Laparoscopic versus open liver segmentectomy: prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness

Polignano, Francesco M.; Quyn, Aaron; Figueiredo, Rodrigo; Henderson, Nikola; Kulli, Christoph; Tait, Iain S.

doi:10.1007/s00464-008-0110-y

Cited by 151 publications

(117 citation statements)

References 35 publications

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“…Although liver resection specific complications were reported in similar rate with open surgery, rate of liver decompensation among cirrhotic patients has a trend to decrease at application of laparoscopic approach (63,71,76). General morbidity -cardiopulmonary complications, abscesses and wound complications have a tendency to reduce in application of laparoscopic approach (59,63,64,68,71,77). Rate of incisional hernias after LHR is appreciably lower then after the open counterpart (24,72).…”

Section: Mortality Postoperative Morbiditymentioning

confidence: 98%

Laparoscopic Liver Surgery: New Frontiers

2011

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Section: Mortality Postoperative Morbiditymentioning

confidence: 98%

Laparoscopic Liver Surgery: New Frontiers

2011

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“…However, less severe complications such as postoperative ascites, wound infection, and pneumonia remain common. Recently, laparoscopic liver resection has become popular, especially for minor resections or resection of the left lateral segment, and may reduce morbidity of liver resection [256]. However, thus far, no randomized trial comparing open and laparoscopic liver resection has been reported.…”

Section: Liver Resectionmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

et al. 2010

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Introduction The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. Methods The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. 123Hepatol Int (2010) 4: 439-474 DOI 10.1007/s12072-010-9165-7 Results Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.

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“…We were not able to identify appropriate HRGs in the NHS reference costs for laparoscopic liver resection, but we identified a cost study reported by Polignano et al 173 in which the costs of elective laparoscopic and open liver segmentectomy, performed with an intention to treat the disease, were compared (Table 114) The two groups were homogeneous by age, sex, coexistent morbidity and magnitude of resection. Hospital costs were obtained from the Scottish Health Service Costs (ISD Scotland) and average costs were calculated.…”

Section: Independent Economic Assessmentmentioning

confidence: 99%

The clinical effectiveness and cost-effectiveness of cetuximab (review of technology appraisal no. 176) and panitumumab (partial review of technology appraisal no. 240) for previously untreated metastatic colorectal cancer: a systematic review and economic evaluation

Huxley

Crathorne

Varley-Campbell

et al. 2017

Health Technol Assess

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BackgroundColorectal cancer is the fourth most commonly diagnosed cancer in the UK after breast, lung and prostate cancer. People with metastatic disease who are sufficiently fit are usually treated with active chemotherapy as first- or second-line therapy. Targeted agents are available, including the antiepidermal growth factor receptor (EGFR) agents cetuximab (Erbitux®, Merck Serono UK Ltd, Feltham, UK) and panitumumab (Vecitibix®, Amgen UK Ltd, Cambridge, UK).ObjectiveTo investigate the clinical effectiveness and cost-effectiveness of panitumumab in combination with chemotherapy and cetuximab in combination with chemotherapy for rat sarcoma (RAS) wild-type (WT) patients for the first-line treatment of metastatic colorectal cancer.Data sourcesThe assessment included a systematic review of clinical effectiveness and cost-effectiveness studies, a review and critique of manufacturer submissions, and a de novo cohort-based economic analysis. For the assessment of effectiveness, a literature search was conducted up to 27 April 2015 in a range of electronic databases, including MEDLINE, EMBASE and The Cochrane Library.Review methodsStudies were included if they were randomised controlled trials (RCTs) or systematic reviews of RCTs of cetuximab or panitumumab in participants with previously untreated metastatic colorectal cancer withRASWT status. All steps in the review were performed by one reviewer and checked independently by a second. Narrative synthesis and network meta-analyses (NMAs) were conducted for outcomes of interest. An economic model was developed focusing on first-line treatment and using a 30-year time horizon to capture costs and benefits. Costs and benefits were discounted at 3.5% per annum. Scenario analyses and probabilistic and univariate deterministic sensitivity analyses were performed.ResultsThe searches identified 2811 titles and abstracts, of which five clinical trials were included. Additional data from these trials were provided by the manufacturers. No data were available for panitumumab plus irinotecan-based chemotherapy (folinic acid + 5-fluorouracil + irinotecan) (FOLFIRI) in previously untreated patients. Studies reported results forRASWT subgroups. First-line treatment with anti-EGFR therapies in combination with chemotherapy appeared to have statistically significant benefits for patients who areRASWT. For the independent economic evaluation, the base-case incremental cost-effectiveness ratio (ICER) forRASWT patients for cetuximab plus oxaliplatin-based chemotherapy (folinic acid + 5-fluorouracil + oxaliplatin) (FOLFOX) compared with FOLFOX was £104,205 per quality-adjusted life-year (QALY) gained; for panitumumab plus FOLFOX compared with FOLFOX was £204,103 per QALY gained; and for cetuximab plus FOLFIRI compared with FOLFIRI was £122,554 per QALY gained. The ICERs were sensitive to treatment duration, progression-free survival, overall survival (resected patients only) and resection rates.LimitationsThe trials includedRASWT populations only as subgroups. No evidence was available for panitumumab plus FOLFIRI. Two networks were used for the NMA and model, based on the different chemotherapies (FOLFOX and FOLFIRI), as insufficient evidence was available to the assessment group to connect these networks.ConclusionsAlthough cetuximab and panitumumab in combination with chemotherapy appear to be clinically beneficial forRASWT patients compared with chemotherapy alone, they are likely to represent poor value for money when judged by cost-effectiveness criteria currently used in the UK. It would be useful to conduct a RCT in patients withRASWT.Study registrationThis study is registered as PROSPERO CRD42015016111.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Laparoscopic versus open liver segmentectomy: prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness

Abstract: Laparoscopic liver segmentectomy and bisegmentectomy are feasible, safe and cost effective compared to similar open resections. Large-scale application of laparoscopic liver surgery could translate into significant savings to hospitals and health care programmes.

Cited by 151 publications

References 35 publications

Laparoscopic Liver Surgery: New Frontiers

Laparoscopic Liver Surgery: New Frontiers

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

The clinical effectiveness and cost-effectiveness of cetuximab (review of technology appraisal no. 176) and panitumumab (partial review of technology appraisal no. 240) for previously untreated metastatic colorectal cancer: a systematic review and economic evaluation

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