Liver Transplantation for Hepatic Metastases from Colorectal Cancer: Current Knowledge and Open Issues

Abstract

More than 40% of patients with colorectal cancer present liver metastases (CRLM) during the course of their disease and up to 50% present with unresectable disease. Without surgical interventions, survival for patients treated with systemic therapies alone is dismal. In the past, liver transplantation (LT) for patients with unresectable CRLM failed to show any survival benefit due to poor selection, ineffective chemotherapeutic regimens, unbalanced immunosuppression and high perioperative mortality. Since then and for many years LT for CRLM was abandoned. The turning point occurred in 2013, when the results from the Secondary Cancer (SECA I) pilot study performed at Oslo University were published reporting a 60% 5-year overall survival after LT in patients with unresectable CRLM. These results effectively reignited the interest in LT as a potential therapy for CRLM, and several trials are undergoing. The aims of this article are to give a comprehensive overview of the available evidence on LT for CRLM, discuss the open issues in this rapidly evolving field, and highlight possible ways to address the future of this fascinating therapeutic alternative for selected patients with CRLM.

The Role of Liver Transplantation in the Treatment of Liver Metastases from Neuroendocrine Tumors

“…On the opposite, also some expansion of LT in the field of resectable NELM can be foreseen. Resectability of liver metastases depend on factors related to patient conditions, to anatomical limitations (i.e., technical resectability) and to tumor characteristics (i.e., oncologic resectability, impacting on long-term outcomes after a R0 liver resection) [72,73]. Even if technically resectable, NELM patients with very high tumor burden experience liver recurrence in almost 100% of cases [38]; moreover, patients with extensive liver disease often require highly demolitive liver resections that might result in severe postoperative morbidity [46•].…”

Extracellular Vesicles in Liver Transplantation: Current Evidence and Future Challenges

“…When LT is considered in the case of unresectable hepatic metastases from colorectal cancer, patient selection is crucial in order to achieve successful outcomes [51]. In this setting, levels of circulating tumor cells or circulating tumor-derived DNA can identify patients with residual metastatic cells in the bloodstream.…”

Liver Transplantation for Unresectable Colorectal Liver Metastasis: Perspective and Review of Current Literature

“…Given the low number of patients who qualify for surgical resection of liver metastases and the high rate of cancer recurrence after resection, alternative strategies are needed to optimize outcomes in these patients. Liver transplant (LT) is one possible option that is garnering more attention [14][15][16][17][18][19] in treating unresectable CRLM.…”