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: AIM Fast track protocol ( FTP ) showed to improve perioperative care . The study aims to evaluate the impact of the FTP in the open extraperitoneal rectal cancer ( ERC ) surgical treatment without a primary derivative stoma ( DS ) and the QoL in patients with or without a secondary DS . PATIENTS AND METHODS 50 patients affected by ERC were enrolled and operated on with open low anterior resection without a primary DS .  They were r and omized in two groups : one was treated perioperativelly in the traditional way ( group T ) , the other using a modif ed FTP ( group FT ) . A QoL question naire was administered prior to discharge and at 1-month follow-up . RESULTS Five courses ( 10 % ) were complicated by anastomotic leakage : 3 ( 12 % ) in the FT group ( 2 minor and 1 maior ) and 2 ( 8 % ) in the T group ( 1 minor and 1 maior ) ( p = n.s . ) . All the maiors and one minor were treated with a DS . Patients of the group FTP were considered dischargeable earlier that those of group T ( p<0.05 ) . Patients with DS had a significantly lower QoL score ( p<0.0001 ) . CONCLUSION FTP with minor modifications is feasible and safe in the ERC open surgery without using a DS . Better results were obtained without increasing complication rate . A secondary DS impacts detrimentally on The aim of this r and omized clinical trial was to compare patients treated using a multimodal approach [ enhanced recovery after surgery ( ERAS ) ]  , with a special focus on counselling , to patients treated in a st and ard conventional care pathway , who underwent elective colorectal resection BACKGROUND / AIMS Fast track ( IT ) rehabilitation programmes have demonstrated advantages over traditional perioperative care after open colonic surgery ; however . their contribution in recovery after laparoscopic colonic surgery is not clearly defined . This study was conducted to estimate the value of FT rehabilitation programme in laparoscopic colonic resections . METHODOLOGY This is a r and omized prospect i ve controlled clinical trial . Ninety-nine consecutive patients underwent elective laparoscopic colonic resection between February 2008 and March 2009 . Forty-nine patients received FT multimodal rehabilitation programme as FT group and 50 patients underwent traditional perioperative care as non-FT group . Postoperative hospital stay , return of gastrointestinal function , postoperative complications were recorded . RESULTS Postoperative hospital stay was shorter in the FT group , a median duration of 4.0 days versus 5.0 days in the non-FT group ( p<0.01 ) . Gastrointestinal functional recovery occurred 1 day earlier in FT group ( passage of flatus after 2.0 days vs. 3.0 days , p<0.01 ) . There were no significant differences in complications within 30 postoperative days ( 12 % in FT group vs. 20 % in non-FT group , p=0.295 ) . CONCLUSIONS When applied after laparoscopic colonic surgery , FT rehabilitation programme is feasible , safe and may lead to accelerated functional recovery and reductions in postoperative hospital stay BACKGROUND Studies have shown the value of using fast-track postoperative recovery . St and ard procedures ( non-fast-track strategies ) remain in common use for perioperative care . Few prospect i ve reports exist on the outcome of fast-tracking in Central Europe . The aim of our study was to assess the effect and safety of our own fast-track protocol with regard to the postoperative period after open bowel resection . PATIENTS AND METHODS One hundred and five patients with ASA score I-II scheduled for open intestinal resection in the period April 2005-December 2007 were r and omly selected for the fast-track group ( FT ) and non-fast-track group ( non-FT ) . A design ed protocol was used in the FT group with the emphasis on an interdisciplinary approach . The control group ( non-FT ) was treated by st and ard established procedures .  Postoperative pain , rehabilitation , gastrointestinal functions , postoperative complications , and post-op length of stay were recorded . RESULTS Of 105 patients , 103 were statistically analyzed . Patients in the FT group ( n=51 ) and non-FT group ( n=52 ) did not differ in age , surgical diagnosis , or procedure . The fast-track procedure led to significantly better control of postoperative pain and faster restoration of GI functions ( bowel movement after 1.3 days vs. 3.1 , p<0.001 ) . Food tolerance was significantly better in the FT group and rehabilitation was also faster . Hospital stay was shorter in the FT group - median seven days ( 95 % CI 7.0 - 7.7 ) versus ten days ( 95 % CI 9.5 - 11.3 ) in non-FT ( p<0.001 ) . Postoperative complications within 30 postoperative days were also significantly lower in the FT group ( 21.6 vs. 48.1 % , p=0.003 ) . There were no deaths and no patients were readmitted within 30 days . CONCLUSIONS Following the FT protocol helped to reduce frequency of postoperative complications and reduced hospital stay . We conclude that the FT strategy is safe and effective in improving postoperative outcomes STUDY OBJECTIVE To study the application of a fast-track care protocol in colorectal surgery for deep infiltrating endometriosis . Bowel endometriosis is an infrequent but not rare condition that often needs intestinal surgery and imposes a high economic burden on society . DESIGN Prospect i ve r and omized trial ( Canadian Task Force classification I ) . SETTING Tertiary referral center . PATIENTS Two hundred twenty-seven patients with preoperative evidence of bowel endometriosis . INTERVENTIONS We r and omly assigned 227 patients with preoperative evidence of bowel endometriosis to a fast-track protocol ( no preoperative bowel preparation , early restoration of diet , no postoperative antibiotics , and early postoperative mobilization ) or conventional care for laparoscopic intestinal surgery . R and omization was obtained on a double-blind , date -based schedule , and all procedures were performed by a homogenous group of expert surgeons . Surgical outcomes and a health economic evaluation were assessed . MEASUREMENTS AND MAIN RESULTS The primary outcome was hospital stay . Patient 's well-being and intraoperative and postoperative complications up to 30 days after surgery were also assessed . Subsequently , direct medical costs were analyzed . Patients assigned to the fast-track protocol were discharged earlier ( median 3 vs 7 days , p < .001 ) with no significant differences in subjective well-being ( p = .55 ) . Operative details , postoperative complications , and need of temporary ileostomy were similar ( p = .89 ) between groups as well as readmission rates within 30 days ( p = .69 ) . The application of a fast-track protocol result ed in an overall significant reduction of costs ( USD 6699 vs 8674 , p < .01 ) , and differences were more evident in cases of protective stoma ( 7652 vs 8793 , p < .05 ) and surgery with postoperative complications ( 10 835 vs 14 005 , p < .01 ) . CONCLUSION The application of a fast-track care protocol for laparoscopy in cases of pelvic and intestinal endometriosis does not increase the risk of complications and ensures a reduction of medical costs Objective Enhanced recovery after surgery ( ERAS ) integrates evidence -based interventions to reduce surgical stress and accelerate rehabilitation . Our study was to compare the short-term quality of life ( QOL ) in patients undergoing open colonic surgery using ERAS program or conventional management .  Methods A prospect i ve study of 57 patients using ERAS program and 60 patients using conventional management was conducted . The clinical characteristics of all patients were recorded . QOL was evaluated longitudinally using the question naires ( EORTC QLQ-C30 and QLQ-CR29 ) pre- and postoperatively . Generalized estimating equation was used to do the analysis in order to determine the effective impact of correlative factors on the postoperative QOL , including age , sex , BMI , ASA grade , tumor location , tumor size , pTNM stage , recovery program and length of time after surgery . Results The morbidity in ERAS and control group was 17.5 versus 26.7 % ( p = 0.235 ) . The patients in ERAS group had much faster rehabilitation and less hospital stay . In the primary statistical analysis , the scores of global QOL ( on POD3 , POD6 , POD10 , POD14 , POD21 ) , physical functioning ( on POD3 , POD6 , POD10 , POD14 , POD21 ) , role functioning ( on POD6 , POD10 , POD14 , POD21 ) , emotional functioning ( on POD3 , POD6 , POD10 , POD14 , POD21 ) , cognitive functioning ( on POD3 , POD6 ) and social functioning ( on POD3 , POD6 , POD10 , POD14 , POD21 , POD28 ) were higher in ERAS group than in control group , which suggested that the patients in ERAS group had a better life status . However , the scores of pain ( on POD10 , POD14 , POD21 ) , appetite loss ( on POD3 , POD6 ) , constipation ( on POD3 , POD6 , POD10 ) , diarrhea ( on POD3 , POD10 ) , financial difficulties ( on POD10 , POD14 , POD21 ) , perspective of future health ( on POD6 , POD10 , POD14 ) , gastrointestinal tract problems ( on POD3 , POD6 , POD10 ) and defecation problems ( on POD6 , POD10 , POD14 ) were lower in ERAS group than in control group , which revealed that the patients in ERAS group suffered less symptoms . In the further generalized estimating equation analysis , the result showed that recovery program and length of time after surgery had independently positive impact on the patient ’s postoperative QOL . ConclusionS hort-term QOL in patients undergoing colonic cancer using ERAS program was better than that using conventional management The value of fast-track ( FT ) multimodal recovery programs in improving hospitalization of surgical patients has been widely proved . The application of FT protocol s to laparoscopic colorectal surgery seems to maximize the effects of the minimally invasive approach . The objectives of this r and omized-controlled trial are to compare the short-term outcomes ( bowel function , return to oral nutrition , day of discharge , fatigue , time to resume normal activities , functional capabilities , and readmission rate ) of patients undergoing elective laparoscopic high anterior resection ( HAR ) following either a FT or a st and ard program . The prospect i ve r and omized-controlled trial included 52 consecutive patients undergoing elective laparoscopic HAR . Group 1 was treated with a FT rehabilitation program , and group 2 was treated with a st and ard care ( SC ) program . Patients were interviewed 14 and 30 days postoperatively . One patient in each group was excluded from the study . Mean hospital stay , time of first bowel movement , and bowel function resumption were significantly shorter in the FT group ( P<0.05 ) . Patients in the FT group referred more pain in day 0 versus patients in the SC group ( P<0.05 ) even though the difference disappeared from day 1 . Fatigue was significantly reduced at day 14 in the FT group compared with the SC group ( P<0.01 ) . Similarly , ability to resume the normal preoperative attitude ( walking stairs , cooking , housekeeping , shopping , and walking outdoors ) was significantly better at day 14 in the FT group ( P<0.005 ) . There was no significant difference between the 2 groups at day 30 for the same parameters . There were no readmissions in both the groups and no need for consultations from general practitioners . FT multimodal program is a safe approach effective on postoperative short-term outcome significantly reducing hospital stay . Early postoperative pain control needs to be optimized Purpose The aim of this multi-institutional study was to prospect ively evaluate the safety and efficacy of an enhanced recovery after surgery ( ERAS ) protocol for colonic surgery . Methods The subjects of this study were 320 patients with an American Society of Anesthesiologists ( ASA ) grade I or II physical status . Patients underwent elective open or laparoscopic colonic resection or high anterior resection between April 2011 and January 2014 at one of six institutions . Three hospitals implemented an ERAS protocol ( n = 159 ) , and three administered conventional care ( n = 161 ) . The primary outcome measure was the surgical complication rate . Results Most operations , irrespective of group , were performed laparoscopically . The incidence of a surgical complication was 17.0 % in the ERAS group vs. 16.1 % in the conventional group ( P = 0.842 ) , in which several non-surgical complications also arose . Oral food intake was implemented earlier for the ERAS group vs. the conventional group , after a median ( range ) of 1 ( 1–31 ) vs. 3 ( 1–9 ) days for the ERAS vs. conventional care groups , respectively ( P < 0.001 ) . The median length of postoperative hospital stay was reduced by 5.5 days for the ERAS group , being 8.5 ( 5–41 ) vs. 14 ( 7–56 ) days for the ERAS vs. conventional care groups , respectively ( P < 0.001 ) . Con 
    Output:
    
agent
In predefined subgroup analyses , findings did not vary by surgical approach ( open vs laparoscopic ) or colorectal condition .
CONCLUSIONS : Enhanced recovery protocol s for adults undergoing colorectal surgery improve patient outcomes with no increase in adverse events .
Evidence was insufficient regarding which components , or component combinations , are key to improving patient outcomes .
***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: AIM Fast track protocol ( FTP ) showed to improve perioperative care . The study aims to evaluate the impact of the FTP in the open extraperitoneal rectal cancer ( ERC ) surgical treatment without a primary derivative stoma ( DS ) and the QoL in patients with or without a secondary DS . PATIENTS AND METHODS 50 patients affected by ERC were enrolled and operated on with open low anterior resection without a primary DS .  They were r and omized in two groups : one was treated perioperativelly in the traditional way ( group T ) , the other using a modif ed FTP ( group FT ) . A QoL question naire was administered prior to discharge and at 1-month follow-up . RESULTS Five courses ( 10 % ) were complicated by anastomotic leakage : 3 ( 12 % ) in the FT group ( 2 minor and 1 maior ) and 2 ( 8 % ) in the T group ( 1 minor and 1 maior ) ( p = n.s . ) . All the maiors and one minor were treated with a DS . Patients of the group FTP were considered dischargeable earlier that those of group T ( p<0.05 ) . Patients with DS had a significantly lower QoL score ( p<0.0001 ) . CONCLUSION FTP with minor modifications is feasible and safe in the ERC open surgery without using a DS . Better results were obtained without increasing complication rate . A secondary DS impacts detrimentally on The aim of this r and omized clinical trial was to compare patients treated using a multimodal approach [ enhanced recovery after surgery ( ERAS ) ]  , with a special focus on counselling , to patients treated in a st and ard conventional care pathway , who underwent elective colorectal resection BACKGROUND / AIMS Fast track ( IT ) rehabilitation programmes have demonstrated advantages over traditional perioperative care after open colonic surgery ; however . their contribution in recovery after laparoscopic colonic surgery is not clearly defined . This study was conducted to estimate the value of FT rehabilitation programme in laparoscopic colonic resections . METHODOLOGY This is a r and omized prospect i ve controlled clinical trial . Ninety-nine consecutive patients underwent elective laparoscopic colonic resection between February 2008 and March 2009 . Forty-nine patients received FT multimodal rehabilitation programme as FT group and 50 patients underwent traditional perioperative care as non-FT group . Postoperative hospital stay , return of gastrointestinal function , postoperative complications were recorded . RESULTS Postoperative hospital stay was shorter in the FT group , a median duration of 4.0 days versus 5.0 days in the non-FT group ( p<0.01 ) . Gastrointestinal functional recovery occurred 1 day earlier in FT group ( passage of flatus after 2.0 days vs. 3.0 days , p<0.01 ) . There were no significant differences in complications within 30 postoperative days ( 12 % in FT group vs. 20 % in non-FT group , p=0.295 ) . CONCLUSIONS When applied after laparoscopic colonic surgery , FT rehabilitation programme is feasible , safe and may lead to accelerated functional recovery and reductions in postoperative hospital stay BACKGROUND Studies have shown the value of using fast-track postoperative recovery . St and ard procedures ( non-fast-track strategies ) remain in common use for perioperative care . Few prospect i ve reports exist on the outcome of fast-tracking in Central Europe . The aim of our study was to assess the effect and safety of our own fast-track protocol with regard to the postoperative period after open bowel resection . PATIENTS AND METHODS One hundred and five patients with ASA score I-II scheduled for open intestinal resection in the period April 2005-December 2007 were r and omly selected for the fast-track group ( FT ) and non-fast-track group ( non-FT ) . A design ed protocol was used in the FT group with the emphasis on an interdisciplinary approach . The control group ( non-FT ) was treated by st and ard established procedures .  Postoperative pain , rehabilitation , gastrointestinal functions , postoperative complications , and post-op length of stay were recorded . RESULTS Of 105 patients , 103 were statistically analyzed . Patients in the FT group ( n=51 ) and non-FT group ( n=52 ) did not differ in age , surgical diagnosis , or procedure . The fast-track procedure led to significantly better control of postoperative pain and faster restoration of GI functions ( bowel movement after 1.3 days vs. 3.1 , p<0.001 ) . Food tolerance was significantly better in the FT group and rehabilitation was also faster . Hospital stay was shorter in the FT group - median seven days ( 95 % CI 7.0 - 7.7 ) versus ten days ( 95 % CI 9.5 - 11.3 ) in non-FT ( p<0.001 ) . Postoperative complications within 30 postoperative days were also significantly lower in the FT group ( 21.6 vs. 48.1 % , p=0.003 ) . There were no deaths and no patients were readmitted within 30 days . CONCLUSIONS Following the FT protocol helped to reduce frequency of postoperative complications and reduced hospital stay . We conclude that the FT strategy is safe and effective in improving postoperative outcomes STUDY OBJECTIVE To study the application of a fast-track care protocol in colorectal surgery for deep infiltrating endometriosis . Bowel endometriosis is an infrequent but not rare condition that often needs intestinal surgery and imposes a high economic burden on society . DESIGN Prospect i ve r and omized trial ( Canadian Task Force classification I ) . SETTING Tertiary referral center . PATIENTS Two hundred twenty-seven patients with preoperative evidence of bowel endometriosis . INTERVENTIONS We r and omly assigned 227 patients with preoperative evidence of bowel endometriosis to a fast-track protocol ( no preoperative bowel preparation , early restoration of diet , no postoperative antibiotics , and early postoperative mobilization ) or conventional care for laparoscopic intestinal surgery . R and omization was obtained on a double-blind , date -based schedule , and all procedures were performed by a homogenous group of expert surgeons . Surgical outcomes and a health economic evaluation were assessed . MEASUREMENTS AND MAIN RESULTS The primary outcome was hospital stay . Patient 's well-being and intraoperative and postoperative complications up to 30 days after surgery were also assessed . Subsequently , direct medical costs were analyzed . Patients assigned to the fast-track protocol were discharged earlier ( median 3 vs 7 days , p < .001 ) with no significant differences in subjective well-being ( p = .55 ) . Operative details , postoperative complications , and need of temporary ileostomy were similar ( p = .89 ) between groups as well as readmission rates within 30 days ( p = .69 ) . The application of a fast-track protocol result ed in an overall significant reduction of costs ( USD 6699 vs 8674 , p < .01 ) , and differences were more evident in cases of protective stoma ( 7652 vs 8793 , p < .05 ) and surgery with postoperative complications ( 10 835 vs 14 005 , p < .01 ) . CONCLUSION The application of a fast-track care protocol for laparoscopy in cases of pelvic and intestinal endometriosis does not increase the risk of complications and ensures a reduction of medical costs Objective Enhanced recovery after surgery ( ERAS ) integrates evidence -based interventions to reduce surgical stress and accelerate rehabilitation . Our study was to compare the short-term quality of life ( QOL ) in patients undergoing open colonic surgery using ERAS program or conventional management .  Methods A prospect i ve study of 57 patients using ERAS program and 60 patients using conventional management was conducted . The clinical characteristics of all patients were recorded . QOL was evaluated longitudinally using the question naires ( EORTC QLQ-C30 and QLQ-CR29 ) pre- and postoperatively . Generalized estimating equation was used to do the analysis in order to determine the effective impact of correlative factors on the postoperative QOL , including age , sex , BMI , ASA grade , tumor location , tumor size , pTNM stage , recovery program and length of time after surgery . Results The morbidity in ERAS and control group was 17.5 versus 26.7 % ( p = 0.235 ) . The patients in ERAS group had much faster rehabilitation and less hospital stay . In the primary statistical analysis , the scores of global QOL ( on POD3 , POD6 , POD10 , POD14 , POD21 ) , physical functioning ( on POD3 , POD6 , POD10 , POD14 , POD21 ) , role functioning ( on POD6 , POD10 , POD14 , POD21 ) , emotional functioning ( on POD3 , POD6 , POD10 , POD14 , POD21 ) , cognitive functioning ( on POD3 , POD6 ) and social functioning ( on POD3 , POD6 , POD10 , POD14 , POD21 , POD28 ) were higher in ERAS group than in control group , which suggested that the patients in ERAS group had a better life status . However , the scores of pain ( on POD10 , POD14 , POD21 ) , appetite loss ( on POD3 , POD6 ) , constipation ( on POD3 , POD6 , POD10 ) , diarrhea ( on POD3 , POD10 ) , financial difficulties ( on POD10 , POD14 , POD21 ) , perspective of future health ( on POD6 , POD10 , POD14 ) , gastrointestinal tract problems ( on POD3 , POD6 , POD10 ) and defecation problems ( on POD6 , POD10 , POD14 ) were lower in ERAS group than in control group , which revealed that the patients in ERAS group suffered less symptoms . In the further generalized estimating equation analysis , the result showed that recovery program and length of time after surgery had independently positive impact on the patient ’s postoperative QOL . ConclusionS hort-term QOL in patients undergoing colonic cancer using ERAS program was better than that using conventional management The value of fast-track ( FT ) multimodal recovery programs in improving hospitalization of surgical patients has been widely proved . The application of FT protocol s to laparoscopic colorectal surgery seems to maximize the effects of the minimally invasive approach . The objectives of this r and omized-controlled trial are to compare the short-term outcomes ( bowel function , return to oral nutrition , day of discharge , fatigue , time to resume normal activities , functional capabilities , and readmission rate ) of patients undergoing elective laparoscopic high anterior resection ( HAR ) following either a FT or a st and ard program . The prospect i ve r and omized-controlled trial included 52 consecutive patients undergoing elective laparoscopic HAR . Group 1 was treated with a FT rehabilitation program , and group 2 was treated with a st and ard care ( SC ) program . Patients were interviewed 14 and 30 days postoperatively . One patient in each group was excluded from the study . Mean hospital stay , time of first bowel movement , and bowel function resumption were significantly shorter in the FT group ( P<0.05 ) . Patients in the FT group referred more pain in day 0 versus patients in the SC group ( P<0.05 ) even though the difference disappeared from day 1 . Fatigue was significantly reduced at day 14 in the FT group compared with the SC group ( P<0.01 ) . Similarly , ability to resume the normal preoperative attitude ( walking stairs , cooking , housekeeping , shopping , and walking outdoors ) was significantly better at day 14 in the FT group ( P<0.005 ) . There was no significant difference between the 2 groups at day 30 for the same parameters . There were no readmissions in both the groups and no need for consultations from general practitioners . FT multimodal program is a safe approach effective on postoperative short-term outcome significantly reducing hospital stay . Early postoperative pain control needs to be optimized Purpose The aim of this multi-institutional study was to prospect ively evaluate the safety and efficacy of an enhanced recovery after surgery ( ERAS ) protocol for colonic surgery . Methods The subjects of this study were 320 patients with an American Society of Anesthesiologists ( ASA ) grade I or II physical status . Patients underwent elective open or laparoscopic colonic resection or high anterior resection between April 2011 and January 2014 at one of six institutions . Three hospitals implemented an ERAS protocol ( n = 159 ) , and three administered conventional care ( n = 161 ) . The primary outcome measure was the surgical complication rate . Results Most operations , irrespective of group , were performed laparoscopically . The incidence of a surgical complication was 17.0 % in the ERAS group vs. 16.1 % in the conventional group ( P = 0.842 ) , in which several non-surgical complications also arose . Oral food intake was implemented earlier for the ERAS group vs. the conventional group , after a median ( range ) of 1 ( 1–31 ) vs. 3 ( 1–9 ) days for the ERAS vs. conventional care groups , respectively ( P < 0.001 ) . The median length of postoperative hospital stay was reduced by 5.5 days for the ERAS group , being 8.5 ( 5–41 ) vs. 14 ( 7–56 ) days for the ERAS vs. conventional care groups , respectively ( P < 0.001 ) . Con 
    Output:
    