***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: To compare the outcomes after D1 gastrectomy with those after modified D2 gastrectomy ( preserving pancreas and spleen ) performed by specialist surgeons for gastric cancer in a large UK NHS Trust . In all , 118 consecutive patients with gastric adenocarcinoma were referred by postcode , to undergo either a D1 gastrectomy  ( North Gwent ( RJ ) , n=36 , median age 76 years , 21 m ) or a modified D2 gastrectomy  ( South Gwent ( WL ) , n=82 , 70 years , 57 m ) . Operative mortality in the two groups of patients was similar ( D1 8.3 % vs D2 7.3 % , χ2 0.286 , DF 1 , P=0.593 ) . Overall cumulative survival at 5 years was 32 % after D1 gastrectomy compared to 59 % after D2 gastrectomy ( χ2 4.25 , DF 1 , P=0.0392 ) . In patients with stage III cancers  , survival was 8 % after D1 , compared with 33 % after D2 gastrectomy ( χ2 6.43 , DF 1 , P=0.0112 ) . In a multivariate analysis , T stage ( hazard ratio 2.339 , 95 % CI 1.683–2.995 , P=0.01 ) , N stage ( hazard ratio 4.026 , 95 % CI 3.536–4.516 , P=0.0001 ) and the extent of lymphadenectomy ( hazard ratio 0.258 , 95 % CI –0.426–0.942 , P=0.0001 ) were independently associated with duration s of survival . In conclusion , modified D2 gastrectomy  can improve survival four-fold for patients with stage III gastric cancer , without significantly increasing morbidity and mortality when compared with a D1 gastrectomy Background For gastric cancer patients , surgical resection with en-bloc lymphadenectomy is the cornerstone of curative treatment . Open gastrectomy has long been the preferred surgical approach worldwide . However , this procedure is associated with considerable morbidity . Several meta-analyses have shown an advantage in short-term outcomes of laparoscopic gastrectomy compared to open procedures , with similar oncologic outcomes . However , it remains unclear whether the results of these Asian studies can be extrapolated to the Western population . In this trial from the Netherl and s , patients with resectable gastric cancer will be r and omized to laparoscopic or open gastrectomy . Methods The study is a non-blinded , multicenter , prospect ively r and omized controlled superiority trial . Patients ( ≥18 years ) with histologically proven , surgically resectable ( cT1 - 4a , N0 - 3b , M0 ) gastric adenocarcinoma and European Clinical Oncology Group performance status 0 , 1 or 2 are eligible to participate in the study after obtaining informed consent . Patients ( n = 210 ) will be included in one of the ten participating Dutch centers and are r and omized to either laparoscopic or open gastrectomy . The primary outcome is postoperative hospital stay ( days ) . Secondary outcome parameters include postoperative morbidity and mortality , oncologic outcomes , readmissions , quality of life and cost-effectiveness . Discussion In this r and omized controlled trial laparoscopic and open gastrectomy are compared in patients with resectable gastric cancer . It is expected that laparoscopic gastrectomy will result in a faster recovery of the patient and a shorter hospital stay . Secondly , it is expected that laparoscopic gastrectomy will be associated with a lower postoperative morbidity , less readmissions , higher cost-effectiveness , better postoperative quality of life , but with similar mortality and oncologic outcomes , compared to open gastrectomy . The study started on 1 December 2014 . Inclusion and follow-up will take 3 and 5 years respectively . Short-term results will be analyzed and published after discharge of the last r and omized patient . Trial registration BACKGROUND Laparoscopic gastrectomy ( LG ) has been established as a procedure for the treatment of gastric cancer . However , there have been few reports on the long-term outcomes of LG for gastric cancer . The aim of this study is to investigate the long-term outcomes of LG for gastric cancer . METHODS A total of 278 consecutive patients who underwent LG in our unit between January 1999 and December 2006 were included in this study . Survival , recurrence , and late gastrointestinal complications were analyzed . RESULTS The median follow-up period was 73.7 mo ( 6 - 165 mo ) . Distal gastrectomy  was performed in 229 patients ,  total gastrectomy in 23 patients ,  proximal gastrectomy in 15 patients , and  pylorus-preserving gastrectomy in 11 patients . Five-year overall and disease-specific survival rates were 91 % and 99 % for stage IA , 75 % and 91 % for stage IB , 72 % and 88 % for stage II , and 40 % and 50 % for stage III , respectively . Recurrences were detected in 15 ( 5.4 % ) patients , including 5 distant lymph node , 5 peritoneal , 4 hematogenous , and 1 locoregional recurrences . Bowel obstruction occurred in 4 ( 1.4 % ) patients , and gallstones developed in 37 ( 15 % ) patients . CONCLUSIONS This follow-up investigation suggested that LG for gastric cancer is a feasible procedure from the st and point of long-term oncological outcome and postoperative complications Background Laparoscopic gastrectomy ( LG ) for gastric cancer has increased in popularity due to advances in surgical techniques . The aim of this study is to vali date the efficacy and safety of laparoscopic gastrectomy for gastric cancer compared with open gastrectomy ( OG ) . Methods The study comprised 3,580 patients who were treated with curative intent either by laparoscopic gastrectomy ( 2,041 patients ) or open gastrectomy ( 1,539 patents ) between January 2005 and October 2013 . The surgical outcomes were compared between the two groups . Results Laparoscopic gastrectomy was associated with significantly less blood loss , transfused patient number , time to ground activities , and post-operative hospital stay , but with similar operation time , time to first flatus , and time to resumption of diet , compared with the open gastrectomy . No significant difference in the number of lymph nodes dissected was observed between these two groups . The morbidity and mortality rates of the LG group were comparable to those of the OG group ( 13.6 % vs. 14.4 % , P = 0.526 , and 0.3 % vs. 0.2 % , P = 0.740 ) . The 3-year disease-free and overall survival rates between the two groups were statistically significant ( P<0.05 ) . According to the UICC TNM classification of gastric cancer , the 3-year disease-free and overall survival rates were not statistically different at each stage . Conclusions Our single-center study of a large patient series revealed that LG for gastric cancer yields comparable surgical outcomes . This result was also true of local advanced gastric cancer ( AGC ) . A well- design ed r and omized controlled trial comparing surgical outcomes between LG and OG in a larger number of patients for AGC can be carried out Objective : The aim of this study was to compare technical feasibility and both early and 5-year clinical outcomes of laparoscopic-assisted and open radical subtotal gastrectomy for distal gastric cancer . Summary Background Data : The role of laparoscopic surgery in the treatment of gastric cancer has not yet been defined , and many doubts remain about the ability to satisfy all the oncologic criteria met during conventional , open surgery . Methods : This study was design ed as a prospect i ve , r and omized clinical trial with a total of 59 patients . Twenty-nine ( 49.1 % ) patients were r and omized to undergo open subtotal gastrectomy ( OG ) , while 30 ( 50.9 % ) patients were r and omized to the laparoscopic group ( LG ) .  Demographics , ASA status , pTNM stage , histologic type of the tumor , number of resected lymph nodes , postoperative complications , and 5-year overall and disease-free survival rates were studied to assess outcome differences between the groups . Results : The demographics , preoperative data , and characteristics of the tumor were similar . The mean number of resected lymph nodes was 33.4 ± 17.4 in the OG group and 30.0 ± 14.9 in the LG ( P = not significant ) . Operative mortality rates were 6.7 % ( 2 patients ) in the OG and 3.3 % ( 1 patient ) in the LG ( P = not significant ) ; morbidity rates were 27.6 % and 26.7 % , respectively ( P = not significant ) . Five-year overall and disease-free survival rates were 55.7 % and 54.8 % and 58.9 % and 57.3 % in the OG and the LG , respectively ( P = not significant ) . Conclusions : Laparoscopic radical subtotal gastrectomy for distal gastric cancer is a feasible and safe oncologic procedure with short- and long-term results similar to those obtained with an open approach . Additional benefits for the LG were reduced blood loss , shorter time to resumption of oral intake , and earlier discharge from hospital Background Most studies about complication after gastric cancer surgery have been performed without consideration of the severity of each complication . The purpose s of this study were to prospect ively analyze all postgastrectomy complications according to severity using Clavien – Dindo classification and to identify risk factors related to postoperative complications . Methods Complication data were collected prospect ively through weekly conferences with all gastric adenocarcinoma patients who underwent gastrectomy between March 2011 and February 2012 at Seoul National University Hospital . Complications were categorized according to the Clavien – Dindo classification . Results Out of the 881 patients who underwent gastrectomy , there were 254 events in 197 patients ( 22.4 % ) . The numbers of grade I , II , IIIa , IIIb , IVa , and V complications according to the Clavien – Dindo classification were 71 ( 8.1 % ) , 58 ( 6.6 % ) , 108 ( 12.3 % ) , 8 ( 0.9 % ) , 5 ( 0.6 % ) , and 4 ( 0.5 % ) , respectively . Extended gastrectomy ( odds ratio [ OR ] , 3.92 ; 95 % confidence interval [ CI ] , 1.96–7.82 , p < 0.001 ) , total gastrectomy ( OR , 1.97 ; 95 % CI , 1.24–3.14 , p = 0.004 ) , and age of 60 years or more ( OR , 1.66 ; 95 % CI , 1.15–2.38 , p = 0.007 ) were found to be significant independent risk factors for overall complications of gastrectomy . These three factors were also risk factors for the complications of grade IIIa or over and local and systemic complications . In addition , ASA 3 or 4 and moderate or severe malnutrition as well as those three factors were risk factors for systemic complications . Conclusion Age and the extent of gastrectomy were revealed as the prognostic factors for overall complications and the complications of grade IIIa or over according to the Clavien – Dindo classification following gastrectomy for gastric cancer BACKGROUND Historical data and recent studies show that st and ardised extended ( D2 ) lymphadenectomy leads to better results than st and ardised limited ( D1 ) lymphadenectomy . Based on these findings , the Dutch D1D2 trial , a nationwide prospect ively r and omised clinical trial , was undertaken to compare D2 with D1 lymphadenectomy in patients with resectable primary adenocarcinoma of the stomach . The aim of the study was to assess the effect of D2 compared with D1 surgery on disease recurrence and survival in patients treated with curative intent . METHODS Between August , 1989 , and July , 1993 , patients were entered and r and omised at 80 participating hospitals by means of a telephone call to the central data centre of the trial . The sequence of r and omisation was in blocks of six with stratification for the participating centre . Eligibility criteria were a histologically proven adenocarcinoma of the stomach without evidence of distance metastasis , age younger than 85 years , and adequate physical condition for D1 or D2 lymphadenectomy . Patients were excluded if they had previous or coexisting cancer or had undergone gastrectomy for benign tumours . Strict quality control measures for pathological assessment were implemented and monitored . Analyses were by intention to treat . This study is registered with the NCI trial register , as DUT-KWF-CKVO-8905 , EU-90003 . FINDINGS A total of 1078 patients were entered in the study , of whom 996 were eligible . 711 patients underwent the r and omly assigned treatment with curative intent ( 380 in the D1 group and 331 in the D2 group ) and 285 had palliative treatment . Data were collected prospect ively and 
    Output:
    
No significant differences were observed between LG and OG for the number of harvested lymph nodes .
Conclusions LG is a feasible and safe approach for elderly patients with gastric cancer .
Compared with OG , LG has less blood loss , faster postoperative recovery , and reduced postoperative morbidity