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 The benefits of preoperative biliary drainage , which was introduced to improve the postoperative outcome in patients with obstructive jaundice caused by a tumor of the pancreatic head , are unclear . METHODS In this multicenter , r and omized trial , we compared preoperative biliary drainage with surgery alone for patients with cancer of the pancreatic head . Patients with obstructive jaundice and a bilirubin level of 40 to 250 micromol per liter ( 2.3 to 14.6 mg per deciliter ) were r and omly assigned to undergo either preoperative biliary drainage for 4 to 6 weeks , followed by surgery , or surgery alone within 1 week after diagnosis . Preoperative biliary drainage was attempted primarily with the placement of an endoprosthesis by means of endoscopic retro grade cholangiopancreatography . The primary outcome was the rate of serious complications within 120 days after r and omization . RESULTS We enrolled 202 patients ; 96 were assigned to undergo early surgery and 106 to undergo preoperative biliary drainage ; 6 patients were excluded from the analysis . The rates of serious complications were 39 % ( 37 patients ) in the early-surgery group and 74 % ( 75 patients ) in the biliary-drainage group ( relative risk in the early-surgery group , 0.54 ; 95 % confidence interval [ CI ] , 0.41 to 0.71 ; P<0.001 ) . Preoperative biliary drainage was successful in 96 patients ( 94 % ) after one or more attempts , with complications in 47 patients ( 46 % ) . Surgery-related complications occurred in 35 patients ( 37 % ) in the early-surgery group and in 48 patients ( 47 % ) in the biliary-drainage group ( relative risk , 0.79 ; 95 % CI , 0.57 to 1.11 ; P=0.14 ) . Mortality and the length of hospital stay did not differ significantly between the two groups . CONCLUSIONS Routine preoperative biliary drainage in patients undergoing surgery for cancer of the pancreatic head increases the rate of complications . ( Current Controlled Trials number , IS RCT N31939699 . Background Whether octreotide prevents pancreatic fistula following pancreatoduodenectomy is controversial and it is believed to be beneficial in soft gl and s and normal-sized ducts . The aim of this study is to assess the potential value of octreotide in reducing the incidence of pancreatic fistula , postoperative complications , morbidity and hospital stay in patients with soft pancreas and non-dilated ducts . Methods A total of 109 patients undergoing elective pancreatoduodenectomy with soft pancreas and non-dilated duct were r and omized to  octreotide group versus no octreotide —  the control group . Surgical steps were st and ardized and incidences of pancreatic fistula , complications , death and hospital stay were assessed . Results There were 55 patients in  octreotide group and 54 in the control group . Demographic features and pancreatic duct diameter of the groups were comparable . The rates of clinical ly significant pancreatic fistulae ( grade s B and C ) were 10.9 and 18.5 % ( p = ns ) , and morbidity was 18 and 29.6 % ( p = ns ) , respectively . Patients who received octreotide resumed oral diet early and had a shorter hospital stay . Conclusion This study demonstrated no statistical difference in pancreatic fistulae with the use of octreotide , though there was a trend towards fewer incidences of pancreatic fistulae , morbidity and shorter hospital stay . Clinical Trials.gov Identifier : BACKGROUND Mild perioperative hypothermia , which is common during major surgery , may promote surgical-wound infection by triggering thermoregulatory vasoconstriction , which decreases subcutaneous oxygen tension . Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing wound by reducing the deposition of collagen . Hypothermia also directly impairs immune function . We tested the hypothesis that hypothermia both increases susceptibility to surgical-wound infection and lengthens hospitalization . METHODS Two hundred patients undergoing colorectal surgery were r and omly assigned to routine intraoperative thermal care ( the hypothermia group ) or additional warming ( the normothermia group ) . The patient 's anesthetic care was st and ardized , and they were all given cefam and ole and metronidazole . In a double-blind protocol , their wounds were evaluated daily until discharge from the hospital and in the clinic after two weeks ; wounds containing culture-positive pus were considered infected . The patients ' surgeons remained unaware of the patients ' group assignments . RESULTS The mean ( + /- SD ) final intraoperative core temperature was 34.7 + /- 0.6 degrees C in the hypothermia group and 36.6 + /- 0.5 degrees C in the normothermia group ( P < 0.001 ) Surgical-wound infections were found in 18 of 96 patients assigned to hypothermia ( 19 percent ) but in only 6 of 104 patients assigned to normothermia ( 6 percent , P = 0.009 ) . The sutures were removed one day later in the patients assigned to hypothermia than in those assigned to normothermia ( P = 0.002 ) , and the duration of hospitalization was prolonged by 2.6 days ( approximately 20 percent ) in hypothermia group ( P = 0.01 ) . CONCLUSIONS Hypothermia itself may delay healing and predispose patients to wound infections . Maintaining normothermia intraoperatively is likely to decrease the incidence of infectious complications in patients undergoing colorectal resection and to shorten their hospitalizations Background Postoperative ileus is common after surgery . One non-pharmacological intervention that has shown promising results in reducing the duration of postoperative ileus is chewing gum after surgery . However , this has not been investigated in upper gastrointestinal surgery such as pancreatic surgery . Hence the aim of this study was to investigate the effects of chewing gum treatment on patients undergoing pancreaticoduodenectomy ad modum whipple due to pancreatic or periampullary cancer . Methods This study was conducted as a phase III trial that was terminated early . Patients diagnosed with pancreatic tumours scheduled for pancreaticoduodenectomy ad modum whipple were included . The treatment group received chewing gum postoperatively and st and ard care . Controls received glucose solution and st and ard care . Chewing gum and glucose were used four times a day during the whole hospital stay . Time to first flatus and stool was defined as the primary outcome . The secondary outcome was start with clear liquids , start with liquid diet and length of hospital stay . Results No statistically significant differences could be observed between the chewing gum intervention group and the control group . However , a numerical difference in mean time was observed in first flatus , first stool , start of clear fluids , and start of liquid diet and length of hospital stay in favour of the intervention group . Conclusions Although this study did not find statistically significant differences favouring the use of chewing gum for postoperative ileus , a positive trend was observed of a reduction of the impact of postoperative ileus among patients after pancreatic surgery . It also contributes valuable method ological experience that is important for future studies of chewing gum interventions during recovery after pancreatic surgery . Trial registration Clinical Trials.gov identifier : NCT02319512 , publication date 2014 - 12 - 17 Summary Background Data : The epidemiology of venous thromboembolism ( VTE ) after cancer surgery is based on clinical trials on VTE prophylaxis that used venography to screen deep vein thrombosis ( DVT ) . However , the clinical relevance of asymptomatic venography-detected DVT is unclear , and the population of these clinical trials is not necessarily representative of the overall cancer surgery population . Objective : The aim of this study was to evaluate the incidence of clinical ly overt VTE in a wide spectrum of consecutive patients undergoing surgery for cancer and to identify risk factors for VTE . Methods : @RISTOS was a prospect i ve observational study in patients undergoing general , urologic , or gynecologic surgery . Patients were assessed for clinical ly overt VTE occurring up to 30 ± 5 days after surgery or more if the hospital stay was longer than 35 days . All outcome events were evaluated by an independent Adjudication Committee . Results : A total of 2373 patients were included in the study : 1238 ( 52 % ) undergoing general , 685 ( 29 % ) urologic , and 450 ( 19 % ) gynecologic surgery . In-hospital prophylaxis was given in 81.6 % and postdischarge prophylaxis in 30.7 % of the patients . Fifty patients ( 2.1 % ) were adjudicated as affected by clinical ly overt VTE ( DVT , 0.42 % ; nonfatal pulmonary embolism , 0.88 % ; death 0.80 % ) . The incidence of VTE was 2.83 % in general surgery , 2.0 % in gynecologic surgery , and 0.87 % in urologic surgery . Forty percent of the events occurred later than 21 days from surgery . The overall death rate was 1.72 % ; in 46.3 % of the cases , death was caused by VTE . In a multivariable analysis , 5 risk factors were identified : age above 60 years ( 2.63 , 95 % confidence interval , 1.21–5.71 ) , previous VTE ( 5.98 , 2.13–16.80 ) , advanced cancer ( 2.68 , 1.37–5.24 ) , anesthesia lasting more than 2 hours ( 4.50 , 1.06–19.04 ) , and bed rest longer than 3 days ( 4.37 , 2.45–7.78 ) . Conclusions : VTE remains a common complication of cancer surgery , with a remarkable proportion of events occurring late after surgery . In patients undergoing cancer surgery , VTE is the most common cause of death at 30 days after surgery Objective To evaluate the endpoints of complications ( specifically pancreatic fistula and total complications ) and death in patients undergoing pancreaticoduodenectomy . Summary Background Data Four r and omized , placebo-controlled , multicenter trials from Europe have evaluated prophylactic octreotide ( the long-acting synthetic analog of native somatostatin ) in patients undergoing pancreatic resection . Each trial reported significant decreases in overall complication rates , and two of the four reported significantly lowered rates of pancreatic fistula in patients receiving prophylactic octreotide . However , none of these four trials studied only pancreaticoduodenal resections , and all trials had high pancreatic fistula rates ( > 19 % ) in the placebo group . A fifth r and omized trial from the United States evaluated the use of prophylactic octreotide in patients undergoing pancreaticoduodenectomy and found no benefit to the use of octreotide . Prophylactic use of octreotide adds more than $ 75 to the daily hospital charge in the United States . In calendar year 1996 , 288 patients received octreotide on the surgical service at the authors ’ institution , for total billed charges of $ 74,652 . Methods Between February 1998 and February 2000 , 383 patients were recruited into this study on the basis of preoperative anticipation of pancreaticoduodenal resection . Patients who gave consent were r and omized to saline control versus octreotide 250 & mgr;g subcutaneously every 8 hours for 7 days , to start 1 to 2 hours before surgery . The primary postoperative endpoints were pancreatic fistula , total complications , death , and length of hospital stay . Results Two hundred eleven patients underwent pancreaticoduodenectomy with pancreatic-enteric anastomosis , received appropriate saline/octreotide doses , and were available for endpoint analysis . The two groups were comparable with respect to demographics ( 54 % male , median age 66 years ) , type of pancreaticoduodenal resection ( 60 % pylorus-preserving ) , type of pancreatic-enteric anastomosis ( 87 % end-to-side pancreaticojejunostomy ) , and pathologic diagnosis . The pancreatic fistula rates were 9 % in the control group and 11 % in the octreotide group . The overall complication rates were 34 % in the control group and 40 % in the octreotide group ; the in-hospital death rates were 0 % versus 1 % , respectively . The median postoperative length of hospital stay was 9 days in both groups . Conclusions These data demonstrate that the prophylactic use of perioperative octreotide does not reduce the incidence of pancreatic fistula or total complications after pancreaticoduodenectomy . Prophylactic  octreotide use in this setting should be eliminated , at a considerable cost savings Laparoscopic resection as an alternative to open pancreatoduodenectomy may yield short‐term benefits , but has not been investigated in a r and omized trial . The aim of this study was to compare laparoscopic and open pancreatoduodenectomy for short‐term outcomes in a r and omized trial Background : Forced-air warming is sometimes unable to maintain perioperative normothermia 
    Output:
    
agent
A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay .
***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 The benefits of preoperative biliary drainage , which was introduced to improve the postoperative outcome in patients with obstructive jaundice caused by a tumor of the pancreatic head , are unclear . METHODS In this multicenter , r and omized trial , we compared preoperative biliary drainage with surgery alone for patients with cancer of the pancreatic head . Patients with obstructive jaundice and a bilirubin level of 40 to 250 micromol per liter ( 2.3 to 14.6 mg per deciliter ) were r and omly assigned to undergo either preoperative biliary drainage for 4 to 6 weeks , followed by surgery , or surgery alone within 1 week after diagnosis . Preoperative biliary drainage was attempted primarily with the placement of an endoprosthesis by means of endoscopic retro grade cholangiopancreatography . The primary outcome was the rate of serious complications within 120 days after r and omization . RESULTS We enrolled 202 patients ; 96 were assigned to undergo early surgery and 106 to undergo preoperative biliary drainage ; 6 patients were excluded from the analysis . The rates of serious complications were 39 % ( 37 patients ) in the early-surgery group and 74 % ( 75 patients ) in the biliary-drainage group ( relative risk in the early-surgery group , 0.54 ; 95 % confidence interval [ CI ] , 0.41 to 0.71 ; P<0.001 ) . Preoperative biliary drainage was successful in 96 patients ( 94 % ) after one or more attempts , with complications in 47 patients ( 46 % ) . Surgery-related complications occurred in 35 patients ( 37 % ) in the early-surgery group and in 48 patients ( 47 % ) in the biliary-drainage group ( relative risk , 0.79 ; 95 % CI , 0.57 to 1.11 ; P=0.14 ) . Mortality and the length of hospital stay did not differ significantly between the two groups . CONCLUSIONS Routine preoperative biliary drainage in patients undergoing surgery for cancer of the pancreatic head increases the rate of complications . ( Current Controlled Trials number , IS RCT N31939699 . Background Whether octreotide prevents pancreatic fistula following pancreatoduodenectomy is controversial and it is believed to be beneficial in soft gl and s and normal-sized ducts . The aim of this study is to assess the potential value of octreotide in reducing the incidence of pancreatic fistula , postoperative complications , morbidity and hospital stay in patients with soft pancreas and non-dilated ducts . Methods A total of 109 patients undergoing elective pancreatoduodenectomy with soft pancreas and non-dilated duct were r and omized to  octreotide group versus no octreotide —  the control group . Surgical steps were st and ardized and incidences of pancreatic fistula , complications , death and hospital stay were assessed . Results There were 55 patients in  octreotide group and 54 in the control group . Demographic features and pancreatic duct diameter of the groups were comparable . The rates of clinical ly significant pancreatic fistulae ( grade s B and C ) were 10.9 and 18.5 % ( p = ns ) , and morbidity was 18 and 29.6 % ( p = ns ) , respectively . Patients who received octreotide resumed oral diet early and had a shorter hospital stay . Conclusion This study demonstrated no statistical difference in pancreatic fistulae with the use of octreotide , though there was a trend towards fewer incidences of pancreatic fistulae , morbidity and shorter hospital stay . Clinical Trials.gov Identifier : BACKGROUND Mild perioperative hypothermia , which is common during major surgery , may promote surgical-wound infection by triggering thermoregulatory vasoconstriction , which decreases subcutaneous oxygen tension . Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing wound by reducing the deposition of collagen . Hypothermia also directly impairs immune function . We tested the hypothesis that hypothermia both increases susceptibility to surgical-wound infection and lengthens hospitalization . METHODS Two hundred patients undergoing colorectal surgery were r and omly assigned to routine intraoperative thermal care ( the hypothermia group ) or additional warming ( the normothermia group ) . The patient 's anesthetic care was st and ardized , and they were all given cefam and ole and metronidazole . In a double-blind protocol , their wounds were evaluated daily until discharge from the hospital and in the clinic after two weeks ; wounds containing culture-positive pus were considered infected . The patients ' surgeons remained unaware of the patients ' group assignments . RESULTS The mean ( + /- SD ) final intraoperative core temperature was 34.7 + /- 0.6 degrees C in the hypothermia group and 36.6 + /- 0.5 degrees C in the normothermia group ( P < 0.001 ) Surgical-wound infections were found in 18 of 96 patients assigned to hypothermia ( 19 percent ) but in only 6 of 104 patients assigned to normothermia ( 6 percent , P = 0.009 ) . The sutures were removed one day later in the patients assigned to hypothermia than in those assigned to normothermia ( P = 0.002 ) , and the duration of hospitalization was prolonged by 2.6 days ( approximately 20 percent ) in hypothermia group ( P = 0.01 ) . CONCLUSIONS Hypothermia itself may delay healing and predispose patients to wound infections . Maintaining normothermia intraoperatively is likely to decrease the incidence of infectious complications in patients undergoing colorectal resection and to shorten their hospitalizations Background Postoperative ileus is common after surgery . One non-pharmacological intervention that has shown promising results in reducing the duration of postoperative ileus is chewing gum after surgery . However , this has not been investigated in upper gastrointestinal surgery such as pancreatic surgery . Hence the aim of this study was to investigate the effects of chewing gum treatment on patients undergoing pancreaticoduodenectomy ad modum whipple due to pancreatic or periampullary cancer . Methods This study was conducted as a phase III trial that was terminated early . Patients diagnosed with pancreatic tumours scheduled for pancreaticoduodenectomy ad modum whipple were included . The treatment group received chewing gum postoperatively and st and ard care . Controls received glucose solution and st and ard care . Chewing gum and glucose were used four times a day during the whole hospital stay . Time to first flatus and stool was defined as the primary outcome . The secondary outcome was start with clear liquids , start with liquid diet and length of hospital stay . Results No statistically significant differences could be observed between the chewing gum intervention group and the control group . However , a numerical difference in mean time was observed in first flatus , first stool , start of clear fluids , and start of liquid diet and length of hospital stay in favour of the intervention group . Conclusions Although this study did not find statistically significant differences favouring the use of chewing gum for postoperative ileus , a positive trend was observed of a reduction of the impact of postoperative ileus among patients after pancreatic surgery . It also contributes valuable method ological experience that is important for future studies of chewing gum interventions during recovery after pancreatic surgery . Trial registration Clinical Trials.gov identifier : NCT02319512 , publication date 2014 - 12 - 17 Summary Background Data : The epidemiology of venous thromboembolism ( VTE ) after cancer surgery is based on clinical trials on VTE prophylaxis that used venography to screen deep vein thrombosis ( DVT ) . However , the clinical relevance of asymptomatic venography-detected DVT is unclear , and the population of these clinical trials is not necessarily representative of the overall cancer surgery population . Objective : The aim of this study was to evaluate the incidence of clinical ly overt VTE in a wide spectrum of consecutive patients undergoing surgery for cancer and to identify risk factors for VTE . Methods : @RISTOS was a prospect i ve observational study in patients undergoing general , urologic , or gynecologic surgery . Patients were assessed for clinical ly overt VTE occurring up to 30 ± 5 days after surgery or more if the hospital stay was longer than 35 days . All outcome events were evaluated by an independent Adjudication Committee . Results : A total of 2373 patients were included in the study : 1238 ( 52 % ) undergoing general , 685 ( 29 % ) urologic , and 450 ( 19 % ) gynecologic surgery . In-hospital prophylaxis was given in 81.6 % and postdischarge prophylaxis in 30.7 % of the patients . Fifty patients ( 2.1 % ) were adjudicated as affected by clinical ly overt VTE ( DVT , 0.42 % ; nonfatal pulmonary embolism , 0.88 % ; death 0.80 % ) . The incidence of VTE was 2.83 % in general surgery , 2.0 % in gynecologic surgery , and 0.87 % in urologic surgery . Forty percent of the events occurred later than 21 days from surgery . The overall death rate was 1.72 % ; in 46.3 % of the cases , death was caused by VTE . In a multivariable analysis , 5 risk factors were identified : age above 60 years ( 2.63 , 95 % confidence interval , 1.21–5.71 ) , previous VTE ( 5.98 , 2.13–16.80 ) , advanced cancer ( 2.68 , 1.37–5.24 ) , anesthesia lasting more than 2 hours ( 4.50 , 1.06–19.04 ) , and bed rest longer than 3 days ( 4.37 , 2.45–7.78 ) . Conclusions : VTE remains a common complication of cancer surgery , with a remarkable proportion of events occurring late after surgery . In patients undergoing cancer surgery , VTE is the most common cause of death at 30 days after surgery Objective To evaluate the endpoints of complications ( specifically pancreatic fistula and total complications ) and death in patients undergoing pancreaticoduodenectomy . Summary Background Data Four r and omized , placebo-controlled , multicenter trials from Europe have evaluated prophylactic octreotide ( the long-acting synthetic analog of native somatostatin ) in patients undergoing pancreatic resection . Each trial reported significant decreases in overall complication rates , and two of the four reported significantly lowered rates of pancreatic fistula in patients receiving prophylactic octreotide . However , none of these four trials studied only pancreaticoduodenal resections , and all trials had high pancreatic fistula rates ( > 19 % ) in the placebo group . A fifth r and omized trial from the United States evaluated the use of prophylactic octreotide in patients undergoing pancreaticoduodenectomy and found no benefit to the use of octreotide . Prophylactic use of octreotide adds more than $ 75 to the daily hospital charge in the United States . In calendar year 1996 , 288 patients received octreotide on the surgical service at the authors ’ institution , for total billed charges of $ 74,652 . Methods Between February 1998 and February 2000 , 383 patients were recruited into this study on the basis of preoperative anticipation of pancreaticoduodenal resection . Patients who gave consent were r and omized to saline control versus octreotide 250 & mgr;g subcutaneously every 8 hours for 7 days , to start 1 to 2 hours before surgery . The primary postoperative endpoints were pancreatic fistula , total complications , death , and length of hospital stay . Results Two hundred eleven patients underwent pancreaticoduodenectomy with pancreatic-enteric anastomosis , received appropriate saline/octreotide doses , and were available for endpoint analysis . The two groups were comparable with respect to demographics ( 54 % male , median age 66 years ) , type of pancreaticoduodenal resection ( 60 % pylorus-preserving ) , type of pancreatic-enteric anastomosis ( 87 % end-to-side pancreaticojejunostomy ) , and pathologic diagnosis . The pancreatic fistula rates were 9 % in the control group and 11 % in the octreotide group . The overall complication rates were 34 % in the control group and 40 % in the octreotide group ; the in-hospital death rates were 0 % versus 1 % , respectively . The median postoperative length of hospital stay was 9 days in both groups . Conclusions These data demonstrate that the prophylactic use of perioperative octreotide does not reduce the incidence of pancreatic fistula or total complications after pancreaticoduodenectomy . Prophylactic  octreotide use in this setting should be eliminated , at a considerable cost savings Laparoscopic resection as an alternative to open pancreatoduodenectomy may yield short‐term benefits , but has not been investigated in a r and omized trial . The aim of this study was to compare laparoscopic and open pancreatoduodenectomy for short‐term outcomes in a r and omized trial Background : Forced-air warming is sometimes unable to maintain perioperative normothermia 
    Output:
    