***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 : Roux-en-Y reconstruction with and without jejunal pouch was compared in a r and omized controlled trial to identify the optimal reconstruction procedure in terms of quality of life . Background Data : R and omized trials comparing techniques of reconstruction after total gastrectomy have shown controversial results . Methods : One hundred and thirty-eight patients with gastric cancer were intraoperatively r and omized for Roux-en-Y reconstruction with pouch  ( n = 71 ) or without pouch  ( n = 67 ) after gastrectomy and stratified into curative or palliative resection . Intra- and postoperative complications were recorded . Body weight and quality of life were determined every 6 months with a follow-up of up to 12 years . Results : Both groups were comparable for age , sex , incidence of concomitant disease , and staging . There were no differences in operative time , postoperative complications , and mortality . Short- and long-term weight loss was similar in both groups . In the first postoperative year , there were no benefits of pouch reconstruction in terms of quality of life , independent of the resection status . In the third , fourth , and fifth year after surgery quality of life was significantly improved for patients with a pouch . Conclusions : Roux-en-Y pouch reconstruction after gastrectomy is simple to perform and safe . Long-term survivors benefit from pouch reconstruction . Therefore , a pouch is recommended for patients with a good prognosis BACKGROUND AND OBJECTIVE To develop a checklist of items measuring the quality of reports of r and omized clinical trials ( RCTs ) assessing nonpharmacological treatments ( NPTs ) . STUDY DESIGN AND SETTING The Delphi consensus method was used to select and reduce the number of items in the checklist . A total of 154 individuals were invited to participate : epidemiologists and statisticians involved in the field of methodology of RCTs ( n = 55 ) , members of the Cochrane Collaboration ( n = 41 ) , and clinicians involved in planning NPT clinical trials ( n = 58 ) . Participants ranked on a 10-point Likert scale whether an item should be included in the checklist . RESULTS Fifty-five experts ( 36 % ) participated in the survey . They were experienced in systematic review s ( 68 % were involved in the Cochrane Collaboration ) and in planning RCTs ( 76 % ) . Three rounds of the Delphi method were conducted to achieve consensus . The final checklist contains 10 items and 5 subitems , with items related to the st and ardization of the intervention , care provider influence , and additional measures to minimize the potential bias from lack of blinding of participants , care providers , and outcome assessors . CONCLUSIONS This tool can be used to critically appraise the medical literature , design NPT studies , and assess the quality of trial reports included in systematic review Quality of life ( QOL ) was studied in gastric cancer patients treated on a r and omised , controlled trial comparing D1 ( level 1 ) with D3 ( levels 1 , 2 and 3 ) lymphadenectomy . A total of 221 patients were r and omly assigned to D1 ( n=110 ) and D3 ( n=111 ) surgery .  Quality -of-life assessment s included functional outcomes ( a 14-item survey about treatment-specific symptoms ) and health perception ( Spitzer QOL Index ) was performed before and after surgery at disease-free status . Patients suffered from irrelative events such as loss of partners was excluded thereafter . Main analyses were done by intention-to-treat . Thus , 214 D1 ( 106/110=96.4 % ) and D3 ( 108/111=97.3 % ) R0 patients were assessed . Longitudinal analysis showed that functional outcomes decreased at 6 months after surgery and increased over time thereafter , while health perceptions increased over time in general . On the basis of linear mixed model analyses , patients having total gastrectomy , advanced cancer and hemipancreaticosplenectomy , but not complications had poorer QOL than those without . D1 and D3 patients showed no significant difference in QOL . The results suggest that changes of QOL were largely due to scope of gastric resection , disease status and distal pancreaticosplenectomy , rather than the extent of lymph node dissection . This indicates that nodal dissection can be performed for a potentially curable gastric cancer This is an interim report of a r and omized clinical trial on esophagojeju-nostomy ( EJ ) versus Hunt-Lawrence-Rodino ( HLR ) pouch as reconstruction techniques following total gastrectomy and systematic lymphadenectomy for gastric cancer treatment . The r and omized trial preceded a pilot study comparing the Longmire-Gütgemann interposition and the HLR .  The pilot study included 7 patients , the r and omized trial 38 patients ( 60 planned ) . The main outcome variables in the pilot study were food resorption , caloric intake , and body weight . Survival probability and general well-being ( quality of life ) were measured in the r and omized trial . A score was composed of disease-specific and socio-personal variables with well-being ranging from 0 ( worst ) to 14 ( best ) points . Concerning food resorption in the pilot study , no relevant advantage of the duodenal passage was found . The main postoperative disorder was insufficient food intake . Despite a radical operation , a hospital mortality rate of 16 % , and a complication rate of 37 % , gastric cancer still has a poor prognosis . In the r and omized trial only 15 ( 39 % ) of 38 patients were alive 1 year after operation , but the survival probability was higher ( 58 % ) after HLR than after EJ ( 24 % ) ( p<0.05 ) . Hunger and appetite were strongly reduced during the first 6 months after operation . Food intake was less than half of the preoperative values , which was reflected by an average decrease in body weight of 7 kg . Patients dying within the first year after total gastrectomy suffered an irreversible loss of quality of life ( scoring 7 points ) . They had no objective benefit from the operation . Patients surviving this period regained quality of life and exceeded preoperative values , especially after HLR.We conclude that HLR-operated patients who have a chance of surviving for at least 1 year benefit from total gastrectomy in regard to quality of life . RésuméCet article est consacré au bilan provisoire d'une étude clinique r and omisée de l'oesophago-jéjunostomie ( EJ ) par rapport à l'opération de Hunt-Lawrence-Rodino ( HLR ) comme technique de reconstruction après gastrectomie totale et lymphadénectomie systématique pour cancer de l'estomac . Le bilan a été établi à partir d'une étude pilote comparant l'interposition Longmire-Gütgemann et la HLR . Cette première étude a porté sur 7 patients et le étude r and omisée sur 38 patients ( 60 sont prévues ) . Dans l'étude pilote la réabsorption intestinale , le poids et l'absorption calorique furent les variables essentielles pour mesurer l'avenir des malades . Dans le étude r and omisée la probabilité de survie et la qualité de la vie ont été ajoutées . L'état général a été représenté par un score comprenant des variables spécifiques de la maladie et socio-personnelles allant de 0 ( très mal ) à 14 ( très bien ) points . Dans l'étude pilote le passage duodénal n'a pas montré d'avantage concernant la réabsorption intestinale . Le malaise post-opératoire essentiel a été l'insuffisance de l'absorption calorique . L'opération radicale a une mortalité hospitalière de 16 % et comprend un taux de complication de 37 % . Le cancer de l'estomac est de prognostic peu favorable . Seuls 15 ( 39 % ) des 38 patients ont survécu la première année dans le étude r and omisée mais la probabilité de survie après HLR ( 58 % ) dépasse celle après EJ ( 24 % ) ( p<0.05 ) . La f aim et l'appétit ont été sévèrement réduits pendant les 6 premiers mois post-opératoires . Comparée à la situation pré-opératoire , la quantitié de nourriture a diminué d'au moins 50 % ce qui correspond à une perte de poids de 7 kilos en moyenne . Les malades qui ne survivent pas la première année subissent une perte importante et irréversible de leur qualité de vie . Ceci nous amène à dire qu'ils ne profitent pas de l'intervention chirurgicale contraitement aux autres qui regagnent une qualité de vie égale ou même supérieure aux valeurs pré-opératoires . Au total nous pouvons affirmer que ce sont essentiellement les patients opérés qui ont subi une HLR qui survivent un an ou plus et qui tirent profit de la gastrectomie totale . ResumenEste es un informe provisional de un ensayo clínico aleatorizado para comparar la esofagoyeyunostomía ( EY ) con la bolsa de Hunt-Lawrence-Rodino ( HLR ) como técnicas de reconstrucción gástrica después de gastrectomía total con linfadenectomía sistemática como tratamiento del cáncer gástrico . El ensayo aleatorizado fue precedido de un estudio piloto para comparar el procedimiento de interposición de Longmire-Gütgemann con la HLR . El estudio piloto incluyó 7 pacientes y el ensayo aleatorizado 38 pacientes ( 60 fueron planeados ) . Las principales variables analizadas en el estudio piloto fueron la resorción de alimentos , la ingesta calórica , y el peso corporal . En el ensayo aleatorizado fueron analizadas , además , la probabilidad de supervivencia y el estado de bienestar general ( calidad de la vida ) . Se construyó un puntaje a partir de variables específicas de la enfermedad y sociopersonales para calificar el estado de bienestar general ( calidad de la vida ) entre 0 ( peor ) y 14 (óptimo).En el estudio piloto el paso a través del duodeno no demostró ventaja significativa en cuanto a la resorción intestinal . La principal alteración postoperatoria fue la ingesta alimenticia insuficiente . A pesar de una operación radical , una mortalidad de 16 % , y una tasa de complicaciones de 37 % , el cáncer gástrico mantiene un pronóstico poco favorable . En el ensayo aleatorizado sólo 15 ( 39 % ) de 38 pacientes sobrevivían 1 año después de la operación , con una probabilidad de supervivencia mayor ( 58 % ) después de la HLR que después de la EY ( 24 % ) ( p<0.05 ) . El hambre y el apetito aparecieron notoriamente disminuidos durante el primer semestre después de la operación . La ingesta de alimento fue menos de la mitad del valor preoperatorio , lo cual se manifestó en una disminución del peso corporal de 7 kg en promedio . Los pacientes que murieron en el curso del primer año después de la gastrectomía total exhibieron una disminución importante e irreversible de la calidad de la vida ( cerca de 7 puntos ) y no demostraron beneficio objetivo de la operación , en comparación con los que sobrevivieron tal período , quienes recuperaron una buena calidad de la vida con valores iguales o superiores a los preoperatorios , especialmente después de HLR.Nuestra conclusión es que los pacientes sometidos al procedimiento HLR que sobreviven por lo menos 1 año , se benefician de la gastrectomía total en lo relativo a la calidad de la vida Objective : During recent years considerable interest has been focused on quality of life as an additional therapeutic outcome measure in the surgical treatment of gastric carcinoma . However , the long term consequences of gastrectomy and the impact on quality of life of different reconstructive techniques are still a matter of controversy . To broaden the criteria for choice of treatment , we conducted a prospect i ve r and omized clinical trial to determine the impact of various gastrectomy procedures on quality of life during a 5-yr follow-up period . Methods : Consecutive patients ( n= 64 ) eligible for curative gastric cancer surgery were r and omized to have either total ( n= 31 ) or subtotal ( n= 13 ) gastrectomy or a jejunal S-shaped pouch ( n= 20  ) as a gastric substitute after total gastrectomy . Assessment s of quality of life were made on seven occasions during a 5-yr period : within 1 wk before surgery , 3 and 12 months after the surgical intervention , and then once/yr . All patients were interviewed by one of two psychiatrists , who rated their symptoms and introduced st and ardized self-report question naires covering both general and specific aspects of life . The raters were blinded for the patients ’ group affiliations . Results : Survival rates were similar in all treatment groups . Patients who had a total gastrectomy continued to suffer from alimentary symptoms , especially indigestion and diarrhea , during the entire follow-up period . However , patients who underwent subtotal gastrectomy had a significantly better outcome already during the first postoperative yr . Patients given a gastric substitute after gastrectomy improved with the passage of time and had an even better outcome in the long run . Conclusions : To optimize the rehabilitation after gastrectomy , patients ’ quality of life must be taken into consideration . When subtotal gastrectomy is clinical ly feasible , this procedure has advantages in the early postoperative period . However , a pouch reconstruction after total gastrectomy should be considered in patients having a favorable tumor status suggesting a fair chance of 
    Output:
    
Conclusions Most RCTs of gastric cancer surgery do not include measures of QOL and those that do suffer from important limitations .
RCTs would be more useful to surgeons and patients if authors measured PROs and utilized existing approaches to present the results of PROs in ways that provide an intuitive sense of the magnitude of effects