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: Purpose Laparoscopy-assisted colectomy ( LAC ) has gained acceptance for the treatment of colorectal cancer . However , conventional palpation of the liver and adequate observation of the abdominal cavity are not achievable during LAC . The aim of this study was to assess the clinical value of using Sonazoid ( contrast enhanced)-intraoperative laparoscopic ultrasonography ( S-IOLUS ) in patients with primary colorectal cancer . Methods From May 2005 to August 2008 , 454 patients underwent 339 LACs and 115 open colectomies for colorectal cancer . One hundred forty-eight patients with clinical stage II or III colorectal cancer , as determined by preoperative imaging , who were undergoing LACs were prospect ively enrolled . Results Although IOLUS did not detect any lesions , small hypoechoic lesions were detected by the S-IOLUS ( n = 71 ) in the Kupffer-phase view of two patients ( 2.8 % ) . None of the 71 patients who underwent S-IOLUS showed liver metastases within 6 months after LAC . In the conventional IOLUS group ( n = 77 ) , metastatic lesions were identified in two patients ( 2.6 % ) . The new liver metastases in these two patients were detected within 6 months after LAC . Conclusions S-IOLUS of the liver during colorectal cancer surgery is useful for staging and as a diagnostic modality . It can identify lesions that are undetectable by preoperative imaging , and may be considered for routine use during LAC Background Advanced colorectal cancer ( CRC ) , either locally advanced , metastasized ( mCRC ) or both , is present in a relevant proportion of patients . The chances on curation of advanced CRC are continuously improving with modern multi-modality treatment options . For incurable CRC the focus lies on palliation of symptoms , which is not necessarily a resection of the primary tumor . Both situations motivate adequate staging before treatment in CRC . This prospect i ve observational study evaluates the outcomes after the introduction of routine staging with abdominal CT before treatment . Methods In a prospect i ve observational study of 612 consecutive patients ( 2007 - 2009 ) , the ability of abdominal CT to find liver metastases ( LM ) , peritoneal carcinomatosis ( PC ) and T4 stage in colon cancer ( CC ) was analysed . Results Advanced CRC was present in 58 % of patients , mCRC in 31 % . The ability to find LM was excellent ( 99 % ) , cT4 stage CC good ( 86 % ) and PC poor ( 33 % ) . In the group of surgical patients with emergency presentations , the incidences of both mCRC ( 51 % ) and locally advanced colon cancer ( LACC ) ( 69 % ) were higher than in the elective group ( 20 % and 26 % respectively ) . Staging tended to be omitted more often in the emergency group ( 35 % versus 12 % in elective surgery ) . Conclusions The strengths of staging with abdominal CT are to find LM and LACC , however it fails in diagnosing PC . On grounds of the incidence of advanced CRC , staging is warranted in patients with emergency presentations as well Abstract Background : Laparoscopic resection of colorectal carcinoma is now a well-established surgical technique with oncology treatment outcome similar to open surgery , yet performing better in some short-term variables . The technique , however , does not allow palpation of intra-abdominal organs and the liver in particular . This prospect i ve study aims to assess the performance of laparoscopic intra-operative ulrasonography of the liver ( L-IOUS ) and compare its findings with pre-operative staging data . Methods : In total 70 patients , 53 men and 17 women , who were recruited into the study , were indicated for primary laparoscopic resection for colorectal carcinoma , with  laparoscopic intra-operative ulrasonographic examination of the liver ( L-IOUS )  being used during the initial part of the operation . Before surgery , all patients underwent abdominal and pelvic contrast CT examinations . Ultrasonographic examination of the liver was included . Results : In 14 patients L-IOUS detected a synchronous metastatic lesion of the liver as opposed to only six patients with pre-operative CT-positive findings . Furthermore , CT-positive metastases in three patients were not confirmed by L-IOUS . Several patients were diagnosed with benign lesions not disclosed during pre-operative assessment , e.g. haemangioma in 5 vs 2 patients , focal nodular hyperplasia in 3 vs 1 patient and liver cysts in 7 vs 5 patients . Conclusion : Results of the presented prospect i ve study substantiate the use of laparoscopic intra-operative ultrasound of the liver ( L-IOUS ) within the st and ard staging protocol , as this seems to appropriately supplement the results of the pre-operative staging . In cases of colorectal carcinoma the method allows highly sensitive detection of occult synchronous liver metastases that could finally alter a therapeutic strategy Objective The authors describe the technique of staging laparoscopy with laparoscopic contact ultrasonography in the preoperative assessment of patients with liver tumors , and assess its impact on the selection of patients for hepatic resection with curative intent . Summary Background Data Laparoscopy may be useful in the selection of patients with a variety of intra-abdominal malignancies for operative intervention . Laparoscopic ultrasonography is a new technique that combines the principles of high resolution intraoperative contact ultrasound with those of the laparoscopic examination , and thus , allows the laparoscopist to perform detailed assessment of the liver . Methods This study analyzes a cohort of 50 consecutive patients who were diagnosed as having potentially resectable liver tumors , and in whom staging laparoscopy was successfully undertaken .  Laparoscopic ultrasonography was performed in 43 patients , and the impact of the ensuing findings on the decision to proceed to operative assessment of resectability is examined . The resectability rate in those patients assessed laparoscopically and subsequently su bmi tted to laparotomy is compared with a preceding group of patients in whom no laparoscopic assessment was performed . Results Laparoscopy demonstrated factors precluding curative resection in 23 patients ( 46 % ) . Laparoscopic ultrasonography identified liver tumors not visible during laparoscopy in 14 patients ( 33 % ) , and provided staging information in addition to that derived from laparoscopy alone in 18/43 patients ( 42 % ) . The resectability rate was significantly higher among those patients undergoing laparoscopic staging ( 93 % ) compared with those in whom operative assessment was undertaken without laparoscopy ( 58 % ) . Conclusions Staging laparoscopy with laparoscopic ultrasonography optimizes patient selection for liver resection with curative intent Abstract Background :  Laparoscopic colectomy  has developed rapidly with the explosion of technology . In most cases , laparoscopic resection is performed for colorectal cancer . Intraoperative staging during laparoscopic procedure is limited . Laparoscopic ultrasonography ( LUS ) represents the only real alternative to manual palpation during laparoscopic surgery . Methods : We evaluated the diagnostic accuracy of LUS in comparison with preoperative staging and laparoscopy in 33 patients with colorectal cancer . Preoperative staging included abdominal US , CT , and endoscopic US ( for rectal cancer ) . Laparoscopy and LUS were performed in all cases . Pre- and intraoperative staging were related to definitive histology . Staging was done according to the TNM classification . Results : LUS obtained good results in the evaluation of hepatic metastases , with a sensitivity of 100 % versus 62.5 % and 75 % by preoperative diagnostic means and laparoscopy , respectively . Nodal metastases were diagnosed with a sensitivity of 94 % versus 18 % with preoperative staging and 6 % with laparoscopy , but the method had a low specificity ( 53 % ) . The therapeutic program was changed thanks to laparoscopy and LUS in 11 cases ( 33 % ) . In four cases ( 12 % ) , the planned therapeutic approach was changed after LUS alone . Conclusions : The results obtained in this study demonstrate that LUS is an accurate and highly sensitive procedure in staging colorectal cancer , providing a useful and reliable diagnostic tool complementary to laparoscopy This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence PURPOSE : This study was undertaken to evaluate the feasibility of intraoperative laparoscopic ultrasonography ( ILUS ) to completely scan all anatomic segments of the liver through a single port site during laparoscopic resection for colorectal cancer . METHODS : ILUS was performed in patients who were undergoing laparoscopic colorectal cancer surgery using the following approach : 1 ) presence of a radiologist in the operating room ;  2 ) introduction of the probe through a single cannula site ; 3 ) st and ardized sequence of four probe positions on liver surface ; 4 ) identification of all major vascular/biliary hepatic structures as a guideline to scan all parenchymal segments of the liver . RESULTS : Twenty-two patients who were undergoing laparoscopic colorectal cancer surgery were prospect ively enrolled .  Computed tomography ( CT ) scan films were available for an immediate comparative analysis in the first 12 cases . Mean duration of the procedure was 10 ( range , 5–15 ) minutes . All major vascular and biliary structures were identified in all patients . Sixteen focal abnormalities were identified by ILUS , and ten focal abnormalities were identified by CT scan in the same seven patients . In one patient , detection of a suspected metastasis not seen by preoperative CT scan led to conversion of the surgical procedure to a laparotomy . CONCLUSIONS : ILUS is a safe and expeditious technique that permits scanning of all anatomic liver parenchyma segments through a single cannula site . Because intraoperative palpation of the liver is not possible during laparoscopic colorectal cancer surgery , ILUS should probably be a st and ard component of the curative laparoscopic colorectal cancer operation PURPOSE : To prospect ively and blindly compare intraoperative laparoscopic ultrasonography to preoperative contrast-enhanced computerized tomography in detecting liver lesions in colorectal cancer patients . Additionally , we compared conventional ( open ) intraoperative ultrasonography with bimanual liver palpation to contrast-enhanced computerized tomography in a subset of patients . METHODS : From December 1995 to March 1998 , 77 consecutive patients underwent curative ( n=63 ) or palliative ( n=14 ) resections for colorectal cancer . All patients undergoing curative resections were r and omized to either laparoscopic ( n=34 ) or conventional ( n=29 ) surgery after informed consent . All patients underwent contrast-enhanced computerized tomography , diagnostic laparoscopy , and laparoscopic ultrasonography before resection . In those patients who had conventional procedures , intraoperative ultrasonography with bimanual liver palpation was also done . All laparoscopic ultrasonography and intraoperative ultrasonography evaluations were performed by one of two radiologists who were blinded to the CT results . All hepatic segments were scanned using a st and ardized method . The yield of each modality was calculated using the number of lesions identified by each imaging modality divided by the total number of lesions identified . RESULTS : In 43 of the 77 patients , both the laparoscopic ultrasonography and CT scan were negative for any liver lesions . In 34 patients , a total of 130 lesions were detected by laparoscopic ultrasonography , CT , or both . When compared with laparoscopic ultrasonography , intraoperative ultrasonography with bimanual liver palpation identified one additional metastatic lesion and no additional benign lesions .  laparoscopic ultrasonography identified two patients with mets who had negative preoperative contrast-enhanced computerized tomography . CONCLUSIONS : Laparoscopic ultrasonography of the liver at the time of primary resection of colorectal cancer yields more lesions than preoperative contrast-enhanced computerized tomography and should be considered for routine use during laparoscopic oncologic colorectal surgery 
    Output:
    
agent
***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: Purpose Laparoscopy-assisted colectomy ( LAC ) has gained acceptance for the treatment of colorectal cancer . However , conventional palpation of the liver and adequate observation of the abdominal cavity are not achievable during LAC . The aim of this study was to assess the clinical value of using Sonazoid ( contrast enhanced)-intraoperative laparoscopic ultrasonography ( S-IOLUS ) in patients with primary colorectal cancer . Methods From May 2005 to August 2008 , 454 patients underwent 339 LACs and 115 open colectomies for colorectal cancer . One hundred forty-eight patients with clinical stage II or III colorectal cancer , as determined by preoperative imaging , who were undergoing LACs were prospect ively enrolled . Results Although IOLUS did not detect any lesions , small hypoechoic lesions were detected by the S-IOLUS ( n = 71 ) in the Kupffer-phase view of two patients ( 2.8 % ) . None of the 71 patients who underwent S-IOLUS showed liver metastases within 6 months after LAC . In the conventional IOLUS group ( n = 77 ) , metastatic lesions were identified in two patients ( 2.6 % ) . The new liver metastases in these two patients were detected within 6 months after LAC . Conclusions S-IOLUS of the liver during colorectal cancer surgery is useful for staging and as a diagnostic modality . It can identify lesions that are undetectable by preoperative imaging , and may be considered for routine use during LAC Background Advanced colorectal cancer ( CRC ) , either locally advanced , metastasized ( mCRC ) or both , is present in a relevant proportion of patients . The chances on curation of advanced CRC are continuously improving with modern multi-modality treatment options . For incurable CRC the focus lies on palliation of symptoms , which is not necessarily a resection of the primary tumor . Both situations motivate adequate staging before treatment in CRC . This prospect i ve observational study evaluates the outcomes after the introduction of routine staging with abdominal CT before treatment . Methods In a prospect i ve observational study of 612 consecutive patients ( 2007 - 2009 ) , the ability of abdominal CT to find liver metastases ( LM ) , peritoneal carcinomatosis ( PC ) and T4 stage in colon cancer ( CC ) was analysed . Results Advanced CRC was present in 58 % of patients , mCRC in 31 % . The ability to find LM was excellent ( 99 % ) , cT4 stage CC good ( 86 % ) and PC poor ( 33 % ) . In the group of surgical patients with emergency presentations , the incidences of both mCRC ( 51 % ) and locally advanced colon cancer ( LACC ) ( 69 % ) were higher than in the elective group ( 20 % and 26 % respectively ) . Staging tended to be omitted more often in the emergency group ( 35 % versus 12 % in elective surgery ) . Conclusions The strengths of staging with abdominal CT are to find LM and LACC , however it fails in diagnosing PC . On grounds of the incidence of advanced CRC , staging is warranted in patients with emergency presentations as well Abstract Background : Laparoscopic resection of colorectal carcinoma is now a well-established surgical technique with oncology treatment outcome similar to open surgery , yet performing better in some short-term variables . The technique , however , does not allow palpation of intra-abdominal organs and the liver in particular . This prospect i ve study aims to assess the performance of laparoscopic intra-operative ulrasonography of the liver ( L-IOUS ) and compare its findings with pre-operative staging data . Methods : In total 70 patients , 53 men and 17 women , who were recruited into the study , were indicated for primary laparoscopic resection for colorectal carcinoma , with  laparoscopic intra-operative ulrasonographic examination of the liver ( L-IOUS )  being used during the initial part of the operation . Before surgery , all patients underwent abdominal and pelvic contrast CT examinations . Ultrasonographic examination of the liver was included . Results : In 14 patients L-IOUS detected a synchronous metastatic lesion of the liver as opposed to only six patients with pre-operative CT-positive findings . Furthermore , CT-positive metastases in three patients were not confirmed by L-IOUS . Several patients were diagnosed with benign lesions not disclosed during pre-operative assessment , e.g. haemangioma in 5 vs 2 patients , focal nodular hyperplasia in 3 vs 1 patient and liver cysts in 7 vs 5 patients . Conclusion : Results of the presented prospect i ve study substantiate the use of laparoscopic intra-operative ultrasound of the liver ( L-IOUS ) within the st and ard staging protocol , as this seems to appropriately supplement the results of the pre-operative staging . In cases of colorectal carcinoma the method allows highly sensitive detection of occult synchronous liver metastases that could finally alter a therapeutic strategy Objective The authors describe the technique of staging laparoscopy with laparoscopic contact ultrasonography in the preoperative assessment of patients with liver tumors , and assess its impact on the selection of patients for hepatic resection with curative intent . Summary Background Data Laparoscopy may be useful in the selection of patients with a variety of intra-abdominal malignancies for operative intervention . Laparoscopic ultrasonography is a new technique that combines the principles of high resolution intraoperative contact ultrasound with those of the laparoscopic examination , and thus , allows the laparoscopist to perform detailed assessment of the liver . Methods This study analyzes a cohort of 50 consecutive patients who were diagnosed as having potentially resectable liver tumors , and in whom staging laparoscopy was successfully undertaken .  Laparoscopic ultrasonography was performed in 43 patients , and the impact of the ensuing findings on the decision to proceed to operative assessment of resectability is examined . The resectability rate in those patients assessed laparoscopically and subsequently su bmi tted to laparotomy is compared with a preceding group of patients in whom no laparoscopic assessment was performed . Results Laparoscopy demonstrated factors precluding curative resection in 23 patients ( 46 % ) . Laparoscopic ultrasonography identified liver tumors not visible during laparoscopy in 14 patients ( 33 % ) , and provided staging information in addition to that derived from laparoscopy alone in 18/43 patients ( 42 % ) . The resectability rate was significantly higher among those patients undergoing laparoscopic staging ( 93 % ) compared with those in whom operative assessment was undertaken without laparoscopy ( 58 % ) . Conclusions Staging laparoscopy with laparoscopic ultrasonography optimizes patient selection for liver resection with curative intent Abstract Background :  Laparoscopic colectomy  has developed rapidly with the explosion of technology . In most cases , laparoscopic resection is performed for colorectal cancer . Intraoperative staging during laparoscopic procedure is limited . Laparoscopic ultrasonography ( LUS ) represents the only real alternative to manual palpation during laparoscopic surgery . Methods : We evaluated the diagnostic accuracy of LUS in comparison with preoperative staging and laparoscopy in 33 patients with colorectal cancer . Preoperative staging included abdominal US , CT , and endoscopic US ( for rectal cancer ) . Laparoscopy and LUS were performed in all cases . Pre- and intraoperative staging were related to definitive histology . Staging was done according to the TNM classification . Results : LUS obtained good results in the evaluation of hepatic metastases , with a sensitivity of 100 % versus 62.5 % and 75 % by preoperative diagnostic means and laparoscopy , respectively . Nodal metastases were diagnosed with a sensitivity of 94 % versus 18 % with preoperative staging and 6 % with laparoscopy , but the method had a low specificity ( 53 % ) . The therapeutic program was changed thanks to laparoscopy and LUS in 11 cases ( 33 % ) . In four cases ( 12 % ) , the planned therapeutic approach was changed after LUS alone . Conclusions : The results obtained in this study demonstrate that LUS is an accurate and highly sensitive procedure in staging colorectal cancer , providing a useful and reliable diagnostic tool complementary to laparoscopy This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence PURPOSE : This study was undertaken to evaluate the feasibility of intraoperative laparoscopic ultrasonography ( ILUS ) to completely scan all anatomic segments of the liver through a single port site during laparoscopic resection for colorectal cancer . METHODS : ILUS was performed in patients who were undergoing laparoscopic colorectal cancer surgery using the following approach : 1 ) presence of a radiologist in the operating room ;  2 ) introduction of the probe through a single cannula site ; 3 ) st and ardized sequence of four probe positions on liver surface ; 4 ) identification of all major vascular/biliary hepatic structures as a guideline to scan all parenchymal segments of the liver . RESULTS : Twenty-two patients who were undergoing laparoscopic colorectal cancer surgery were prospect ively enrolled .  Computed tomography ( CT ) scan films were available for an immediate comparative analysis in the first 12 cases . Mean duration of the procedure was 10 ( range , 5–15 ) minutes . All major vascular and biliary structures were identified in all patients . Sixteen focal abnormalities were identified by ILUS , and ten focal abnormalities were identified by CT scan in the same seven patients . In one patient , detection of a suspected metastasis not seen by preoperative CT scan led to conversion of the surgical procedure to a laparotomy . CONCLUSIONS : ILUS is a safe and expeditious technique that permits scanning of all anatomic liver parenchyma segments through a single cannula site . Because intraoperative palpation of the liver is not possible during laparoscopic colorectal cancer surgery , ILUS should probably be a st and ard component of the curative laparoscopic colorectal cancer operation PURPOSE : To prospect ively and blindly compare intraoperative laparoscopic ultrasonography to preoperative contrast-enhanced computerized tomography in detecting liver lesions in colorectal cancer patients . Additionally , we compared conventional ( open ) intraoperative ultrasonography with bimanual liver palpation to contrast-enhanced computerized tomography in a subset of patients . METHODS : From December 1995 to March 1998 , 77 consecutive patients underwent curative ( n=63 ) or palliative ( n=14 ) resections for colorectal cancer . All patients undergoing curative resections were r and omized to either laparoscopic ( n=34 ) or conventional ( n=29 ) surgery after informed consent . All patients underwent contrast-enhanced computerized tomography , diagnostic laparoscopy , and laparoscopic ultrasonography before resection . In those patients who had conventional procedures , intraoperative ultrasonography with bimanual liver palpation was also done . All laparoscopic ultrasonography and intraoperative ultrasonography evaluations were performed by one of two radiologists who were blinded to the CT results . All hepatic segments were scanned using a st and ardized method . The yield of each modality was calculated using the number of lesions identified by each imaging modality divided by the total number of lesions identified . RESULTS : In 43 of the 77 patients , both the laparoscopic ultrasonography and CT scan were negative for any liver lesions . In 34 patients , a total of 130 lesions were detected by laparoscopic ultrasonography , CT , or both . When compared with laparoscopic ultrasonography , intraoperative ultrasonography with bimanual liver palpation identified one additional metastatic lesion and no additional benign lesions .  laparoscopic ultrasonography identified two patients with mets who had negative preoperative contrast-enhanced computerized tomography . CONCLUSIONS : Laparoscopic ultrasonography of the liver at the time of primary resection of colorectal cancer yields more lesions than preoperative contrast-enhanced computerized tomography and should be considered for routine use during laparoscopic oncologic colorectal surgery 
    Output:
    