Liver transplantation for colorectal liver metastases: What do we need to know?. (October 2020)

• Record Type: Journal Article
• Authors: Line, Pål-Dag; Ruffolo, Luis I.; Toso, Christian; Dueland, Svein; Nadalin, Silvio; Hernandez-Alejandro, Roberto
• Is Part Of: International journal of surgery. Volume 82(2020)Supplement
• Page Start: 87
• Page End: 92
• Publication Date: 2020-10
• Subjects: Liver transplantation -- Colorectal liver metastases -- SECA -- Selection criteria -- Review -- RAPID; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2020.03.079
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Adenocarcinoma of the colon and rectum (CRC) is the second leading cause of cancer mortality, driven by stage IV disease (Rahib et al., 2014) [1 ]. While surgical resection of liver metastases has demonstrated a survival advantage, a minority of patients are candidates for resection due to anatomic involvement of disease. Recent advances in liver surgery, chemotherapy, and decision making guided by stratification at the time of presentation has better equipped us to perform aggressive metastasectomies, with resulting improved survival (Fong et al., 1999; Abdalla et al., 2001; Cremolini et al., 2017) [2–4 ]. As a result, there is a resurgent interest in the concept of total hepatectomy and liver transplantation (LT) for colorectal liver metastases (CRLM). As of this writing, eight prospective clinical trials in six countries are assessing the viability of split or whole LT for CRLM. However, LT for CRLM remains controversial. Recent prospective trials have illustrated the importance of patient selection, and a disciplined respect for tumor biology. Here we present the current status of LT for CRLM, and suggest clinical decision criteria aimed at matching survival benefit comparable to other indications for LT. Highlights: Liver transplantation (LT) for patients with liver-only unresectable colorectal liver metastases (CRLM) has resurged in interest in the last two decades. Following LT, the recurrence pattern of highly selected patients appears to be favorable, and dissimilar from chemotherapy or primary surgical resection. Patients treated with LT for CRLM experience favorable survival compared to systemic therapy. Various selection criteria can be employed to improve expected survival in patients being offered LT for colorectal liver metastases with similar benefit as other accepted indications for LT. The level of evidence continues to build supporting LT for CRLM, and future trials in Europe, Norway, and North America are actively enrolling.