***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: PURPOSE OEO2 is a r and omized , controlled trial of preoperative chemotherapy in patients undergoing radical surgery for esophageal cancer . R and om assignment was to surgery alone ( S ) or to two cycles of combination cisplatin and fluorouracil before surgery ( CS ) . Initial results reported in 2002 demonstrated an advantage for both disease-free and overall survival in the CS group . The analysis has now been up date d after a median follow-up of 6 years . PATIENTS AND METHODS OEO2 recruited 802 patients , 400 on CS and 402 on S. The nature of the first recurrence event and cause of death are detailed . Survival has been determined from Kaplan-Meier curves and treatment comparisons made with the log-rank test . Survival by extent of resection is presented . RESULTS There were 655 deaths , 335 for S and 320 for CS . The survival benefit has been maintained with a hazard ratio ( HR ) of 0.84 ( 95 % CI , 0.72 to 0.98 ; P = .03 ) which in absolute terms is a 5-year survival of 23.0 % for CS compared with 17.1 % for S. The treatment effect is consistent in both adenocarcinoma and squamous cell carcinoma . The first disease-free survival event was macroscopic residual disease from incomplete resection ( R2 ) or no resection in 26.4 % of the S group versus 14.3 % of the CS P < .001 . Three-year survival by type of resection was R0 42.4 % , R1 was 18.0 % , and R2 was 8.6 % . CONCLUSION Long-term follow-up confirms that preoperative chemotherapy improves survival in operable esophageal cancer and should be considered as a st and ard of care The surgical strategy for adenocarcinoma of the esophagogastric junction is still controversial . The aim of this study was to evaluate surgical results of the abdominal-transhiatal approach for 100 consecutively operated type II and III cardia adenocarcinoma , to clarify clinicopathological differences between these tumors , and to define prognostic factors . A prospect ively maintained data base identified 100 consecutively operated patients with Siewert type II and III cardia adenocarcinoma . Survival was analyzed by the Kaplan-Meier method . Differences between subgroups and prognostic factors were evaluated by the log rank test and Cox regression . Concerning clinicopathological characteristics , only the incidence of T1–2 stage was significantly higher in Siewert II type ( P = .006 ) . A complete ( R0 ) resection was obtained in 74 patients ( 74 % ) . Overall postoperative mortality and morbidity rates were 6 % and 28 % , respectively . Overall actuarial 5-year survival rate in resected patients was 27.4 % ( median 27 months ) , with 20.6 % for type II and 34 for type III cancers ( P = .07 ) . Considering R0 resections , overall actuarial 5-year survival rate was 33.9 % ( median 33 months ) , with 26.7 % for type II and 40.5 for type III cancer ( P = .06 ) . Pathologic T and N stage and R status were independent prognostic factors by multivariate analysis , and Siewert type showed a trend toward significance . The abdominal-transhiatal approach is a safe surgical approach , allowing complete tumor resection and adequate lymphadenectomy in these patients . True carcinoma of the cardia may be a distinct clinical entity with a more aggressive natural history than subcardial gastric carcinoma BACKGROUND Because of the inaccessibility of mediastinal nodal metastases , the left thoracoabdominal approach ( LTA ) has often been used to treat gastric cancer of the cardia or subcardia . In a r and omised phase III study , we aim ed to compare LTA with the abdominal-transhiatal approach ( TH ) in the treatment of these tumours . METHODS Between July , 1995 , and December , 2003 , 167 patients were enrolled from 27 Japanese hospitals and r and omly assigned to TH ( n=82 ) or LTA ( n=85 ) . The primary endpoint was overall survival , and secondary endpoints were disease-free survival , postoperative morbidity and hospital mortality , and postoperative symptoms and change of respiratory function .  The projected sample size was 302 . After the first interim analysis , the predicted probability of LTA having a significantly better overall survival than TH at the final analysis was only 3.65 % , and the trial was closed immediately . Analysis was by intention to treat . This study is registered with , number NCT00149266 . FINDINGS 5-year overall survival was 52.3 % ( 95 % CI 40.4 - 64.1 ) in the TH group and 37.9 % ( 26.1 - 49.6 ) in the LTA group . The hazard ratio of death for LTA compared with TH was 1.36 ( 0.89 - 2.08 , p=0.92 ) . Three patients died in hospital after LTA but none after TH . Morbidity was worse after LTA than after TH . INTERPRETATION Because LTA does not improve survival after TH and leads to increased morbidity in patients with cancer of the cardia or subcardia , LTA can not be justified to treat these tumours BACKGROUND / AIMS Transthoracic and transhiatal esophagectomy are two common procedures for esophageal cancer resection . Prospect i ve studies comparing the two methods in Asian people are few . In addition , the data comparing their effects on the quality of life are lacking . METHODOLOGY A prospect i ve r and omized study was conducted from January 2003 . Patients of resectable esophageal cancer of comparable stage were allocated to undergo the transthoracic or transhiatal procedure in turn . They were all reconstructed with stomach interposition through the retrosternal route .  Discharged patients were followed-up in the outpatient clinic . They were question ed on the topics of ( i ) severity of pain , ( ii ) ease of swallowing , ( iii ) satisfaction of daily activities , ( iv ) dependence on medications , ( v ) working ability , ( vi ) fatigue , ( vii ) appetite , ( viii ) sociality , ( ix ) happiness and ( x ) self respect , in the third , sixth and twelfth month . Also the demographic data , operative results and survival were recorded . RESULTS Up to December 2006 , eighty-seven patients of stage II and III , including 71 patients of middle third lesions and 16 lower third lesions were enrolled . The operation time was significantly longer , and the leakage rate was higher in the transthoracic group ( Student 's t-test and Fischer 's exact test , respectively ) . However , intraoperative blood loss and postoperative hospital stay were not significantly different ( Student t-test ) . Also , the Kaplan-Meier survival curves of these two groups were not significantly different by log-rank test ( p=0.286 ) . The score on the quality of life of transhiatal patients was significantly higher than that of transthoracic patients in the third , sixth and twelfth month . CONCLUSIONS Transhiatal esophagectomy is a safe and fast procedure . The survival was similar to that of transthoracic approach . Its leakage rate was lower and quality of life was better BACKGROUND Uncontrolled studies suggest that a combination of chemotherapy and radiotherapy improves the survival of patients with esophageal adenocarcinoma . We conducted a prospect i ve , r and omized trial comparing surgery alone with combined chemotherapy , radiotherapy , and surgery . METHODS Patients assigned to multimodal therapy received two courses of chemotherapy in weeks 1 and 6 ( fluorouracil , 15 mg per kilogram of body weight daily for five days , and cisplatin , 75 mg per square meter of body-surface area on day 7 ) and a course of radiotherapy ( 40 Gy , administered in 15 fractions over a three-week period , beginning concurrently with the first course of chemotherapy ) , followed by surgery . The patients assigned to surgery had no preoperative therapy . RESULTS Of the 58 patients assigned to multimodal therapy and the 55 assigned to surgery  , 10 and 1 , respectively , were withdrawn for protocol violations . At the time of surgery , 23 of 55 patients ( 42 percent ) treated with preoperative multimodal therapy who could be evaluated had positive nodes or metastases , as compared with 45 of the 55 patients ( 82 percent ) who underwent surgery alone ( P<0.001 ) . Thirteen of the 52 patients ( 25 percent ) who underwent surgery after multimodal therapy had complete responses as determined pathologically . The median survival of patients assigned to multimodal therapy was 16 months , as compared with 11 months for those assigned to surgery alone ( P=0.01 ) . At one , two , and three years , 52 , 37 , and 32 percent , respectively , of patients assigned to multimodal therapy were alive , as compared with 44 , 26 , and 6 percent of those assigned to surgery , with the survival advantage favoring multimodal therapy reaching significance at three years ( P=0.01 ) . CONCLUSIONS Multimodal treatment is superior to surgery alone for patients with resectable adenocarcinoma of the esophagus Aims : To assess the postoperative morbidity and mortality , length of stay and long-term survival after resection of carcinoma of the oesophagus and gastro-oesophageal junction , after establishment of a new surgical team unit between thoracic and gastroenterologic surgeons . Methods : We analysed the prospect i ve collected data of 166 consecutive patients who underwent a transthoracic oesophageal resection between June 1997 and December 2003 . Results : There were 119 men and 47 women . The median age was 63 years ( range 36–81 ) . Fifty-five patients ( 33 % ) had squamous cell carcinoma and 111 ( 67 % ) had adenocarcinoma .  Postoperative complications occurred in a total of 60 patients ( 36 % ) . Ten patients ( 6 % ) died postoperatively , eight ( 4.8 % ) due to medical and two ( 1.2 % ) due to surgical complications . The median postoperative length of stay was 11 days ( range 6–75 ) . The overall 3- and 5- years survival was 35.6 % and 30.6 % respectively . Survival was adversely affected by patient age and tumor stage . Conclusions : Concentrating resection for carcinoma of the oesophagus and oesophagogastric junction to a dedicated team of specialists , including both gastrointestinal and thoracic surgeons as well as thoracic-anaesthesiological know-how , results in acceptable complication rates as well as low mortality rates especially due to surgical complications BACKGROUND Controversy exists about the best surgical treatment for esophageal carcinoma . METHODS We r and omly assigned 220 patients with adenocarcinoma of the mid-to-distal esophagus or adenocarcinoma of the gastric cardia involving the distal esophagus either to transhiatal esophagectomy or to transthoracic esophagectomy with extended en bloc lymphadenectomy . Principal end points were overall survival and disease-free survival . Early morbidity and mortality , the number of quality -adjusted life-years gained , and cost effectiveness were also determined . RESULTS A total of 106 patients were assigned to undergo transhiatal esophagectomy , and 114 to undergo transthoracic esophagectomy .  Demographic characteristics and characteristics of the tumor were similar in the two groups . Perioperative morbidity was higher after transthoracic esophagectomy , but there was no significant difference in in-hospital mortality ( P=0.45 ) . After a median follow-up of 4.7 years , 142 patients had died--74 ( 70 percent ) after transhiatal resection and 68 ( 60 percent ) after transthoracic resection ( P=0.12 ) . Although the difference in survival was not statistically significant , there was a trend toward a survival benefit with the extended approach at five years : disease-free survival was 27 percent in the transhiatal-esophagectomy group , as compared with 39 percent in the transthoracic-esophagectomy group ( 95 percent confidence interval for the difference , -1 to 24 percent [ the negative value indicates better survival with transhiatal resection ] ) , whereas overall survival was 29 percent as compared with 39 percent ( 95 percent confidence interval for the difference , -3 to 23 percent ) . CONCLUSIONS Transhiatal esophagectomy was associated with lower morbidity than transthoracic esophagectomy with extended en bloc lymphadenectomy . Although median overall , disease-free , and quality -adjusted survival did not differ statistically between the groups , there was a trend toward improved long-term survival at five years with the extended transthoracic approach Objective : To determine whether extended transthoracic esophagectomy for adenocarcinoma of the mid/distal esophagus improves long-term survival . Background : A r and omized trial was performed to compare surgical techniques . Complete 5-year survival data are now available . Methods : A total of 220 patients with adenocarcinoma of the distal esophagus ( type I ) or gastr 
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There were no significant difference between two approaches concerning duration of operation , blood loss , anastomotic leakage and positive of proximal incisal margin .
Lymph node excised also showed no significant differences between two procedures in RCTs while in TA group of Non- RCTs , the number of lymph node dissection is higher .
TH approach was associated with a longer length of hospital stay and had higher incidence of respiratory and cardiovascular complications and early postoperative mortality .
Overall analysis of 1 , 3 , 5-year survival showed no significant difference between two approaches .
Based on the study , TA approach had a positive impact than TH for AEG with respect to respiratory and cardiovascular complications , hospital stay and early mortality rates .
There were no significant differences between the two approaches for long-term survival .