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: The frequency of postoperative infectious complications is significantly increased in patients with colorectal cancer receiving perioperative blood transfusion .  It is still debated , however , whether perioperative blood transfusion alters the incidence of disease recurrence or otherwise affects the prognosis BACKGROUND Liver resection is performed with increasing frequency . Nearly all of the published information on operative mortality and morbidity rates associated with liver resection is derived from studies that rely on retrospective data collection from single centers . The goal of this study is to use audited multiinstitutional data from the private sector of the Patient Safety in Surgery Study to characterize complications after liver resection and to identify variables that are associated with 30-day morbidity and mortality . STUDY DESIGN Prospect ively collected data on liver resection patients from 14 hospitals were collected using National Surgical Quality Improvement Program 's methodology . Rates of occurrence of 21 defined postoperative complications were measured . Bivariate analyses and stepwise logistic regression were used to identify factors associated with 30-day morbidity and mortality . RESULTS At least one complication occurred in 22.6 % of patients within 30 days . Stepwise logistic regression identified several preoperative factors associated with morbidity , including serum albumin , SGOT > 40 , previous cardiac operation , operative work relative value unit , and history of severe COPD . Mortality within 30 days was observed in 2.6 % of patients . Factors associated with mortality were found to be male gender , American Society of Anesthesiologists class 3 or higher , presence of ascites , dyspnea , and severe COPD . Only 0.7 % of patients without any complications died , compared with 9.0 % of patients with at least 1 complication ( p < 0.0001 ) . CONCLUSIONS Prospect i ve , st and ardized , audited , multiinstitutional data were analyzed to identify several preoperative and intraoperative factors associated with morbidity and mortality after liver resection . These factors should be considered during patient selection and perioperative management Background This study aim ed to investigate the impact of postoperative complications on long-term survival and disease recurrence in patients who underwent curative resection for colorectal cancer . Method Patients who underwent radical resection for colorectal cancer with curative intent from January 1996 to December 2004 were included .  Operative mortality and morbidity were documented prospect ively . Factors that might affect long-term outcome were analyzed with multivariate analysis . Results Curative resection was performed in 1657 patients ( 943 men ) , and the median age was 70 years ( range : 24–94 years ) . The 30-day mortality was 2.4 % , and the complication rate was 27.3 % . Age over 70 years ( P < .001 , odds ratio : 2.06 , 95 % CI : 1.63–2.61 ) , male gender ( P = .001 , odds ratio : 1.49 , 95 % CI : 1.19–1.88 ) , emergency operation ( P < .001 , odds ratio : 3.14 , 95 % CI : 2.26–4.35 ) and rectal cancer ( P < .001 , odds ratio : 1.41 , 95 % CI : 1.25–1.61 ) were associated with a significantly higher complication rate . With exclusion of patients who died within 30 days , the median follow-up of the surviving patients was 45.3 months . The 5-year overall survival was 64.9 % , and the overall recurrence rate was 29.1 % . The presence of postoperative complications was an independent factor associated with a worse overall survival ( P = .023 , hazard ratio : 1.26 ; 95 % CI : 1.03–1.52 ) and a higher overall recurrence rate ( P = .04 , hazard ratio : 1.26 ; 95 % CI : 1.01–1.57 ) . Conclusion The presence of postoperative complication not only affects the short-term results of resection of colorectal cancer , but the long-term oncologic outcomes are also adversely affected . Long-term outcomes can be improved with efforts to reduce postoperative complications Objective : The objective of this study was to identify the determinants of 30-day postoperative mortality and long-term survival after major surgery as exemplified by 8 common operations . Summary Background Data : The National Surgical Quality Improvement Program ( NSQIP ) data base contains pre- , intra- , and 30-day postoperative data , prospect ively collected in a st and ardized fashion by a dedicated nurse review er , on major surgery in the Veterans Administration ( VA ) . The Beneficiary Identification and Records Locator Subsystem ( BIRLS ) is a VA file that depicts the vital status of U.S. veterans with 87 % to 95 % accuracy . Methods : NSQIP data were merged with BIRLS to determine the vital status of 105,951 patients who underwent 8 types of operations performed between 1991 and 1999 , providing an average follow up of 8 years . Logistic and Cox regression analyses were performed to identify the predictors of 30-day mortality and long-term survival , respectively . Results : The most important determinant of decreased postoperative survival was the occurrence , within 30 days postoperatively , of any one of 22 types of complications collected in the NSQIP . Independent of preoperative patient risk , the occurrence of a 30-day complication in the total patient group reduced median patient survival by 69 % . The adverse effect of a complication on patient survival was also influenced by the operation type and was sustained even when patients who did not survive for 30 days were excluded from the analyses . Conclusions : The occurrence of a 30-day postoperative complication is more important than preoperative patient risk and intraoperative factors in determining the survival after major surgery in the VA . Quality and process improvement in surgery should be directed toward the prevention of postoperative complications Objective : To investigate the trend of the posthepatectomy survival outcomes of hepatocellular carcinoma ( HCC ) patients by analysis of a prospect i ve cohort of 1198 patients over a 20-year period . Background : The hospital mortality rate of hepatectomy for HCC has improved but the long-term survival rate remains unsatisfactory . We reported an improvement of survival results 10 years ago . It was not known whether there has been further improvement of results in recent years . Methods : The patients were categorized into two 10-year periods : period 1 , before 1999 ( group 1 , n = 390 ) and period 2 , after 1999 ( group 2 , n = 808 ) . Patients in group 2 were managed according to a modified protocol and technique established in previous years . Results : The patients in group 2 were older and had a higher incidence of comorbid illness and cirrhosis . They had a lower hospital mortality rate ( 3.1 % vs 6.2 % , P = 0.012 ) and longer 5-year overall survival ( 54.8 % vs 42.1 % , P < 0.001 ) and disease-free survival rates ( 34.8 % vs 24 % , P = 0.0024 ) . An improvement in the overall survival rate was observed in patients with cirrhosis , those undergoing major hepatectomy , and those with tumors of tumor-node-metastasis stages II , IIIA , and IVA . A significant increase in the survival rates was also seen in patients whose tumors were considered transplantable by the Milan criteria ( 72.5 % vs 62.7 % , P = 0.0237 ) . Multivariate analysis showed a significantly more favorable patient survival for hepatectomy in period 2 . Conclusions : A continuous improvement of survival outcomes after hepatectomy for HCC was achieved in the past 20 years even in patients with advanced diseases .  Hepatectomy remains the treatment of choice for resectable HCC in a predominantly hepatitis B virus-based Asian population 
    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: The frequency of postoperative infectious complications is significantly increased in patients with colorectal cancer receiving perioperative blood transfusion .  It is still debated , however , whether perioperative blood transfusion alters the incidence of disease recurrence or otherwise affects the prognosis BACKGROUND Liver resection is performed with increasing frequency . Nearly all of the published information on operative mortality and morbidity rates associated with liver resection is derived from studies that rely on retrospective data collection from single centers . The goal of this study is to use audited multiinstitutional data from the private sector of the Patient Safety in Surgery Study to characterize complications after liver resection and to identify variables that are associated with 30-day morbidity and mortality . STUDY DESIGN Prospect ively collected data on liver resection patients from 14 hospitals were collected using National Surgical Quality Improvement Program 's methodology . Rates of occurrence of 21 defined postoperative complications were measured . Bivariate analyses and stepwise logistic regression were used to identify factors associated with 30-day morbidity and mortality . RESULTS At least one complication occurred in 22.6 % of patients within 30 days . Stepwise logistic regression identified several preoperative factors associated with morbidity , including serum albumin , SGOT > 40 , previous cardiac operation , operative work relative value unit , and history of severe COPD . Mortality within 30 days was observed in 2.6 % of patients . Factors associated with mortality were found to be male gender , American Society of Anesthesiologists class 3 or higher , presence of ascites , dyspnea , and severe COPD . Only 0.7 % of patients without any complications died , compared with 9.0 % of patients with at least 1 complication ( p < 0.0001 ) . CONCLUSIONS Prospect i ve , st and ardized , audited , multiinstitutional data were analyzed to identify several preoperative and intraoperative factors associated with morbidity and mortality after liver resection . These factors should be considered during patient selection and perioperative management Background This study aim ed to investigate the impact of postoperative complications on long-term survival and disease recurrence in patients who underwent curative resection for colorectal cancer . Method Patients who underwent radical resection for colorectal cancer with curative intent from January 1996 to December 2004 were included .  Operative mortality and morbidity were documented prospect ively . Factors that might affect long-term outcome were analyzed with multivariate analysis . Results Curative resection was performed in 1657 patients ( 943 men ) , and the median age was 70 years ( range : 24–94 years ) . The 30-day mortality was 2.4 % , and the complication rate was 27.3 % . Age over 70 years ( P < .001 , odds ratio : 2.06 , 95 % CI : 1.63–2.61 ) , male gender ( P = .001 , odds ratio : 1.49 , 95 % CI : 1.19–1.88 ) , emergency operation ( P < .001 , odds ratio : 3.14 , 95 % CI : 2.26–4.35 ) and rectal cancer ( P < .001 , odds ratio : 1.41 , 95 % CI : 1.25–1.61 ) were associated with a significantly higher complication rate . With exclusion of patients who died within 30 days , the median follow-up of the surviving patients was 45.3 months . The 5-year overall survival was 64.9 % , and the overall recurrence rate was 29.1 % . The presence of postoperative complications was an independent factor associated with a worse overall survival ( P = .023 , hazard ratio : 1.26 ; 95 % CI : 1.03–1.52 ) and a higher overall recurrence rate ( P = .04 , hazard ratio : 1.26 ; 95 % CI : 1.01–1.57 ) . Conclusion The presence of postoperative complication not only affects the short-term results of resection of colorectal cancer , but the long-term oncologic outcomes are also adversely affected . Long-term outcomes can be improved with efforts to reduce postoperative complications Objective : The objective of this study was to identify the determinants of 30-day postoperative mortality and long-term survival after major surgery as exemplified by 8 common operations . Summary Background Data : The National Surgical Quality Improvement Program ( NSQIP ) data base contains pre- , intra- , and 30-day postoperative data , prospect ively collected in a st and ardized fashion by a dedicated nurse review er , on major surgery in the Veterans Administration ( VA ) . The Beneficiary Identification and Records Locator Subsystem ( BIRLS ) is a VA file that depicts the vital status of U.S. veterans with 87 % to 95 % accuracy . Methods : NSQIP data were merged with BIRLS to determine the vital status of 105,951 patients who underwent 8 types of operations performed between 1991 and 1999 , providing an average follow up of 8 years . Logistic and Cox regression analyses were performed to identify the predictors of 30-day mortality and long-term survival , respectively . Results : The most important determinant of decreased postoperative survival was the occurrence , within 30 days postoperatively , of any one of 22 types of complications collected in the NSQIP . Independent of preoperative patient risk , the occurrence of a 30-day complication in the total patient group reduced median patient survival by 69 % . The adverse effect of a complication on patient survival was also influenced by the operation type and was sustained even when patients who did not survive for 30 days were excluded from the analyses . Conclusions : The occurrence of a 30-day postoperative complication is more important than preoperative patient risk and intraoperative factors in determining the survival after major surgery in the VA . Quality and process improvement in surgery should be directed toward the prevention of postoperative complications Objective : To investigate the trend of the posthepatectomy survival outcomes of hepatocellular carcinoma ( HCC ) patients by analysis of a prospect i ve cohort of 1198 patients over a 20-year period . Background : The hospital mortality rate of hepatectomy for HCC has improved but the long-term survival rate remains unsatisfactory . We reported an improvement of survival results 10 years ago . It was not known whether there has been further improvement of results in recent years . Methods : The patients were categorized into two 10-year periods : period 1 , before 1999 ( group 1 , n = 390 ) and period 2 , after 1999 ( group 2 , n = 808 ) . Patients in group 2 were managed according to a modified protocol and technique established in previous years . Results : The patients in group 2 were older and had a higher incidence of comorbid illness and cirrhosis . They had a lower hospital mortality rate ( 3.1 % vs 6.2 % , P = 0.012 ) and longer 5-year overall survival ( 54.8 % vs 42.1 % , P < 0.001 ) and disease-free survival rates ( 34.8 % vs 24 % , P = 0.0024 ) . An improvement in the overall survival rate was observed in patients with cirrhosis , those undergoing major hepatectomy , and those with tumors of tumor-node-metastasis stages II , IIIA , and IVA . A significant increase in the survival rates was also seen in patients whose tumors were considered transplantable by the Milan criteria ( 72.5 % vs 62.7 % , P = 0.0237 ) . Multivariate analysis showed a significantly more favorable patient survival for hepatectomy in period 2 . Conclusions : A continuous improvement of survival outcomes after hepatectomy for HCC was achieved in the past 20 years even in patients with advanced diseases .  Hepatectomy remains the treatment of choice for resectable HCC in a predominantly hepatitis B virus-based Asian population 
    Output:
    