human
***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: Background A recent development in gastrointestinal surgery is the implementation of enhanced recovery after surgery ( ERAS ) programs . Evidence regarding the benefit of these programs in patients undergoing esophageal surgery is scarce . We investigated the feasibility and possible benefit of a perioperative ERAS program in patients undergoing esophagectomy for malignant disease . Methods The ERAS program was initiated in 2009 . Patients who underwent esophagectomy and were treated according to the ERAS program were included . Items of ERAS included preoperative nutrition , early extubation , early removal of nasogastric tube , and early mobilization . Primary outcome parameters were hospital stay and the incidence of postoperative complications . Outcome parameters in the ERAS cohort were compared to a cohort of patients who underwent surgical resection in the year prior to the implementation of the ERAS protocol . A feasibility analysis was performed among a sample of ERAS patients to determine the number of achieved items per patient . Results Between 2008 and August 2010 , 181 patients in our department underwent esophagectomy .  Of these , 103 patients were included in the ERAS program ( ERAS+ group ) and were compared to 78 patients who had undergone an esophagectomy in 2008 ( ERAS– group ) .  Overall hospital stay was 14 days versus 15 days ( ERAS+ and ERAS– , respectively ; p = 0.013 ) . There were no significant differences in the incidence of postoperative complications in either group . The percentage of achieved items varied between 42 and 93 % per item . Conclusions The implementation of an ERAS program in esophageal surgery was feasible and result ed in a small but significant reduction in overall hospital stay , whereas overall morbidity was not affected Background and Objectives As a well-established technique for postoperative pain relief , the benefits of epidural analgesia ( EDA ) have been under debate recently . This study aim ed to determine whether EDA could improve perioperative outcomes and survival in patients undergoing esophagectomy . Methods From January 2010 to December 2012 , 587 consecutive cases undergoing McKeown-type esohpageactomy  were retrospectively identified from a prospect ively maintained data base . Results After propensity-matching , incorporating baseline characteristics , 178 cases were included in each group , and patients characteristics distributions were well-balanced between two groups . Compared with intravenous analgesia , the use of EDA significantly decreased the incidence of pneumonia from 32 % to 19.7 % ( P = 0.008 ) , and anastomotic leakage from 23.0 % to 14.0 % ( P = 0.029 ) . The change in CRP level of EDA group was significantly decreased ( preoperative , 6.2 vs. 6.2 ; POD 1 , 108.1 vs. 121.3 ; POD 3 , 131.5 vs. 137.8 ; POD 7 , 69.3 vs. 82.1 mg/L ; P = 0.044 ) . EDA patients had a significantly longer duration of indwelling urinary catheter ( P<0.001 ) , and lower levels in both systolic ( P = 0.001 ) and diastolic blood pressure ( P<0.001 ) . There were n't significant differences in overall survival ( log-rank P = 0.47 ) and recurrence ( Gray-test P = 0.46 ) between two groups . Conclusions These findings revealed that EDA could attenuate inflammatory response and reduce the incidence of pneumonia and anastomotic leakage after esophagectomy , at the price of delayed urinary catheter removal and lower blood pressure . EDA remains an important component of multimodal perioperative management after esophagectomy Background For esophageal cancer patients , radical esophagolymphadenectomy is the cornerstone of multimodality treatment with curative intent . Transthoracic esophagectomy is the preferred surgical approach worldwide allowing for en-bloc resection of the tumor with the surrounding lymph nodes . However , the percentage of cardiopulmonary complications associated with the transthoracic approach is high ( 50 to 70%).Recent studies have shown that robot-assisted minimally invasive thoraco-laparoscopic esophagectomy ( RATE ) is at least equivalent to the open transthoracic approach for esophageal cancer in terms of short-term oncological outcomes . RATE was accompanied with reduced blood loss , shorter ICU stay and improved lymph node retrieval compared with open esophagectomy , and the pulmonary complication rate , hospital stay and perioperative mortality were comparable . The objective is to evaluate the efficacy , risks , quality of life and cost-effectiveness of RATE as an alternative to open transthoracic esophagectomy for treatment of esophageal cancer . Methods / design This is an investigator-initiated and investigator-driven monocenter r and omized controlled parallel-group , superiority trial . All adult patients ( age ≥18 and ≤80 years ) with histologically proven , surgically resectable ( cT1 - 4a , N0 - 3 , M0 ) esophageal carcinoma of the intrathoracic esophagus and with European Clinical Oncology Group performance status 0 , 1 or 2 will be assessed for eligibility and included after obtaining informed consent . Patients ( n = 112 ) with resectable esophageal cancer are r and omized in the outpatient department to either RATE ( n = 56 ) or open three-stage transthoracic esophageal resection ( n = 56 ) . The primary outcome of this study is the percentage of overall complications ( grade 2 and higher ) as stated by the modified Clavien – Dindo classification of surgical complications . Discussion This is the first r and omized controlled trial design ed to compare RATE with open transthoracic esophagectomy as surgical treatment for resectable esophageal cancer . If our hypothesis is proven correct , RATE will result in a lower percentage of postoperative complications , lower blood loss , and shorter hospital stay , but with at least similar oncologic outcomes and better postoperative quality of life compared with open transthoracic esophagectomy . The study started in January 2012 . Follow-up will be 5 years . Short-term results will be analyzed and published after discharge of the last r and omized patient . Trial registration Dutch trial register : NTR3291 Clinical Trial.gov : BACKGROUND AND AIMS The Enhanced Recovery after Surgery ( ERAS ) program has been proposed as a postoperative recovery-enhancing strategy . We frequently apply the Modified-ERAS program following oesophagectomy . This study aims to eluci date the impact of goal -directed fluid therapy ( GDT ) for the perioperative management of oesophageal cancer on the postoperative recovery of patients undergoing oesophagectomy . METHODS This is an interventional before-after comparative observational study conducted at Kanagawa Cancer Centre , Japan . Patients who underwent elective oesophagectomy for oesophageal cancer were recruited . Group H ( retrospectively collected ) received intraoperative and postoperative management consisting of fluid administration without haemodynamic monitoring and the M-ERAS program , while Group S prospect ively received management consisting of GDT and the M-ERAS program . The primary endpoint was the speed of gastrointestinal functional recovery , while secondary endpoints were the level of postoperative mobilisation , incidence of complications , postoperative length of hospital stay ( LOS ) , and nutritional status after discharge . RESULTS The proportion of patients who completely egested Gastrografin by postoperative day 4 , the level of postoperative mobilisation , and achievement ratio for a 100-m walk on the first postoperative attempt were significantly higher in Group S than in Group H ( P = 0.034 , P = 0.0197 , and P < 0.0001 , respectively ) . No significant differences were observed in the postoperative LOS and incidence of complications within 30 days between the groups . The serum albumin levels at 6 months after discharge was higher in Group S than in Group H ( P = 0.0002 ) . CONCLUSIONS The GDT-ERAS program enhanced postoperative gastrointestinal recovery and mobilisation , as well as postoperative nutritional status and protein synthesis . The program did not affect either postoperative LOS or the incidence of complications . TRIAL REGISTRATION UMIN registration number : UMIN000013705 , https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000015999 PURPOSE To observe the clinical efficacy of the application of enhanced recovery after surgery ( ERAS ) in the perioperative period of esophageal carcinoma patients . METHODS A total of 114 patients who were admitted to Affiliated Hospital of Jining Medical University for surgical treatment of esophageal carcinoma between June 2012 and June 2016 were enrolled and r and omly divided into the intervention group and the regular group according to the difference of management procedures during the perioperative period . ERAS was carried out in 57 patients in the intervention group , while conventional management procedures were applied in 57 patients in the regular group . Thereafter , compared were the fluctuations in nutritional indicators and immunological indicators , postoperative complications , time to recovery of gastrointestinal function , length of stay ( LOS ) in hospital and cost of patients between the two groups . RESULTS Seven days post-operation in the intervention group , the evaluation indexes of nutrition status , including total protein ( TP ) , albumin ( ALB ) , prealbumin ( PA ) and transferrin ( TF ) , and of immunological functions , including immunoglobulin G ( IgG ) , immunoglobulin A ( IgA ) , immunoglobulin M ( IgM ) and total blood lymphocyte count ( TLC ) , were significantly higher than those in the regular group . As for postoperative complications , the incidence rate of the intervention group was remarkably lower than that of the regular group ; the recovery time of gastrointestinal function in the intervention group was shorter than that in the regular group ; the LOS in the intervention group was also shorter than that in the regular group ; the in-hospital cost in the intervention group was also lower than that in the regular group . All differences above were statistically significant ( p<0.05 ) . CONCLUSION During the perioperative period of esophageal carcinoma patients , ERAS should be fully applied to sustain the good status , and promote the recovery of immunological functions and gastrointestinal functions ; at the same time , ERAS also reduces the incidence rate of postoperative complications , LOS and in-hospital cost , and we maintain that ERAS should be performed in clinical practice Objective : The aim of this study was to compare open esophagectomy ( OE ) with minimally invasive esophagectomy ( MIE ) in a population -based setting . Background : R and omized controlled trials and cohort studies have shown that MIE is associated with reduced pulmonary complications and shorter hospital stay as compared to OE . Methods : Patients who underwent transthoracic esophagectomy for cancer between 2011 and 2015 were selected from the national Dutch Upper Gastrointestinal Cancer Audit . Hybrid , transhiatal , and emergency procedures were excluded . Patients who underwent  OE were compared with those treated by MIE . Propensity score matching was used to correct for differences in baseline characteristics . The primary endpoint was postoperative pulmonary complications ; secondary endpoints were morbidity , mortality , convalescence , and pathology . Results : Some 1727 patients were included . After propensity score matching the percentage of patients with 1 or more complications was 62.6 % after OE ( N = 433 ) and 60.2 % after MIE ( N = 433 ) ( P = 0.468 ) . Pulmonary complication rate did not differ between groups : 34.2 % ( OE ) versus 35.6 % ( MIE ) ( P = 0.669 ) . Anastomotic leak ( 15.5 % vs 21.2 % , P = 0.028 ) and reintervention rates ( 21.1 % vs 28.2 % , P = 0.017 ) were higher after MIE . Mortality was 3.0 % in the OE group and 4.7 % in the MIE group ( P = 0.209 ) . Median hospital stay was shorter after MIE ( 14 vs 13 days , P = 0.001 ) . Percentages of R0 resections ( 93 % ) did not differ between groups . The median ( range ) lymph node count was 18 ( 2–53 ) ( OE ) versus 20 ( 2–52 ) ( MIE ) ( P < 0.001 ) . Conclusions : This population -based study showed that mortality and pulmonary complications were similar for OE and MIE . Anastomotic leaks and re interventions were more frequently observed after MIE . MIE was associated with a shorter hospital stay Background Our aim was to investigate the influence of FTS on human cellular and humoral immunity using a r and omized controlled clinical study in esophageal cancer patients . Methods Between October 2013 and December 2014 , 276 patients with esophageal cancer in our department were enrolled in the study . The patients were r and omized into two groups : FTS pathway group and conventional pathway group . The postoperative hospital stay , hospitalization expenditure , and postoperative complications were recorded . The markers of inflammatory and immune function were measured before operation as well as on the 1st , 3rd , and 7th postoperative days ( POD ) , including serum level of interleukin-6 ( IL-6 ) , C-reactive protein ( CRP ) , serum globulin 
    Output:
    
agent
A pattern of consistent evolution in fast-track protocol s was clearly demonstrated and these have shown variations in the core-identified components across the studies .
In the future incremental gains through focused improvements in key components will lend itself to even better postoperative outcomes and patient experience during oesophageal cancer treatment
***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: Background A recent development in gastrointestinal surgery is the implementation of enhanced recovery after surgery ( ERAS ) programs . Evidence regarding the benefit of these programs in patients undergoing esophageal surgery is scarce . We investigated the feasibility and possible benefit of a perioperative ERAS program in patients undergoing esophagectomy for malignant disease . Methods The ERAS program was initiated in 2009 . Patients who underwent esophagectomy and were treated according to the ERAS program were included . Items of ERAS included preoperative nutrition , early extubation , early removal of nasogastric tube , and early mobilization . Primary outcome parameters were hospital stay and the incidence of postoperative complications . Outcome parameters in the ERAS cohort were compared to a cohort of patients who underwent surgical resection in the year prior to the implementation of the ERAS protocol . A feasibility analysis was performed among a sample of ERAS patients to determine the number of achieved items per patient . Results Between 2008 and August 2010 , 181 patients in our department underwent esophagectomy .  Of these , 103 patients were included in the ERAS program ( ERAS+ group ) and were compared to 78 patients who had undergone an esophagectomy in 2008 ( ERAS– group ) .  Overall hospital stay was 14 days versus 15 days ( ERAS+ and ERAS– , respectively ; p = 0.013 ) . There were no significant differences in the incidence of postoperative complications in either group . The percentage of achieved items varied between 42 and 93 % per item . Conclusions The implementation of an ERAS program in esophageal surgery was feasible and result ed in a small but significant reduction in overall hospital stay , whereas overall morbidity was not affected Background and Objectives As a well-established technique for postoperative pain relief , the benefits of epidural analgesia ( EDA ) have been under debate recently . This study aim ed to determine whether EDA could improve perioperative outcomes and survival in patients undergoing esophagectomy . Methods From January 2010 to December 2012 , 587 consecutive cases undergoing McKeown-type esohpageactomy  were retrospectively identified from a prospect ively maintained data base . Results After propensity-matching , incorporating baseline characteristics , 178 cases were included in each group , and patients characteristics distributions were well-balanced between two groups . Compared with intravenous analgesia , the use of EDA significantly decreased the incidence of pneumonia from 32 % to 19.7 % ( P = 0.008 ) , and anastomotic leakage from 23.0 % to 14.0 % ( P = 0.029 ) . The change in CRP level of EDA group was significantly decreased ( preoperative , 6.2 vs. 6.2 ; POD 1 , 108.1 vs. 121.3 ; POD 3 , 131.5 vs. 137.8 ; POD 7 , 69.3 vs. 82.1 mg/L ; P = 0.044 ) . EDA patients had a significantly longer duration of indwelling urinary catheter ( P<0.001 ) , and lower levels in both systolic ( P = 0.001 ) and diastolic blood pressure ( P<0.001 ) . There were n't significant differences in overall survival ( log-rank P = 0.47 ) and recurrence ( Gray-test P = 0.46 ) between two groups . Conclusions These findings revealed that EDA could attenuate inflammatory response and reduce the incidence of pneumonia and anastomotic leakage after esophagectomy , at the price of delayed urinary catheter removal and lower blood pressure . EDA remains an important component of multimodal perioperative management after esophagectomy Background For esophageal cancer patients , radical esophagolymphadenectomy is the cornerstone of multimodality treatment with curative intent . Transthoracic esophagectomy is the preferred surgical approach worldwide allowing for en-bloc resection of the tumor with the surrounding lymph nodes . However , the percentage of cardiopulmonary complications associated with the transthoracic approach is high ( 50 to 70%).Recent studies have shown that robot-assisted minimally invasive thoraco-laparoscopic esophagectomy ( RATE ) is at least equivalent to the open transthoracic approach for esophageal cancer in terms of short-term oncological outcomes . RATE was accompanied with reduced blood loss , shorter ICU stay and improved lymph node retrieval compared with open esophagectomy , and the pulmonary complication rate , hospital stay and perioperative mortality were comparable . The objective is to evaluate the efficacy , risks , quality of life and cost-effectiveness of RATE as an alternative to open transthoracic esophagectomy for treatment of esophageal cancer . Methods / design This is an investigator-initiated and investigator-driven monocenter r and omized controlled parallel-group , superiority trial . All adult patients ( age ≥18 and ≤80 years ) with histologically proven , surgically resectable ( cT1 - 4a , N0 - 3 , M0 ) esophageal carcinoma of the intrathoracic esophagus and with European Clinical Oncology Group performance status 0 , 1 or 2 will be assessed for eligibility and included after obtaining informed consent . Patients ( n = 112 ) with resectable esophageal cancer are r and omized in the outpatient department to either RATE ( n = 56 ) or open three-stage transthoracic esophageal resection ( n = 56 ) . The primary outcome of this study is the percentage of overall complications ( grade 2 and higher ) as stated by the modified Clavien – Dindo classification of surgical complications . Discussion This is the first r and omized controlled trial design ed to compare RATE with open transthoracic esophagectomy as surgical treatment for resectable esophageal cancer . If our hypothesis is proven correct , RATE will result in a lower percentage of postoperative complications , lower blood loss , and shorter hospital stay , but with at least similar oncologic outcomes and better postoperative quality of life compared with open transthoracic esophagectomy . The study started in January 2012 . Follow-up will be 5 years . Short-term results will be analyzed and published after discharge of the last r and omized patient . Trial registration Dutch trial register : NTR3291 Clinical Trial.gov : BACKGROUND AND AIMS The Enhanced Recovery after Surgery ( ERAS ) program has been proposed as a postoperative recovery-enhancing strategy . We frequently apply the Modified-ERAS program following oesophagectomy . This study aims to eluci date the impact of goal -directed fluid therapy ( GDT ) for the perioperative management of oesophageal cancer on the postoperative recovery of patients undergoing oesophagectomy . METHODS This is an interventional before-after comparative observational study conducted at Kanagawa Cancer Centre , Japan . Patients who underwent elective oesophagectomy for oesophageal cancer were recruited . Group H ( retrospectively collected ) received intraoperative and postoperative management consisting of fluid administration without haemodynamic monitoring and the M-ERAS program , while Group S prospect ively received management consisting of GDT and the M-ERAS program . The primary endpoint was the speed of gastrointestinal functional recovery , while secondary endpoints were the level of postoperative mobilisation , incidence of complications , postoperative length of hospital stay ( LOS ) , and nutritional status after discharge . RESULTS The proportion of patients who completely egested Gastrografin by postoperative day 4 , the level of postoperative mobilisation , and achievement ratio for a 100-m walk on the first postoperative attempt were significantly higher in Group S than in Group H ( P = 0.034 , P = 0.0197 , and P < 0.0001 , respectively ) . No significant differences were observed in the postoperative LOS and incidence of complications within 30 days between the groups . The serum albumin levels at 6 months after discharge was higher in Group S than in Group H ( P = 0.0002 ) . CONCLUSIONS The GDT-ERAS program enhanced postoperative gastrointestinal recovery and mobilisation , as well as postoperative nutritional status and protein synthesis . The program did not affect either postoperative LOS or the incidence of complications . TRIAL REGISTRATION UMIN registration number : UMIN000013705 , https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000015999 PURPOSE To observe the clinical efficacy of the application of enhanced recovery after surgery ( ERAS ) in the perioperative period of esophageal carcinoma patients . METHODS A total of 114 patients who were admitted to Affiliated Hospital of Jining Medical University for surgical treatment of esophageal carcinoma between June 2012 and June 2016 were enrolled and r and omly divided into the intervention group and the regular group according to the difference of management procedures during the perioperative period . ERAS was carried out in 57 patients in the intervention group , while conventional management procedures were applied in 57 patients in the regular group . Thereafter , compared were the fluctuations in nutritional indicators and immunological indicators , postoperative complications , time to recovery of gastrointestinal function , length of stay ( LOS ) in hospital and cost of patients between the two groups . RESULTS Seven days post-operation in the intervention group , the evaluation indexes of nutrition status , including total protein ( TP ) , albumin ( ALB ) , prealbumin ( PA ) and transferrin ( TF ) , and of immunological functions , including immunoglobulin G ( IgG ) , immunoglobulin A ( IgA ) , immunoglobulin M ( IgM ) and total blood lymphocyte count ( TLC ) , were significantly higher than those in the regular group . As for postoperative complications , the incidence rate of the intervention group was remarkably lower than that of the regular group ; the recovery time of gastrointestinal function in the intervention group was shorter than that in the regular group ; the LOS in the intervention group was also shorter than that in the regular group ; the in-hospital cost in the intervention group was also lower than that in the regular group . All differences above were statistically significant ( p<0.05 ) . CONCLUSION During the perioperative period of esophageal carcinoma patients , ERAS should be fully applied to sustain the good status , and promote the recovery of immunological functions and gastrointestinal functions ; at the same time , ERAS also reduces the incidence rate of postoperative complications , LOS and in-hospital cost , and we maintain that ERAS should be performed in clinical practice Objective : The aim of this study was to compare open esophagectomy ( OE ) with minimally invasive esophagectomy ( MIE ) in a population -based setting . Background : R and omized controlled trials and cohort studies have shown that MIE is associated with reduced pulmonary complications and shorter hospital stay as compared to OE . Methods : Patients who underwent transthoracic esophagectomy for cancer between 2011 and 2015 were selected from the national Dutch Upper Gastrointestinal Cancer Audit . Hybrid , transhiatal , and emergency procedures were excluded . Patients who underwent  OE were compared with those treated by MIE . Propensity score matching was used to correct for differences in baseline characteristics . The primary endpoint was postoperative pulmonary complications ; secondary endpoints were morbidity , mortality , convalescence , and pathology . Results : Some 1727 patients were included . After propensity score matching the percentage of patients with 1 or more complications was 62.6 % after OE ( N = 433 ) and 60.2 % after MIE ( N = 433 ) ( P = 0.468 ) . Pulmonary complication rate did not differ between groups : 34.2 % ( OE ) versus 35.6 % ( MIE ) ( P = 0.669 ) . Anastomotic leak ( 15.5 % vs 21.2 % , P = 0.028 ) and reintervention rates ( 21.1 % vs 28.2 % , P = 0.017 ) were higher after MIE . Mortality was 3.0 % in the OE group and 4.7 % in the MIE group ( P = 0.209 ) . Median hospital stay was shorter after MIE ( 14 vs 13 days , P = 0.001 ) . Percentages of R0 resections ( 93 % ) did not differ between groups . The median ( range ) lymph node count was 18 ( 2–53 ) ( OE ) versus 20 ( 2–52 ) ( MIE ) ( P < 0.001 ) . Conclusions : This population -based study showed that mortality and pulmonary complications were similar for OE and MIE . Anastomotic leaks and re interventions were more frequently observed after MIE . MIE was associated with a shorter hospital stay Background Our aim was to investigate the influence of FTS on human cellular and humoral immunity using a r and omized controlled clinical study in esophageal cancer patients . Methods Between October 2013 and December 2014 , 276 patients with esophageal cancer in our department were enrolled in the study . The patients were r and omized into two groups : FTS pathway group and conventional pathway group . The postoperative hospital stay , hospitalization expenditure , and postoperative complications were recorded . The markers of inflammatory and immune function were measured before operation as well as on the 1st , 3rd , and 7th postoperative days ( POD ) , including serum level of interleukin-6 ( IL-6 ) , C-reactive protein ( CRP ) , serum globulin 
    Output:
    