***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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    ***EXAMPLES*** 
    Input: Abstract Introduction Transanal endoscopic microsurgery ( TEM ) is a minimal invasive technique for local excision of rectal tumours . The procedure is performed via a rectoscope with a diametre of 4 cm . The aim of this prospect i ve study was to assess both functional outcome and quality of life after TEM . Patients and methods Between 2004 and 2006 , 47 patients were studied prior to and at least 6 months after TEM .  Demographics , operative details and post-operative complications were recorded . Functional outcome was determined using the Faecal Incontinence Severity Index ( FISI ) . Quality of life was measured using the EuroQol EQ-5D question naire and the Faecal Incontinence Quality of Life ( FIQL ) score . Results Six months after surgery , median FISI score was found to be decreased ( p < 0.01 ) , depicting an improvement in faecal continence . This improvement was most significant in tumours within 7 cm from the dentate line ( p = 0.01 ) . From the patients ’ perspective , post-operative quality of life was found to be higher ( p < 0.02 ) . A significant improvement was observed in two of the four FIQLS domains ( embarrassment , p = 0.03 ; lifestyle , p = 0.05 ) . The domains of lifestyle , coping and behaviour and embarrassment were correlated with the FISI ( all p < 0.05 ) . Conclusion This study indicates TEM has no deteriorating effect on faecal continence . Moreover , once the tumour has been excised using TEM , quality of life is improved A prospect i ve study of clinical , manometric and proctographic results in 36 patients presenting for transanal endoscopic microsurgery  was performed .  Anorectal manometry  showed no difference in maximal squeeze pressure before and 12 months after operation , but resting pressures were lower after surgery ( mean(s.e.m . ) preoperative 86.1(27.6 ) mmHg versus postoperative 67.2(23.2 ) mmHg , P<0.05 ) . The rectoanal inhibitory reflex was lost in a significant group of patients ( reflex present in 34 of 36 patients before operation and in 27 of 36 12 months after operation , P<0.05 ) . Proctography , manometry and question naire showed preserved function of most modalities 12 months after operation such that if objective function was impaired clinical function was adequate Background : The aim of this study was to evaluate the feasibility , safety , perioperative morbidity , and short-term outcomes of the transanal minimally invasive surgery ( TAMIS ) technique . Methods : This is a descriptive review of prospect ively collected data from 32 consecutive patients who underwent TAMIS procedures in our colorectal unit over a 40-month period .  GelPOINT Path port was used in all cases . Demographic data , indications , tumor characteristics , morbidity , and follow-up data were collected . Primary endpoints included feasibility , safety , perioperative morbidity , and resection quality . Results : Fifteen adenomas , 12 carcinomas , 1 gastrointestinal stromal tumor , and 1 neuroendocrine tumor were locally excised . Additionally , 3 pelvic abscesses were drained transanally using the TAMIS port . Mean distance from the anal verge was 5.6 ± 1.5 cm . Early postoperative complications occurred in 22 % , with only one case of major complication ( 3.1 % ) requiring reoperation , and no postoperative mortality . Four carcinomas were understaged ( 33.3 % ) and 1 adenoma overstaged ( 6.7 % ) preoperatively . Three carcinomas were not suspected preoperatively ( 25 % ) . Microscopic positive lateral margin was found in one case , and no affected deep margin was found . Fragmentation rate was 6.9 % , 2 cases , both lesions over 20 cm2 . In cases of fit patients with high-risk carcinomas , 2 underwent immediate salvage surgery and another 2 refused and were treated with adjuvant radiotherapy . With a median follow-up of 26 months , the overall recurrence rate was 10.3 % , 1 adenoma and 2 carcinomas . Conclusion : TAMIS seems to be a safe and reproducible procedure for local excision of well-selected rectal lesions with low morbidity and good functional outcomes Background Transanal minimally invasive surgery ( TAMIS ) is emerging as an alternative to transanal endoscopic microsurgery .  Quality of life ( QOL ) and functional outcome are important aspects when valuing a new technique . The aim of this prospect i ve study was to assess both functional outcome and QOL after TAMIS . Methods From 2011 to 2013 , patients were prospect ively studied prior to and at least 6 months after TAMIS for rectal adenomas and low-risk T1 carcinomas using a single-site laparoscopy port . Functional outcome was determined using the Faecal Incontinence Severity Index ( FISI ) . Quality of life was measured using functional [ Faecal Incontinence Quality of Life ( FIQL ) ] and generic ( EuroQol EQ-5D ) question naires . Results The study population consisted of 24 patients 13 men , median age 59 ( range 42–83 ) with 24 tumours [ median distance from the dentate line 8 cm ( range 2–17 cm ) ; median tumour size 6 cm2 ( range 0.25–51 cm2 ) ; 20 adenomas ; 4 low-risk T1 carcinomas ] .  Post-operative complications occurred in one patient ( 4 % ; grade IIIb according to Clavien Dindo classification ) . Compared to baseline , FISI remained unaffected ( 9.8 vs 7.3 ; P = 0.26 ) , FIQL remained unaffected , and EuroQol EQ-5D improved ( EQ-VAS : 77 vs 83 ; P = 0.04 ) . Conclusion There was no detrimental effect of TAMIS on anorectal function . Overall QOL was improved after TAMIS , probably due to removal of the tumour , and at 6 months was equal to the general population PURPOSE : The Swedish Rectal Cancer Trial has unequivocally demonstrated that preoperative high-dose ( 5 × 5 Gy ) radiotherapy reduces local failure rates and improves overall survival . This will have an impact on the primary treatment of rectal cancer . This study investigates the effect of preoperative high-dose radiotherapy on long-term bowel function in patients treated with anterior resection .  METHODS : A question naire was answered by 92 percent ( 203/220 ) of patients who were included in the Swedish Rectal Cancer Trial and who were alive after a minimum of five years . Thirty-two patients were excluded , mainly because of postoperative stomas and dementia , which left 171 for analysis . RESULTS : Median bowel frequency per week was 20 in the irradiated group ( n=84 ) and 10 in the surgery-alone group ( n=87;P<0.001 ) . Incontinence for loose stools ( P<0.001 ) , urgency ( P<0.001 ) , and emptying difficulties ( P<0.05 ) were all more common after irradiation . Sensory functions such as “ discrimination between gas and stool ” and “ ability to safely release flatus ” did not , however , differ between groups . Thirty percent of the irradiated group stated that they had an impaired social life because of bowel dysfunction , compared with 10 percent of the surgery-alone group ( P<0.01 ) . CONCLUSIONS : The study indicates that high-dose radiotherapy  influences long-term bowel function , thus emphasizing the need for finding predictive factors for local recurrence to exclude patients with a very high probability for cure with surgery alone and to use optimized radiation techniques BACKGROUND : Currently , the preferred method for local excision of rectal polyps is transanal endoscopic microsurgery , avoiding rectal resection . Transanal minimally invasive surgery is a relatively new technique using a disposable port in combination with conventional laparoscopic instruments . This method is less expensive as compared with transanal endoscopic microsurgery , relatively easy to learn , and available . Despite wide adoption of transanal minimally invasive surgery , to date only a few series on the implementation and use of this technique are reported , and detailed information on the effect of transanal minimally invasive surgery on fecal continence is not available . OBJECTIVE : The purpose of this work was to prospect ively assess the functional outcome after transanal minimally invasive surgery using the Fecal Incontinence Severity Index preoperatively and postoperatively . DESIGN : This was a prospect i ve cohort study . SETTING S : The study was conducted at a large teaching hospital . PATIENTS : Patients included those who underwent transanal minimally invasive surgery between October 2011 and September 2013 . INTERVENTIONS : Transanal minimally invasive surgery was studied . MAIN OUTCOME MEASURES : We measured postoperative surgical and functional results . RESULTS : A total of 37 patients underwent transanal minimally invasive surgery  during our study period . Short-term morbidity rate was 14 % , and positive resection margins were reported in 6 cases ( 16 % ) ; in 1 of these patients , a local recurrence was observed . Overall , there was a significant decline in preoperative and postoperative Fecal Incontinence Severity Index scores ( p = 0.02 ) , indicating an improvement in anorectal function after transanal minimally invasive surgery for patients with impaired preoperative continence . Seventeen patients ( 49 % ) had impaired continence before transanal minimally invasive surgery ( mean Fecal Incontinence Severity Index score = 21 ) . Continence improved in 15 ( 88 % ) of these patients after surgery ; no change was observed in 1 patient ( 6 % ) , and continence further decreased in another . In addition , 18 patients ( 51 % ) had normal preoperative continence ( Fecal Incontinence Severity Index score = 0 ) , of which 83 % had no change in functionality , and continence decreased in 3 . LIMITATIONS : No quality of life was measured . CONCLUSIONS : Short-term functional results of transanal minimally invasive surgery for rectal polyps are excellent and comparable to functional results using the dedicated transanal endoscopic microsurgery equipment . More research on outcome after transanal minimally invasive surgery is needed to assess morbidity rates and oncologic clearance Abstract PURPOSE : There is accumulating evidence , both quantitative and qualitative , that pelvic irradiation adversely affects anorectal function . However , histologic evidence of sphincter injury has not been demonstrated . This study was design ed to perform histologic assessment of collagen deposition and nerve alteration in the internal anal sphincters of rectal cancer patients who underwent abdominoperineal resection after adjuvant chemoradiation therapy  and to correlate the degree of histologic changes with the time interval between chemoradiotherapy and abdominoperineal resection . METHODS : Anal canal specimens were prospect ively collected in patients undergoing abdominoperineal resection .  Representative slides were cut transversely at the level of the dentate line . Using trichrome and S-100 protein staining , a single pathologist blinded to the patients ’ treatment assessed collagen deposition and nerve fiber densities in the internal anal sphincter , respectively . RESULTS : Twelve patients received radiation for rectal cancer ( chemoradiotherapy group ) and six were treated by  surgery alone , including four patients with rectal cancer ( 1 leiomyosarcoma ) and two with Crohn ’s disease ( control group ) . There was a trend toward increased fibrosis ( replacement of > 10 percent of normal structures by collagen ) and nerve density in the chemoradiotherapy group compared with the control group ( P = 0.08 and P = 0.05 , respectively ) . Nerve density significantly increased as chemoradiotherapy to abdominoperineal resection interval increased ( P = 0.04 ) . CONCLUSIONS : Pelvic irradiation results in damage to the myenteric plexus of the internal anal sphincter of patients with rectal cancer ; these alterations seem to be time-dependent . A trend toward increased collagen deposition also was observed . Together , these results provide a morphologic basis , which concurs to previously described physiologic and clinical alterations in the anal sphincter of patients irradiated for rectal cancer PURPOSE Preoperative short-term radiotherapy improves local control in patients treated with total mesorectal excision ( TME ) . This study was performed to assess the presence and magnitude of long-term side effects of preoperative 5 x 5 Gy radiotherapy and TME . Also , hospital treatment was recorded for diseases possibly related to late side effects of rectal cancer treatment . PATIENTS AND METHODS Long-term morbidity was assessed in patients from the prospect i ve r and omized TME trial , which investigated the efficacy of 5 x 5 Gy before TME surgery for mobile rectal cancer . Dutch patients without recurrent disease were sent a question naire . RESULTS Results were obtained from 597 patients , with a median follow-up of 5.1 years .  Stoma function , urinary function , and hospital treatment rates did not differ significantly between the treatment arms . However , irradiated patients , compared with nonirradiated patients , reported increased rates of fecal incontinence ( 62 % v 38 % , respectively ; P < .001 ) , pad wearing as a result of incontinence ( 56 % v 33 % , respectively ; P < .001 ) , anal blood loss ( 11 % v 3 % , respectively ; P = .004 ) , and mucus loss ( 27 % v 15 % , respectively ; P = .005 ) . Satisfaction with bow 
    Output:
    
Conclusions These techniques do not seem to affect continence by themselves except in minor cases .