***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: OBJECTIVE A prospect i ve r and omized phase II trial was conducted to evaluate the efficacy of ghrelin administration in reducing systemic inflammatory response syndrome ( SIRS ) duration after esophagectomy . BACKGROUND Esophagectomy for esophageal cancer is highly invasive and leads to prolonged SIRS duration and postoperative complications . Ghrelin has multiple effects , including anti-inflammatory effects . METHODS Forty patients undergoing esophagectomy were r and omly assigned to either the ghrelin group ( n = 20 ) , which received continuous infusion of ghrelin ( 0.5 μg/kg/h ) for 5 days , or the placebo group ( n = 20 ) , which received pure saline for 5 days . The primary endpoint was SIRS duration . The secondary endpoints were the incidence of postoperative complications , time of a negative nitrogen balance , changes in body weight and composition , and levels of inflammatory markers , including C-reactive protein ( CRP ) and interleukin-6 ( IL-6 ) . RESULTS The ghrelin group had a shorter SIRS duration and lower CRP and IL-6 levels than did the placebo group . The incidence of pulmonary complications was lower in the ghrelin group than in the placebo group , whereas other complications did not differ between the groups . Although time of the negative nitrogen balance was shorter in the ghrelin group than in the placebo group , changes in total body weight and lean body weight did not differ significantly . CONCLUSIONS Postoperative ghrelin administration was effective for inhibiting inflammatory mediators and improving the postoperative clinical course of patients with esophageal cancer OBJECTIVE To determine the safety of laparoscopy-assisted distal gastrectomy ( LADG ) compared with open distal gastrectomy ( ODG ) in patients with clinical stage I gastric cancer in Korea . BACKGROUND There is still a lack of large-scale , multicenter r and omized trials regarding the safety of LADG . METHODS A large-scale , phase 3 , multicenter , prospect i ve r and omized controlled trial was conducted . The primary end point was 5-year overall survival . Morbidity within 30 postoperative days and surgical mortality were compared to evaluate the safety of LADG as a secondary end point RESULTS : A total of 1416 patients were r and omly assigned to the LADG group ( n = 705 ) or the ODG group ( n = 711 ) between February 1 , 2006 , and August 31 , 2010 , and 1384 patients were analyzed for modified intention-to-treat analysis ( ITT ) and 1256 were eligible for per protocol ( PP ) analysis ( 644 and 612 , respectively ) . In the PP analysis , 6 patients ( 0.9 % ) needed open conversion in the LADG group . The overall complication rate was significantly lower in the LADG group ( LADG vs ODG ; 13.0 % vs 19.9 % , P = 0.001 ) . In detail , the wound complication rate of the LADG group was significantly lower than that of the ODG group ( 3.1 % vs 7.7 % , P < 0.001 ) . The major intra-abdominal complication ( 7.6 % vs 10.3 % , P = 0.095 ) and mortality rates ( 0.6 % vs 0.3 % , P = 0.687 ) were similar between the 2 groups . Modified ITT analysis showed similar results with PP analysis . CONCLUSIONS LADG for patients with clinical stage I gastric cancer is safe and has a benefit of lower occurrence of wound complication compared with conventional ODG Objective : To examine the association between anastomotic leak and oncologic outcome after anterior resection , stratifying for defunctioning stoma . Background : It has been hypothesized that anastomotic leak predisposes rectal cancer patients to local recurrence . Many have a defunctioning stoma to reduce risk of clinical ly significant leakage . Methods : The records of patients undergoing low anterior resection ( 1991–2010 ) for rectal adenocarcinoma ( ⩽15 cm from anal verge ) were retrospectively analyzed using a prospect ively collected colorectal data base . Data ( age , gender , stage , defunctioning stoma , neoadjuvant treatment , distance from anal verge , anastomotic leak ) were collected . Clinical leakage was defined as anastomotic complication requiring intervention or interventional radiology within 60 days of surgery . Estimated local recurrence , overall survival , and disease-specific survival were compared using log-rank method and Cox regression analysis . Results : 1127 patients were included , with 5.6-year median follow-up . The incidence of clinical anastomotic leak was 3.5 % . Sixteen of 677 with defunctioning stoma ( 2.2 % ) developed clinical leak ; 24 of 450 without stoma ( 6.3 % ) developed leak ( P = 0.005 ) . There were no perioperative deaths among patients with clinical leakage . When stratified for defunctioning stoma , there was no association between clinical leak and local recurrence , disease-free survival , or overall survival . On multivariable analysis , when controlling for neoadjuvant therapy , distance of tumor from anal verge , defunctioning stoma , and pathologic stage , clinical leak was not associated with time to local recurrence , disease-free survival , or overall survival . Conclusions : In this cohort , anastomotic leakage was not associated with risk of local recurrence . Defunctioning stoma was associated with lower incidence of clinical leakage but not with difference in oncologic outcome . Careful patient selection for defunctioning stoma helps reduce risk of clinical ly significant anastomotic leak BACKGROUND We assessed the impact of complications on recurrence and survival after curative gastric cancer resection . METHODS Patients undergoing R0 resections between 1990 and 2009 were identified in a prospect ively maintained data base and were categorized by presence of any complication Clavien-Dindo ( CD ) ≥ II , sepsis or intra-abdominal sepsis . Cox regression analyses to relate complications and clinico-pathological variables to time to recurrence ( TTR ) and overall survival ( OS ) were performed . RESULTS A total of 271 patients were included with a median follow-up of 149.9 months ( range 140.1 - 159.9 ) . Complications CD ≥ II occurred in 162 ( 59.8 % ) patients , sepsis in 66 ( 22.5 % ) , and intra-abdominal sepsis in 37 ( 13.6 % ) . Recurrence developed in 88 ( 32.4 % ) patients . Independent predictors of short TTR were pTNM stage ( IIIB-IIIC vs. IA-IIA ) ( hazard ratio [ HR ] = 37.55 , 95 % confidence interval [ CI ] 17.57 - 80.24 ; p < 0.001 ) , D1 lymphadenectomy ( HR = 3.14 , 95 % CI 1.94 - 5.07 ; p < 0.001 ) , and male gender ( HR = 1.65 , 95 % CI 1.06 - 2.57 ; p = 0.026 ) . pTNM stage ( IIIB-IIIC vs. IA-IIA , HR = 10.28 , 95 % CI 6.51 - 16.23 ; p < 0.001 ) , male gender ( HR = 1.64 , 95 % CI 1.17 - 2.31 ; p = 0.005 ) , age ( HR = 1.03 , 95 % CI 1.02 - 1.05 ; p < 0.001 ) , and adjuvant therapy ( HR = 0.55 , 95 % CI 0.37 - 0.83 ; p = 0.004 ) were identified as independent predictors of OS .. CONCLUSIONS Evidence provided by this study does not support a negative impact of postoperative complications CD ≥ II , sepsis , and intra-abdominal sepsis on the oncologic outcome after curative gastric cancer resection OBJECTIVES Recent studies have suggested that postoperative complications could have a potential negative effect on long-term outcome after  oesophagectomy for cancer . Because respiratory failures represent the most frequent postoperative complication , we have investigated the prognostic impact of these complications on disease-free survival ( DFS ) . METHODS From a prospect i ve single-institution data base of 405 consecutive patients who underwent transthoracic oesophagectomy for cancer , we retrospectively analysed medical charts of all patients with microscopically complete resection ( R0 , n = 384 patients ) . Complications were grade d according to the modified Clavien classification . Respiratory complications were defined as atelectasis , pneumonia or acute respiratory distress syndrome in the absence of early surgical complications . Patients with grade 5 ( postoperative mortality , n = 43 , 11 % ) were excluded from the analysis . The remaining 341 patients were analysed for estimation of DFS according to the Kaplan-Meier method . Logistic regression analysis was conducted to discriminate predictive factors affecting DFS . RESULTS According to the modified Clavien classification , postoperative complications rates were grade 0 : 147 ( 44 % ) , grade 1 : 7 ( 2 % ) , grade 2 : 56 ( 16 % ) , grade 3 : 69 ( 20 % ) and grade 4 : 62 ( 18 % ) . Five-year DFS rates were not significantly different between grade 0 ( no complication , 38 % , n = 147 ) and other grade s ( grade 1 , 2 , 3 and 4 ( 64 , 45 , 56 and 48 % , respectively ) ) . Respiratory complications occurred in 107 patients ( 31 % ) and the 5-year DFS in this subgroup was 47 % compared with 38 % observed in grade 0 patients ( P = 0.75 ) . Clavien classification and respiratory complications did not come out in the univariate analysis of factors affecting DFS . On logistic regression , only two variables affected DFS : c-N stage and extracapular lymph node involvement . CONCLUSIONS When postoperative mortality is excluded , postoperative complications do not affect DFS in patients with complete resection . This deserves substantial information regarding the prognosis of subgroup of patients in critical situations where incrementing intensive care is debated BACKGROUND Major postoperative events ( acute respiratory failure , sepsis , and surgical complications ) are frequent early after elective gastroesophageal and pancreatic surgery .  It is unclear whether these complications impact equally on long-term outcome . METHODS Prospect i ve observational study including the patients admitted to the surgical intensive care unit between January 2009 and October 2011 after elective gastroesophageal and pancreatic surgery .  Risk factors for 30-day major postoperative events and long-term outcome were evaluated . RESULTS During the study period , 259 patients were consecutively included . Among them , 166 ( 64 % ) , 54 ( 21 % ) , and 39 ( 15 % ) patients underwent pancreatic surgery , gastric surgery , and esophageal surgery , respectively . Using the Clavien-Dindo classification , 117 patients ( 45 % ) developed at least 1 postoperative complication , including 60 ( 23 % ) patients with acute respiratory failure , 77 ( 30 % ) with sepsis , and 89 ( 34 % ) with surgical complications . The median follow-up from the time of intensive care unit admission was 34 months ( 95 % confidence interval , 30 - 37 months ) . The 1-year survival was 95 % ( 95 % confidence interval , 92 - 98 ) . Among the perioperative variables , postoperative sepsis and an American Society of Anesthesiologists score higher than 2 were independently associated with long-term mortality . In septic patients , death ( n = 16 ) was significantly associated with cancer recurrence ( n = 10 ; P < .0001 ) . Independent factors associated with postoperative sepsis were a Sequential Organ Failure Assessment score on day 1 , a systemic inflammatory response syndrome on day 3 , positive intraoperative microbiological sample s , Simplified Acute Physiology Score II and an American Society of Anesthesiologists score higher than 2 ( P < .005 ) . CONCLUSIONS Postoperative sepsis was the only major postoperative event associated with long-term mortality . Postoperative sepsis may reflect a deep impairment of immune response , which is potentially associated with cancer recurrence and mortality Background To evaluate the potential efficacy of preventive effect of ulinastatin in esophagectomy patients . Methods Eighty patients with esophageal cancer were preoperatively allocated at r and om into two equal groups . Ulinastatin was administered to the treatment group ( U ) whereas the control group ( C ) received a placebo . The arterial oxygen tension and carbon dioxide tension were measured and the respiratory index ( RI ) was calculated . Plasma levels of circulating T lymphocyte subsets and interleukin 6 ( IL-6 ) were measured and clinical courses of patients in the two groups were compared . Results RI in the U group was significantly lower than that in the C group . The rate of postoperative complications and the duration of ICU stay were significantly lower in the U group 
    Output:
    
Results Patients with postoperative complications had significantly poorer long-term survival than those without complications .
Complications were associated with impaired oncological outcomes .
High BMI was associated with postoperative morbidity rate but not with poor oncological outcome .
Low BMI was significantly associated with inferior oncological outcome .
Conclusions Complications after radical surgery for esophageal , gastric , and colorectal cancers are associated with patient prognosis .
Avoiding such complications might improve the outcomes