***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: The aim of this trial was to compare  multimodal optimization  with  conventional perioperative management  in a consecutive series of patients undergoing a wide range of colorectal procedures BACKGROUND Minimally invasive , laparoscopically assisted surgery was first considered in 1990 for patients undergoing colectomy for cancer . Concern that this approach would compromise survival by failing to achieve a proper oncologic resection or adequate staging or by altering patterns of recurrence ( based on frequent reports of tumor recurrences within surgical wounds ) prompted a controlled trial evaluation . METHODS We conducted a noninferiority trial at 48 institutions and r and omly assigned 872 patients with adenocarcinoma of the colon to undergo open or laparoscopically assisted colectomy performed by credentialed surgeons . The median follow-up was 4.4 years . The primary end point was the time to tumor recurrence . RESULTS At three years , the rates of recurrence were similar in the two groups--16 percent among patients in the group that underwent laparoscopically assisted surgery and 18 percent among patients in the open-colectomy group ( two-sided P=0.32 ; hazard ratio for recurrence , 0.86 ; 95 percent confidence interval , 0.63 to 1.17 ) . Recurrence rates in surgical wounds were less than 1 percent in both groups ( P=0.50 ) . The overall survival rate at three years was also very similar in the two groups ( 86 percent in the laparoscopic-surgery group and 85 percent in the open-colectomy group ; P=0.51 ; hazard ratio for death in the laparoscopic-surgery group , 0.91 ; 95 percent confidence interval , 0.68 to 1.21 ) , with no significant difference between groups in the time to recurrence or overall survival for patients with any stage of cancer . Perioperative recovery was faster in the laparoscopic-surgery group than in the open-colectomy group , as reflected by a shorter median hospital stay ( five days vs. six days , P<0.001 ) and briefer use of parenteral narcotics ( three days vs. four days , P<0.001 ) and oral analgesics ( one day vs. two days , P=0.02 ) . The rates of intraoperative complications , 30-day postoperative mortality , complications at discharge and 60 days , hospital readmission , and reoperation were very similar between groups . CONCLUSIONS In this multi-institutional study , the rates of recurrent cancer were similar after laparoscopically assisted colectomy and open colectomy , suggesting that the laparoscopic approach is an acceptable alternative to open surgery for colon cancer BACKGROUND Although laparoscopic resection of colorectal carcinoma improves post-operative recovery , long-term survival and disease control are the determining factors for its application . We aim ed to test the null hypothesis that there was no difference in survival after laparoscopic and open resection for rectosigmoid cancer . METHODS From Sept 21 , 1993 , to Oct 21 , 2002 , 403 patients with rectosigmoid carcinoma were r and omised to receive either  laparoscopic assisted ( n=203 ) or conventional open ( n=200 ) resection of the tumour .  Survival and disease-free interval were the main endpoints . Patients were last followed-up in March , 2003 . Perioperative data were recorded and direct cost of operation estimated . Data were analysed by intention to treat . FINDINGS The demographic data of the two groups were similar . After curative resection , the probabilities of survival at 5 years of the laparoscopic and open resection groups were 76.1 % ( SE 3.7 % ) and 72.9 % ( 4.0 % ) respectively . The probabilities of being disease free at 5 years were 75.3 % ( 3.7 % ) and 78.3 % ( 3.7 % ) , respectively . The operative time of the laparoscopic group was significantly longer , whereas postoperative recovery was significantly better than for the open resection group , but these benefits were at the expense of higher direct cost . The distal margin , the number of lymph nodes found in the resected specimen , overall morbidity and operative mortality did not differ between groups . INTERPRETATION Laparoscopic resection of rectosigmoid carcinoma does not jeopardise survival and disease control of patients . The justification for adoption of laparoscopic technique would depend on the perceived value of its effectiveness in improving short-term post-operative outcomes Background : To evaluate the feasibility of a fast-track ( FT ) program and it ’s effect on postoperative recovery . Methods : All patients , scheduled for elective segmental colorectal resection were treated in a FT program ( FT group ) . Data were compared to a control group operated for elective colorectal resections and treated in a traditional care program ( TC group ) . Data from the FT group were collected prospect ively , data from the TC group retrospectively . Outcome parameters included the number of successfully applied FT modalities , patient satisfaction , morbidity rate , re-operation rate , primary ( PHS ) and total hospital stay ( THS ) , and readmission rate . Results : One-hundred and seven patients were included ( 55 FT group vs. 52 TC group ) . The groups were comparable for patient characteristics such as age and cr-POSSUM score ( p = 0.22 and p = 0.40 ) . An average of 7.4 of 13 predefined FT modalities were successfully achieved per patient . Patient satisfaction was comparable ( p = 0.84 ) . Seven versus 5 patients required a re-operation in the FT and TC groups , respectively ( p = 0.52 ) . Morbidity rate was comparable ( n = 16 vs. 15 , p = 0.83 ) . Median PHS was 4.0 vs. 6.0 days and median THS was 4.0 vs. 6.5 days in the FT and TC groups ( p < 0.01 and p < 0.03 , respectively ) . Six vs. 3 patients were re-admitted in the FT and TC groups , respectively ( p = 0.49 ) . Conclusion : Implementation of all FT modalities was difficult since a rather low number of pre-defined FT modalities was effectively realized . Despite incomplete implementation , PHS and THS were shorter in the FT group without affecting patient satisfaction Multimodal optimization of surgical care has been associated with reduced hospital stay and improved physical function . The aim of this r and omized trial was to compare multimodal optimization with st and ard care in patients undergoing colonic resection OBJECTIVE To investigate the feasibility of a 48-hour postoperative stay program after colonic resection . SUMMARY BACKGROUND DATA Postoperative hospital stay after colonic resection is usually 6 to 12 days , with a complication rate of 10 % to 20 % . Limiting factors for early recovery include stress-induced organ dysfunction , paralytic ileus , pain , and fatigue . It has been hypothesized that an accelerated multimodal rehabilitation program with optimal pain relief , stress reduction with regional anesthesia , early enteral nutrition , and early mobilization may enhance recovery and reduce the complication rate . METHODS Sixty consecutive patients undergoing elective colonic resection  were prospect ively studied using a well-defined postoperative care program including continuous thoracic epidural analgesia and enforced early mobilization and enteral nutrition , and a planned 48-hour postoperative hospital stay . Postoperative follow-up was scheduled at 8 and 30 days . RESULTS Median age was 74 years , with 20 patients in ASA group III-IV . Normal gastrointestinal function ( defecation ) occurred within 48 hours in 57 patients , and the median hospital stay was 2 days , with 32 patients staying 2 days after surgery . There were no cardiopulmonary complications . The readmission rate was 15 % , including two patients with anastomotic dehiscence ( one treated conservatively , one with colostomy ) ; other readmissions required only short-term observation . CONCLUSION A multimodal rehabilitation program may significantly reduce the postoperative hospital stay in high-risk patients undergoing colonic resection . Such a program may also reduce postoperative ileus and cardiopulmonary complications . These results may have important implication s for the care of patients after colonic surgery and in the future assessment of open versus laparoscopic colonic resection INTRODUCTION Laparoscopic ( LAP ) versus open ( CON ) colonic resection with traditional perioperative care has some short term benefits postoperatively regarding functional recovery . Whether these benefits may also occur when all patients are treated with multimodal " fast-track"-rehabilitation programs is question able . METHODS Patients undergoing elective left sided colonic surgery were prospect ively non r and omised observed . The " fast-track " program included patient information , thoracic peridural analgesia , forced mobilisation and oral intake , and stress reduction . Endpoints were duration of postoperative ileus and hospital stay , general- and local complication , and pulmonary function . RESULTS 147 consecutive patients were operated on , 47 open and 100 laparoscopically . The time until oral intake was completed seemed to be shorter in the LAP-group ( p=0.07 ) followed by a shorter hospital stay ( p<0.01 ) . The pulmonary function was postoperatively improved in the LAP-group compared to the CON-group ( p<0,01 ) . General complications ( LAP 9 % vs. CON 17 % ) were non significantly increased in the CON-group . Local complications increased in the CON-group ( LAP 13 % vs. CON 28 % , p<0,05 ) . CONCLUSION Even with perioperative " fast-track"-rehabilitation programs short term advantages were found in laparoscopic compared with open colonic surgery in a non r and omised population . The clinical relevance should be examined in controlled r and omised trials Abstract INTRODUCTION : In an era of dwindling hospital re sources and increasing medical costs , safe reduction in postoperative stay has become a major focus to optimize utilization of healthcare re sources . Although several protocol s have been reported to reduce postoperative stay , no Level I evidence exists for their use in routine clinical practice . METHODS : Sixty-four patients undergoing laparotomy and intestinal or rectal resection  were r and omly assigned to a pathway of controlled rehabilitation with early ambulation and diet or to traditional postoperative care .  Time to discharge from hospital , complication and readmission rates , pain level , quality of life , and patient satisfaction scores were determined at the time of discharge and at 10 and 30 days after surgery . Subgroups were defined to evaluate those who derived the optimal benefit from the protocol . RESULTS : Pathway patients spent less total time in the hospital after surgery ( 5.4 vs. 7.1 days ; P = 0.02 ) and less time in the hospital during the primary admission than traditional patients . Patients younger than 70 years old had greater benefits than the overall study group ( 5 vs. 7.1 days ; P = 0.01 ) . Patients treated by surgeons with the most experience with the pathway spent significantly less time in the hospital than did those whose surgeons were less experienced with the pathway ( P = 0.01 ) . There was no difference between pathway and traditional patients for readmission or complication rates , pain score , quality of life after surgery , or overall satisfaction with the hospital stay . CONCLUSIONS : Patients scheduled for a laparotomy and major intestinal or rectal resection  are suitable for management by a pathway of controlled rehabilitation with early ambulation and diet . Pathway patients have a shorter hospital stay , with no adverse effect on patient satisfaction , pain scores , or complication rates . Patients younger than 70 years of age derive the optimal benefit , and increased surgeon experience improves outcome BACKGROUND Multimodal postoperative care regimens accelerate recovery after abdominal surgery . The benefit of thoracic epidural ( TE ) analgesia over patient-controlled analgesia ( PCA ) remains unproven when used with a fast-track postoperative care plan . METHODS Fifty-six patients undergoing major intestinal resection , and on a fast-track postoperative care plan , were r and omized  to preemptive TE or PCA . Patients were evaluated at st and ard time points for pain score , quality of life ( Short Form-36 ) , and complications .  Oral analgesia was substituted for TE and PCA on the second postoperative day . Discharge criteria were identical for both groups . RESULTS Six patients ( 20.6 % ) had a failed epidural . There was no difference in length of stay ( 5.8 versus 6.2 days , TE versus PCA , P = .55 ) , total length of stay ( including readmissions ) , pain scores , quality of life , complications , or hospital costs at any time point . CONCLUSION TE offers no advantage over PCA for patients undergoing major intestinal resections who are on a fast-track postoperative care plan using PCA Objective The primary endpoint was to compare the impact of laparoscopic and open colorectal surgery on 30-day postoperative morbidity . Lymphocyte proliferation to mitogens and gut oxygen tension were surrogate endpoints . Summary Background Data Evidence -based proof of the effect of laparoscopic colorectal surgery on immunometabolic response and clinical ly relevant outcome variables is scanty . Further r and omized trials are desirable before proposing laparoscopy as a superior technique . Methods Two hundred sixty-nine patients with colorectal disease were r and omly assigned to laparoscopic ( n = 136 ) or open ( n = 133 ) colorectal resection . Four trained members of the surgical staff who were not involved in the study registered postoperative complications . L 
    Output:
    
There were no significant differences in mortality rates .