***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: Laparoscopy-assisted colectomy istechnically feasible , but objective evidence of its benefits remainsscarce . This study was done to evaluate the outcomes and operativestress of laparoscopy-assisted colectomy versus the traditional open method in the management of sigmoid complex polyps that can not besafely or adequately removed by colonofibroscopy . Between January 1997 and December 1999 , a total of 42 patients were equally r and omizedto the laparoscopy group and the laparotomy group by the blockedr and omization method . Three patients r and omized to the laparoscopygroup did not complete the trial ; therefore 18 patients treated bylaparoscopy-assisted sigmoidectomy and the other 21 treated by the open method were prospect ively evaluated . These two groups of patients werewell matched in age , gender , symptoms , tumor location , localization method , tumor size , morphology , histopathology , and the accuracy of the clinical diagnosis . Two st and ardized surgical strategies , thelateral-to-medial and medial-to-lateral dissection sequences , wereperformed in 14 and 4 patients of the laparoscopy group , respectively , according to whether their tumors were located above or below 20 cmabove the anal verge . After evaluating the surgical outcomes , we foundthat the laparoscopy group was significantly better than the laparotomygroup in regard to parameters that included severity of postoperativepain , wound size , postoperative complication rate , and the duration ofpostoperative ileus , hospitalization , and disability . There was nosignificant difference in the operating times for these two groups . However , the costs of the laparoscopy group were significantly higher . To evaluate the surgical stress , we measured the serum C-reactiveprotein ( CRP ) level , erythrocyte sedimentation rate ( ESR ) , totallymphocyte count , and CD4+/CD8 + ratio 24 hoursbefore and after surgery . We found that the postoperative serum CRPlevel and the ESR were significantly less elevated and the totallymphocyte counts and CD4+/CD8 + ratio weresignificantly less depressed in the laparoscopy group than in thelaparotomy group . We thus concluded that laparoscopy-assistedsigmoidectomy can be safely performed with shorter convalescence and less operative stress but at a higher cost . We strongly recommended theuse of this technique in the management of sigmoid complex polyps ifthe patient 's economic status permits Background and aims : Reduced fibrinolytic activity of the peritoneum seems to be the main cause of postoperative adhesions . This prospect i ve r and omized trial compared the peritoneal fibrinolytic activity between laparoscopic and conventional colorectal resection .  Methods :  Parietal peritoneal biopsy specimens were taken in st and ardized elective laparoscopic ( n=14 ) and conventional ( n=16 ) colorectal resections at the beginning and at the end of surgery .  Activities and concentrations of tissue-plasminogen activator ( tPA ) , plasminogen activator ( PAI ) type 1 , and tPA/PAI complex were determined by ELISA kits . Results : There was no difference in age , sex , or body mass index between the two groups . Perioperative tPA activity decreased in both groups without differences between the groups . Concentrations and activities of tPA , PAI-1 , and tPA/PAI complex did not differ between the groups at any time . Conclusion : Peritoneal concentrations and activities of tPA , PAI-1 , and tPA/PAI complex are similar during laparoscopic and conventional colorectal resections . A capnoperitoneum of 12 mmHg over 3 h did not affect the peritoneal fibrinolytic BACKGROUND Adjuvant chemotherapy ( 5-fluorouracil , levamisole ) is now st and ard practice in the treatment of Dukes ' B and C coloretal carcinoma ( CRC ) , and this has increased the financial burden on health care systems world-wide . PATIENTS AND METHODS Between 1993 and 1996 , 95 patients in northern Norway were included in a national r and omised CRC study , and assigned to surgery plus adjuvant chemotherapy or surgery alone . In April 1996 , 94 of the patients were evaluable and 82 were still alive . The total treatment costs ( hospital stay , surgery , chemotherapy , administrative and travelling costs ) were calculated . A question naire was mailed to all survivors for assessment of the quality of their lives ( QoL ) ( EuroQol question naire , a simple QoL-scale , global QoL-measure of the EORTC QLQ-C30 ) , and 62 of them ( 76 % ) responded . RESULTS Adjuvant chemotherapy in Dukes ' B and C CRC raised the total treatment costs by 3,369 pounds . The median QoL was 0.83 ( 0 - 1 scale ) in both arms . Employing a 5 % discount rate and an improved survival of adjuvant therapy ranging from 5 % to 15 % , we calculated the cost of one gained quality -adjusted life-year ( QALY ) to be between 4,800 pounds and 16,800 pounds . CONCLUSION Using a cut-off point level of 20,000 pounds per QALY , adjuvant chemotherapy in CRC appears to be cost-effective only when the improvement in 5-year survival is > or = 5 % . Adjuvant chemotherapy does not affect short-term PURPOSE : Traumatic manipulation of cancer specimens during  laparoscopic colectomy  may increase exfoliation of malignant cells into the peritoneal cavity , causing an early occurrence of peritoneal carcinomatosis or port-sites recurrence . Because of this concern , the routine use of intraperitoneal chemotherapy after laparoscopic colectomy for cancer was suggested recently . We assessed if laparoscopicvs . conventional surgery increases exfoliated malignant cells in the peritoneal cavity during resection of colorectal cancer . METHODS : In a prospect i ve , r and omized fashion , 38 colorectal cancer patients undergoing an elective , curative operation were assigned to either a conventional or laparoscopic procedure between June 1996 and May 1997 . In either group ( n=19 ) , after the abdominal cavity was entered , saline was instilled into the peritoneal cavity , and the fluid was collected ( Specimen 1 ) . During surgery , all irrigating fluids were collected ( Specimen 2 ) . Both specimens were assessed for malignancy using four techniques : filtration process ( ThinPrep ® ) , smear , cell block , and immunochemistry using Ber-EP4 . The change in the amount of tumor cells in both specimens was compared between surgical groups . A pilot study was performed to vali date the proposed cytologic method . RESULTS : In the pilot study of 20 consecutive patients with colorectal cancer , postresectional peritoneal cytology was positive in six patients , including two Stage II ( T3,N0,M0 ) patients . The pilot study also vali date d that our semiquantitative scoring system can be reliably used to assess the amount of free peritoneal cancer cells . In the main study , 16 right colectomies , 3 extended right colectomies , 17 proctosigmoidectomies , and 1 left colectomy were performed . The T and N stages were T1 ( n=13 ) , T2 ( n=5 ) , T3 ( n=8 ) , T4 ( n=11 ) ; N0 ( n=22 ) , N1 ( n=8 ) , N2 ( n=7 ) . Malignant cells were not detected in any Specimens 1 or , more importantly , in Specimens 2 in either surgical group . CONCLUSION : When performed according to strict oncologic surgical principles , laparoscopic techniques in curative colorectal cancer surgery did not have an increased risk of intraperitoneal cancer cell spillage , compared with conventional techniques . We hope that these results can decrease some of the concerns about tumors cell spillage and seeding during laparoscopy BACKGROUND The safety and short-term benefits of laparoscopic colectomy for cancer remain debatable . The multicentre COLOR ( COlon cancer Laparoscopic or Open Resection ) trial was done to assess the safety and benefit of laparoscopic resection compared with open resection for curative treatment of patients with cancer of the right or left colon . METHODS 627 patients were r and omly assigned to laparoscopic surgery and 621 patients to open surgery .  The primary endpoint was cancer-free survival 3 years after surgery . Secondary outcomes were short-term morbidity and mortality , number of positive resection margins , local recurrence , port-site or wound-site recurrence , metastasis , overall survival , and blood loss during surgery . Analysis was by intention to treat . Here , clinical characteristics , operative findings , and postoperative outcome are reported . FINDINGS Patients assigned laparoscopic resection had less blood loss compared with those assigned open resection ( median 100 mL [ range 0 - 2700 ] vs 175 mL [ 0 - 2000 ] , p<0.0001 ) , although laparoscopic surgery lasted 30 min longer than did open surgery ( p<0.0001 ) . Conversion to open surgery was needed for 91 ( 17 % ) patients undergoing the laparoscopic procedure . Radicality of resection as assessed by number of removed lymph nodes and length of resected oral and aboral bowel did not differ between groups . Laparoscopic colectomy was associated with earlier recovery of bowel function ( p<0.0001 ) , need for fewer analgesics , and with a shorter hospital stay ( p<0.0001 ) compared with open colectomy .  Morbidity and mortality 28 days after colectomy did not differ between groups . INTERPRETATION Laparoscopic surgery can be used for safe and radical resection of cancer in the right , left , and sigmoid colon Laparoscopic surgery is believed to produce an attenuated metabolic stress response and to have a less dampening effect on the immune response than open surgery . To date , the effect has not been studied in a r and omized clinical trial of colorectal cancer Background : We compared the perioperative parameters and outcomes achieved with h and -assisted laparoscopic colectomy ( HALC ) vs open colectomy ( OC ) for the management of benign and malignant colorectal disease , including cancer patients treated with curative intent . Methods : Sixty eligible patients were r and omized to either HALC ( n = 30 ) or OC ( n = 30 ) treatment groups . We used Pearson ’s chi-square and two- sample t-tests to compare the differences in demographics and perioperative parameters . Results : There were no significant differences in age , gender distribution , disease pattern , operative procedure , comorbidity , or history of abdominal surgery . The HALC patients had significantly shorter hospital stays and incision lengths , faster recovery of gastrointestinal function , less analgesic use and blood loss , and lower pain scores on postoperative days 1 , 3 , and 14 . There were no significant differences in operative time , complications , or time to return to normal activity . Conclusion : H and -assisted laparoscopic colectomy ( HALC ) is safe and produces better therapeutic results in terms of perioperative parameters than OC BACKGROUND Laparotomy causes a significant reduction of pulmonary function , and atelectasis and pneumonia occur after elective conventional colorectal resections . OBJECTIVE To evaluate the hypothesis that pulmonary function is less restricted after laparoscopic than after conventional colorectal resection . DESIGN A r and omized clinical trial . SETTING The surgical department of an academic medical center . PATIENTS Sixty patients underwent laparoscopic ( n = 30 ) or conventional ( n = 30 ) resection of colorectal tumors .  The 2 groups did not differ significantly in age , sex , localization or stage of tumor , or preoperative pulmonary function . MAIN OUTCOME MEASURES Forced vital capacity , forced expiratory volume in 1 second , peak expiratory flow , mid-expiratory phase of forced expiratory flow , and oxygen saturation of arterial blood . RESULTS The forced vital capacity ( mean + /- SD values : conventional resection group , 1.73+/-0.60 L ; laparoscopic surgery group , 2.59+/-1.11 L ; P<.01 ) and the forced expiratory volume in 1 second ( conventional resection group , 1.19+/-0.51 L/s ; laparoscopic surgery group , 1.80+/-0.80 L/s ; P<.01 ) were more profoundly suppressed in the patients having conventional resection than in those having laparoscopic surgery . Similar results were found for the peak expiratory flow ( conventional resection group , 2.51+/-1.37 L/s ; laparoscopic resection group , 3.60+/-2.22 L/s ; P<.05 ) and the midexpiratory phase of forced expiratory flow ( conventional resection group , 1.87+/-1.12 L/s ; laparoscopic surgery group , 2.67+/-1.76 L/s ; P<.05 ) . The oxygen saturation of arterial blood , measured while the patients were breathing room air , was lower after conventional than after laparoscopic resections ( P<.01 ) . The recovery of the forced vital capacity and forced expiratory volume in 1 second to 80 % of the preoperative value took longer in patients having conventional resection than in 
    Output:
    
However , the data they provided on effectiveness was poorer than the evidence from the review of effectiveness .
In terms of incremental cost per life-year ,  laparoscopic surgery was found to be more costly and no more effective than open surgery .
Laparoscopic resection is associated with a quicker recovery ( shorter time to return to usual activities and length of hospitalisation ) and no evidence of a difference in mortality or disease-free survival up to 3 years following surgery .
However , operation times are longer and a significant number of procedures initiated laparoscopically may need to be converted to open surgery .
The rate of conversion may be dependent on experience in terms of both patient selection and performing the technique .
In terms of relative cost-effectiveness , laparoscopic resection is associated with a modest additional cost , short-term benefits associated with more rapid recovery and similar long-term outcomes in terms of survival and cure rates up to 3 years .
Assuming equivalence of long-term outcomes , a judgement is required as to whether the benefits associated with earlier recovery are worth this extra cost .