated at surgery and only 43 ( 11 per cent ) found eligible ( S0–2 , P0 , H0 , N0–1 ) , 22 of whom underwent R1 and 21 R2 gastrectomy .  Seven patients had final histological stages in excess of the protocol . The R2 group had a longer operating time ( P<0.005 ) , a greater blood transfusion requirement ( P<0.005 ) , a longer hospital stay ( 0.05>P>0.025 ) and required reoperation in four cases . There were no postoperative deaths . Four patients have died from the disease in the R1 group and five in the R2 group , there being no difference in the probability of survival at a median follow‐up of 3.1 years . The small proportion of patients suitable for radical R2 surgery , the high associated morbidity and the fact that survival advantage has yet to be proven in trial suggest that this procedure should not yet be performed outside of controlled clinical trials BACKGROUND The aim of this trial was to compare multimodal optimization with conventional perioperative management in a consecutive series of patients undergoing gastrectomy procedures . METHODS According to r and omized controlled studies and conclusions made by meta-analyses in colorectal surgery , optimized perioperative measures were design ed and applied in gastrectomy surgery . Thirty-three patients were r and omized to the optimized group and 30 patients to a control group .  Two groups were treated in 1 center by a single surgical team in different wards . Both groups used patient-controlled intravenous analgesia for postoperative analgesia . The primary end point was length of postoperative hospital stay . Secondary outcomes included bowel function recovery after surgery , perioperative changes of inflammatory factors , glucocorticoid , insulin resistance , and body composition . Perioperative complications and adverse events were also recorded . RESULTS The groups were similar in terms of age , sex ratio , and Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity ( POSSUM score ) . The optimized group was associated with a significantly shorter postoperative hospital stay compared with the conventional care group ( P < .001 ) . Duration s of urinary catheterization and abdominal drainage were also less ( P < .001 ) . The diet program in the optimization group was well tolerated and was associated with an earlier recovery of gut function ( P < .001 ) . Proinflammatory factors were less elevated and body composition was more stable in the optimized group than in controls . There were no differences in morbidity or mortality between the groups . CONCLUSIONS Optimization of care in gastrectomy can shorten postoperative hospital stay and provides multiple beneficial outcomes , including hastening the return of gut function , without increasing morbidity 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 UNLABELLED In traditional practice patterns , physicians take care of all clinical decisions , such as diagnosis , treatment , and recovery . In the Nippon Medical School Hospital a clinical pathway for distal gastrectomy patients , recorded as a post-operative care map , was introduced in August 2000 . In January 2001 the post-operative management was analyzed and st and ardization of practice was carried out with printed order sets , such as drugs and infusion solutions . The aim of this study was to evaluate the clinical significance of the clinical pathway for gastrectomy patients by employing st and ardized postoperative management and printed order sets . PATIENTS AND METHODS From January 2001 to December 2001 , 87 patients underwent distal ( 43 ) , total ( 28 ) , proximal ( 7 ) and partial gastrectomy ( 9 ) for gastric cancer ( stage IA : 47 , IB : 9 , II : 7 , IIIA : 8 , IIIB 2 , IV : 10 ) and gastrointestinal stromal tumor ( 4 ) . These patients were r and omly assigned to either the main building or the east building of our hospital . In the main building 38 patients were looked after using traditional practice ( control group ) . In the east building 47 patients were looked after according to the clinical pathway ( path group ) and 2 patients were excluded from the path group because of neo-adjuvant chemotherapy and severe heart failure . Aspects of the patients ' outcomes , including length of stay , the first day of the diet , morbidity , and medical costs , were compared between the path group and the control group . All data were expressed as means+/-st and ard deviation . Statistical analyses were made using Student t-test , Mann-Whitney U-test , and chi(2 ) test , and the 5%level was chosen for statistical significance . RESULTS The length of the hospital stay was 27.1+/-10.0 and 40.8+/-26.1 days ( p<0.005 ) and the length of post-operative stay was 18.1+/-9.5 and 28.2+/-22.3 days ( p<0.01 ) in the path group and the control group , respectively . The post-operative day when the diet was started for the path and control groups was 6.8+/-8.9 and 8.2+/-7.2 , respectively ; however , the length of the intravenous infusion for the two groups was 11.8+/-1.1 and 16.5+/-1.2 days ( p<0.01 ) , respectively . There was no statistically significant difference in the morbidity rate between the path group ( 3/47 ) and the control group ( 5/38 ) . The total cost was 1,502,587 yen + /-41,650 in the path group and 1,932,197 yen + /-131,030 in the control ( p<0.001 ) . CONCLUSION A clinical pathway for gastrectomy patients proved useful to optimize their postoperative care , including medication management and diet education . It is suggested that the implementation of a st and ardized clinical pathway for gastrectomy patients reduced the length of the hospital stay and the medical costs 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 , the other three groups had earlier first flatus and shorter postoperative hospital stay ( all P < 0.01 ; all P < 0.05 ) , especially in the FTS + LADG group . The level of ALB was higher in the FTS + LADG group than in the LADG group at 4 and 7 days after surgery ( P < 0.05 , P < 0.01 ) . The level of CRP in the FTS + LADG group was lower than in the FTS+ODG group at 4 and 7 days after surgery ( P < 0.05 , P < 0.05 ) . The FTS + ODG group had lowest medical costs . Conclusion Combination of FTS and LADG in gastric cancer is safe , feasible , and efficient and can improve nutritional status , lessen postoperative stress , and accelerate postoperative rehabilitation . Compared with FTS + ODG and LADG , its advantages were limited in short-term follow-up OBJECTIVE To investigate the safety and efficacy of fast track surgery ( FTS ) management in gastric cancer undergoing D2 gastrectomy . METHODS Eighty gastric cancer patients undergoing D2 gastrectomy were recruited prospect ively . Patients were assigned to receive FTS management ( n = 40 ) or conventional perioperative care ( n = 40 ) . The FTS care included shorten preoperative fasting time , no nasogastric decompressing tubes and abdominal drainage placed , early postoperative oral feeding , multimodal analgesia , and early mobilisation . The length of postoperative hospital stay , medical cost , nutritional status , gut function , and postoperative complications in the two groups were recorded and compared . RESULTS FTS group was associated with a significantly shorter postoperative hospital stay compared with conventional care group [ ( 5.6 + /- 1.3 ) d vs. ( 9.4 + /- 1.9 ) d , P < 0.05 ] . Medical cost was less [ ( 18 620 + /- 2360 ) Yuan vs. ( 20 370 + /- 2440 ) Yuan , P < 0.05 ] and duration of intravenous infusion [ ( 3.5 + /- 1.4 ) d vs. ( 5.8 + /- 1.9 ) d , P < 0.05 ] was also shorter . First passage of flatus was earlier in FTS group than in conventional care group [ ( 4.3 + /- 0.4 ) d vs. ( 5.5 + /- 0.9 ) d , P < 0.05 ] . Loss of body weight in the postoperative period was less in FTS group [ ( 3.2 + /- 0.8 ) kg vs. ( 4.3 + /- 1.6 ) kg , P < 0.05 ] . There was no difference in morbidity or mortality between the two groups . CONCLUSION FTS in D2 gastrectomy is safe and efficient , and it can shorten postoperative hospital stay and hasten return of gut function PURPOSE Patients with locally advanced gastric cancer benefit from combined pre- and postoperative chemotherapy , although fewer than 50 % could receive postoperative chemotherapy . We examined the value of purely preoperative chemotherapy in a phase III trial with strict preoperative staging and surgical resection guidelines . P 
    Output:
    
From this review the authors concluded that multimodal , st and ardized perioperative gastrectomy care appears feasible , safe and cost effective