***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 We investigated very long-term bowel function after  total mesorectal excision ( TME ) with or without preoperative short-course radiotherapy ( PRT ) for rectal cancer , the risk factors for bowel dysfunction , and the association of bowel dysfunction with health-related quality of life ( HRQL ) . PATIENTS AND METHODS In the TME trial ( 1996 - 1999 ) , 1530 Dutch patients with rectal cancer were r and omized to TME preceded by 5 × 5 Gy PRT or TME alone . A set of question naires was sent to the surviving patients ( n = 583 ) in 2012 . The question naires included the Low Anterior Resection Syndrome Score ( LARS score ) , European Organization for Research and Treatment of Cancer Quality of Life Question naire Core ( EORTC QLQ-C30 ) and Colorectal Module ( EORTC QLQ-CR29 ) . The LARS score range was divided into " no LARS , " " minor LARS , " and " major LARS " categories in ascending severity of bowel dysfunction . The potential risk factors for major LARS were tested on multivariable analysis . The HRQL was compared between the LARS score categories . RESULTS Of the 478 respondents , 242 nonstoma patients were included in the present analysis . The median interval since treatment was 14.6 years , and the median age at the follow-up point was 75 years . Major LARS was reported by 46 % of all patients ( 56 % PRT plus TME vs. 35 % TME ) . PRT ( odds ratio [ OR ] , 3.0 ; 99 % confidence interval [ CI ] , 1.3 - 6.9 ) and age ≤ 75 years at the follow-up point ( OR , 2.4 ; 99 % CI , 1.1 - 5.5 ) increased the risk of major LARS . Gender , tumor height , anastomotic leakage , type of anastomosis , interval since treatment , and comorbid diabetes were not significant . Patients with major LARS fared worse in many HRQL domains ( P < .01 ; score difference > 5 % of score range ) . CONCLUSION A considerable proportion of nonstoma patients endured major LARS years after TME . PRT and age ≤ 75 years at follow-up pose further risks of major LARS in addition to surgery . Major LARS is associated with reduced HRQL Abstract Background Information on functional outcomes after laparoscopic-assisted transanal total mesorectal excision ( taTME ) is limited . This study analyzed the functional results in patients with low rectal cancer . Methods Ten consecutive patients ( nine males ) undergoing electrophysiologically controlled nerve-sparing taTME  were investigated prospect ively and asked to complete functional question naires [ the International Prostate Symptom Score ( IPSS ) , International Index of Erectile Function , Female Sexual Function Index , Wexner score , and low anterior resection syndrome ( LARS ) score ] . Bladder function was also assessed according to residual urine volume . Preoperative function was compared to the functional outcome 3 and 6 months , and 9 months if eligible , after stoma closure or surgery in the absence of a diverting stoma . Results Prior to therapy , urinary and sexual function was impaired in 40 and 60 % of patients , respectively . None of the patients developed pathological residual urine volumes after at least unilateral functional pelvic nerve-sparing . Median IPSS was lower than preoperative scores ( p > 0.05 ) . Two males with incomplete nerve preservation were considered impotent during a median follow-up of 15 months ( range 6–20 months ) . The female was judged to be sexually inactive . The median Wexner score was 1 ( range 0–7 ) prior to any therapy and increased to 7 ( range 0–15 ) at 6 months ( p = 0.029 ) , with 40 % of patients categorized as having no LARS and 50 % minor LARS . The median LARS score was 28 ( range 9–38 ) at 3 months and 26 ( range 9–32 ) at 6 months ( p = 0.165 ) . Conclusions Despite a small sample size and confounding factors , data indicate that taTME has the potential to preserve continence , sufficient bowel function , and urogenital function 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 BACKGROUND Compared with open resection , laparoscopic resection of rectal cancers is associated with improved short-term outcomes , but high-level evidence showing similar long-term outcomes is scarce . We aim ed to compare survival outcomes of laparoscopic surgery with open surgery for patients with mid-rectal or low-rectal cancer . METHODS The Comparison of Open versus laparoscopic surgery for mid or low REctal cancer After Neoadjuvant chemoradiotherapy ( COREAN ) trial was an open-label , non-inferiority , r and omised controlled trial done between April 4 , 2006 , and Aug 26 , 2009 , at three centres in Korea . Patients ( aged 18 - 80 years ) with cT3N0 - 2M0 mid-rectal or low-rectal cancer who had received preoperative chemoradiotherapy  were r and omly assigned ( 1:1 ) to receive either open or laparoscopic surgery . R and omisation was stratified by sex and preoperative chemotherapy regimen . Investigators were masked to the r and omisation sequence ; patients and clinicians were not masked to the treatment assignments . The primary endpoint was 3 year disease-free survival , with a non-inferiority margin of 15 % . Analysis was by intention to treat . This trial is registered with Clinical Trials.gov , number NCT00470951 . FINDINGS We r and omly assigned 340 patients to receive either open surgery ( n=170 ) or laparoscopic surgery ( n=170 ) . 3 year disease-free survival was 72·5 % ( 95 % CI 65·0 - 78·6 ) for the open surgery group and 79·2 % ( 72·3 - 84·6 ) for the laparoscopic surgery group , with a difference that was lower than the prespecified non-inferiority margin ( -6·7 % , 95 % CI -15·8 to 2·4 ; p<0·0001 ) . 25 ( 15 % ) patients died in the open group and 20 ( 12 % ) died in the laparoscopic group . No deaths were treatment related . INTERPRETATION Our results show that laparoscopic resection for locally advanced rectal cancer after preoperative chemoradiotherapy provides similar outcomes for disease-free survival as open resection , thus justifying its use . FUNDING National Cancer Center , South Korea This article reports on patient‐reported sexual dysfunction and micturition symptoms following a r and omized trial of laparoscopic and open surgery for rectal cancer 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 Summary and Background Data : The goals in the treatment of rectal cancer are cure , local control , and preservation of sphincter , bladder and sexual function .  Surgical resection using sharp mesorectal dissection is important for achieving these goals . Objectives : The current treatment of choice for carcinoma rectum is sphincter saving procedures , which have practically replaced the previously done abdominoperineal resection . We performed a study in our institute to evaluate the surgical outcome and complications of rectal cancer . Material s and Methods : This prospect i ve study included 117 patients , treated for primary rectal cancer by low anterior resection ( LAR ) from May 2007 to December 2010 . All patients underwent st and ard total mesorectal excision ( TME ) followed by restoration of continuity . Results : The peri-operative mortality rate was 2.5 % ( 3/117 ) . Post-operative complications occurred in 32 % of the patients . After a median follow up of 42 months , local recurrences developed in 6 ( 5 % ) patients and distant metastasis in 5 ( 4.2 % ) . The survival rate was 93 % . Conclusion : The concept of total mesorectal excision ( TME ) , advances in stapling technology and neoadjuvant therapy have made it possible to preserve the anal sphincter in most of the patients . Rectal cancer needs to be managed especially in a specialized unit for better results Previous studies comparing laparoscopic and open surgical techniques have reported improved health‐related quality of life ( HRQL ) . This analysis compared HRQL 12 months after  laparoscopic versus open surgery for rectal cancer in a subset of a r and omized trial BACKGROUND : In rectal surgery , some situations can be critical , such as anterior topography of locally advanced low tumors with a positive predictive radial margin , especially in a narrow pelvis of men who are obese .  Transanal proctectomy is a new laparoscopic technique that uses the transanal endoscopic microsurgery device . OBJECTIVE : The aim of this study is to evaluate the technical feasibility of laparoscopic transanal proctectomy in patients with unfavorable features . DESIGN AND PATIENTS : This is a single-center , prospect i ve analysis of selected patients with rectal cancer operated on from January 2009 to June 2011 . MAIN OUTCOME MEASURES : Intraoperative details and short-term postoperative outcome were described . RESULTS : Thirty men with advanced or recurrent low rectal tumors associated with unfavorable anatomical and /or tumor characteristics underwent a sphincter-sparing transanal endoscopic proctectomy .  Twenty-nine patients had received preoperative treatment . We report a 6 % conversion rate , no postoperative mortality , and a 30 % morbidity rate . At the beginning of our experience , a urethral injury was diagnosed in 2 patients and easily sutured intraoperatively , without postoperative after-effect . The mesorectal resection was grade d as “ good ” in all patients . R0 resection was achieved in 26 patients ( 87 % ) . The short-term stoma closure rate was 85 % . After a median follow-up of 21 months , 4 patients experienced locoregional recurrence alone . Overall survival rates at 12 and 24 months were 96.6 % ( 95 % CI , 78.0–99.5 ) and 80.5 % ( 95 % CI , 53.0–92.9 ) . Relapse- 
    Output:
    
A substantial number of patients experienced functional problems consistent with low anterior resection syndrome ( LARS ) .
However , major heterogeneity was present in the studies together with poor reporting of functional baseline assessment .
No differences in function were observed between transanal and laparoscopic TME