RESUMO
BACKGROUND: Malignancy of the liver has historically meant a poor prognosis and remains the second most common cause of cancer-related deaths globally. Traditionally, hepatectomy has utilized the clamp-crush technique; however, this is associated with high incidence of postoperative complications. Many novel techniques have been developed-radiofrequency ablation and transarterial chemoembolization; however, these are not applicable to numerous cases. Clamp-crush liver resection (CCLR) remains the gold standard. Radiofrequency-assisted liver resection (RFLR) is a technique that aims to reduce mortality through bloodless liver resection. A systematic review was previously performed on RFLR but the results neither recommended nor refuted the use of RFLR owing to the lack of sufficient evidence from well-designed randomized controlled trials (RCTs) at the time. OBJECTIVE: The aim of the study is the meta-analysis and systematic review of recent studies comparing RFLR against CCLR. METHODS: Articles comparing RFLR and CCLR that were published from 2014 until 2019 will be reviewed and relevant data will be extracted and statistically analyzed through Review Manager 5 (by the Cochrane Collaboration) together with the results of the previous meta-analysis. RESULTS: Data collection is currently underway, with papers being screened. We hope to publish the results by the end of 2019. CONCLUSIONS: Given the high mortality rates currently associated with liver resection, it is imperative that novel surgical techniques are undertaken and investigated so we can improve best practice guidance and outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13437.
RESUMO
PURPOSE: This study aimed to perform an economic evaluation of small bite sutures versus large bite sutures in the closure of midline laparotomies in the United Kingdom National Health Service (NHS). METHODS: A cost-utility analysis was conducted using data from a systematic literature review. Large bite sutures placed 10 mm from the wound edge were compared to small bite sutures 3-6 mm from the wound edge. The analysis used a 3-year time horizon in order to take into account complications including incisional hernias and surgical site infections (SSIs). Cost and benefit data were considered from the perspective of the NHS. A two-way sensitivity analysis was conducted to assess the impact of a variation in the clinical effectiveness of small bite sutures. RESULTS: The incremental cost-effectiveness ratio was calculated to be -£482.61 per quality-adjusted life year (QALY) using the proposed small bite suture technique, indicating a cost saving to the NHS. Sensitivity analysis demonstrated that small bites are a cost-neutral technique provided that the cost of using small bites is less than £98 per patient. Small bites cost less than £20,000/QALY when they reduce either the rate of SSIs by more than 15% or the rate of hernias by more than 3.4%. CONCLUSION: This study proposes that small bite sutures should become the mainstay suturing technique in the closure of midline laparotomies, replacing large bite sutures, which dominate current practice. The financial savings accompanied by the decrease in SSI rates and herniation warrant the use of this new technique. The sensitivity analysis demonstrates that findings hold true for a wide range of levels of clinical effectiveness for small bites.
