Liver transplantation for non-resectable colorectal liver metastasis: where we are and where we are going

Purpose Almost 50% of patients diagnosed with colorectal cancer (CRC) will develop liver metastasis (LM). Although their only long-term curative treatment is surgery, less than half of these patients can be eventually resected. Therefore, palliative chemotherapy is offered as a definitive option, th...

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Bibliographic Details
Published in:Langenbeck's archives of surgery 2020-05, Vol.405 (3), p.255-264
Main Authors: Glinka, Juan, Ardiles, Victoria, Pekolj, Juan, Mattera, Juan, Sanchez Clariá, Rodrigo, de Santibañes, Eduardo, de Santibañes, Martin
Format: Article
Language:English
Subjects:
Abdominal Surgery
Cardiac Surgery
Colorectal Neoplasms - mortality
Colorectal Neoplasms - pathology
Colorectal Neoplasms - therapy
General Surgery
Humans
Liver Neoplasms - mortality
Liver Neoplasms - secondary
Liver Neoplasms - surgery
Liver Transplantation
Medicine
Medicine & Public Health
Patient Selection
Review Article
Survival Rate
Thoracic Surgery
Traumatic Surgery
Vascular Surgery
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Summary:Purpose Almost 50% of patients diagnosed with colorectal cancer (CRC) will develop liver metastasis (LM). Although their only long-term curative treatment is surgery, less than half of these patients can be eventually resected. Therefore, palliative chemotherapy is offered as a definitive option, though with poor results. Recently, the University of Oslo group has published encouraging results in the treatment of these patients with liver transplantation (LT), whereby worldwide interest in this option has been renewed. Methods A literature review of LT for patients with unresectable colorectal metastasis was performed. This included information regarding patient selection, complications, overall survival (OS) and disease-free survival (DFS), immunosuppression, chemotherapy, and description of the ongoing trials. Results Improvements in OS and DFS have been observed in consecutive published prospective trials, as patient selection has been refined. Papers reporting OS of patients who randomly presented similar selection criteria also exhibited good results. Conclusion LT within the available therapeutic options in patients with CRC-LM seems to be a compelling alternative in carefully selected patients. The ongoing trials will provide valuable information regarding selection criteria, immunosuppressive therapy and different modalities of adjuvant chemotherapy, which are, to our knowledge, the vital platform of LT in CRC-LM. Although some of the developing techniques involve living donors, graft availability for these patients remains a matter of major concern.
ISSN:1435-2443
1435-2451
DOI:10.1007/s00423-020-01883-2