***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 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 Circumferential resection margin ( CRM ) appears as a new powerful prognostic factor of survival after surgery for rectal cancer . We aim ed to evaluate predictive factors of positive CRM following preoperative radiochemotherapy in a French trial . Patients with rectal cancer were r and omised in long course preoperative radiotherapy 45 Gy plus capecitabine versus 50 Gy plus capecitabine and oxaliplatin . Mesorectal excision was performed 6 weeks after treatment . Impact of clinical , pathological and surgical variables on positive CRM ( ≤1 mm ) were analysed by multivariate analysis . Of 565 r and omised patients , CRM was recorded in 390 cases and was positive in 8 % ( 30/390 ) . Patients with 50 Gy plus capecitabine and oxaliplatin had a 6 % rate of positive CRM while those treated by 45 Gy plus capecitabine had a 10 % rate ( p=0.128 ) . Three independent predictive factors of positive CRM were identified : abdominoperineal resection ( APR ) ( odds ratio OR=3.24 ; p=0.004 ) , vascular tumour invasion ( OR=2.78 ; p=0.026 ) and poor histological response ( modified Dworak 0 - 2 ) ( OR=9.01 ; p=0.003 ) . Significant predictive factors of positive CRM are related to type of surgery , especially APR , and poor histological prognostic factors . Intensification of neoadjuvant radiochemotherapy does not seem to have a major role in this study Background : The aim of the study was to evaluate quality of life ( QOL ) outcomes after  colorectal surgery for cancer from a 6-month perspective at a single institution . Methods : Cohort study to prospect ively assess postoperative QOL in patients who underwent elective colorectal resection at the University Hospital Ostrava .  QOL was assessed using the vali date d Short Form 36 ( SF-36v2 ™ ) question naire at fixed time points . Results : A total of 148 patients were enrolled in the study ( 83 and 65 patients underwent laparoscopic and open colorectal resection  ,  respectively ) . Operative time was significantly longer ( 161 vs. 133 min ; p = 0.0073 ) and length of hospital stay was significantly shorter ( 10.7 vs. 13.1 days ; p = 0.0451 ) in the laparoscopic group . Overall 30-day morbidity rates were lower in the laparoscopic group , but the difference was not significant ( 27.7 vs. 33.8 % ; p = 0.2116 ) . QOL scores were comparable in both study groups before surgery ( p ≥ 0.05 ) . QOL was statistically significantly lower 2 days and 1 week after open colorectal surgery compared with laparoscopic surgery . One month and 6 months after surgery , there were no statistically significant differences between groups . Conclusion : The present study suggests a higher postoperative QOL during the first month after laparoscopic colorectal resection could be one of the benefits of laparoscopy BACKGROUND Laparoscopic resection of colorectal cancer is widely used . However , robust evidence to conclude that laparoscopic surgery and open surgery have similar outcomes in rectal cancer is lacking . A trial was design ed to compare 3-year rates of cancer recurrence in the pelvic or perineal area ( locoregional recurrence ) and survival after laparoscopic and open resection of rectal cancer . METHODS In this international trial conducted in 30 hospitals , we r and omly assigned patients with a solitary adenocarcinoma of the rectum within 15 cm of the anal verge , not invading adjacent tissues , and without distant metastases to undergo either laparoscopic or open surgery in a 2:1 ratio . The primary end point was locoregional recurrence 3 years after the index surgery . Secondary end points included disease-free and overall survival . RESULTS A total of 1044 patients were included ( 699 in the laparoscopic-surgery group and 345 in the open-surgery group ) . At 3 years , the locoregional recurrence rate was 5.0 % in the two groups ( difference , 0 percentage points ; 90 % confidence interval [ CI ] , -2.6 to 2.6 ) . Disease-free survival rates were 74.8 % in the laparoscopic-surgery group and 70.8 % in the open-surgery group ( difference , 4.0 percentage points ; 95 % CI , -1.9 to 9.9 ) . Overall survival rates were 86.7 % in the laparoscopic-surgery group and 83.6 % in the open-surgery group ( difference , 3.1 percentage points ; 95 % CI , -1.6 to 7.8 ) . CONCLUSIONS Laparoscopic surgery in patients with rectal cancer was associated with rates of locoregional recurrence and disease-free and overall survival similar to those for open surgery . ( Funded by Ethicon Endo-Surgery Europe and others ; COLOR II Clinical Trials.gov number , NCT00297791 . ) Purpose This study was design ed to evaluate the impact of  laparoscopic rectal resection  on short-term postoperative morbidity and costs . Methods A total of 168 patients with rectal cancer were r and omly assigned to laparoscopic ( n = 83 ) or open ( n = 85 ) resection . Outcome parameters were : postoperative morbidity , length of hospital stay , quality of life , long-term survival , and local recurrences . The mean follow-up period was 53.6 months . Cost-benefit analysis was based on hospital costs . Results Operative time was 53 minutes longer in the laparoscopic group ( P < 0.0001 ) . Postoperative morbidity rate was 28.9 percent in the laparoscopic vs. 40 percent in the open group ( P = 0.18 ) . The mean length of hospital stay was 10 ( 4.9 ) days in the laparoscopic group and 13.6 ( 10 ) days in the open group ( P = 0.004 ) . Local recurrence rate and five-year survival were similar in both groups ; however , the limited number of patients does not allow firm conclusions . Quality of life was better in the laparoscopic group only in the first year after surgery ( P < 0.0001 ) . The additional charge in the laparoscopic group was $ 1,748 per patient r and omized ( $ 1,194 the result of surgical instruments and $ 554 the result of longer operative time ) . The saving in the laparoscopic group was $ 1,396 per patient r and omized ( $ 647 the result of shorter length of hospital stay and $ 749 the result of the lower cost of postoperative complications ) . The net balance result ed in $ 351 extra cost per patient r and omly allocated to the laparoscopic group . Conclusions Short-term postoperative morbidity was similar in the two groups . Laparoscopic resection reduced length of hospital stay , improved first-year quality of life , and slightly increased hospital costs IMPORTANCE Evidence about the efficacy of laparoscopic resection of rectal cancer is incomplete , particularly for patients with more advanced-stage disease . OBJECTIVE To determine whether laparoscopic resection is noninferior to open resection , as determined by gross pathologic and histologic evaluation of the resected proctectomy specimen . DESIGN , SETTING , AND PARTICIPANTS A multicenter , balanced , noninferiority , r and omized trial enrolled patients between October 2008 and September 2013 . The trial was conducted by credentialed surgeons from 35 institutions in the United States and Canada . A total of 486 patients with clinical stage II or III rectal cancer within 12 cm of the anal verge were r and omized after completion of neoadjuvant therapy to laparoscopic or open resection .  INTERVENTIONS St and ard laparoscopic and open approaches were performed by the credentialed surgeons . MAIN OUTCOMES AND 
    Output:
    
Conclusions Laparoscopic surgery for rectal cancer is associated with similar short-term and long-term oncologic outcomes compared to open surgery .
The oncologic quality of extracted specimens seems comparable regardless of the approach used