Living donor liver transplantation with two-stage hepatectomy for patients with isolated, irresectable colorectal liver—the LIVER-T(W)O-HEAL study

Abstract

BackgroundColorectal cancer is the third most common malignancy worldwide. The occurrence of liver metastases worsens the prognosis of the patient significantly if the tumor burden is not resectable.Liver transplantation might be an option for otherwise irresectable colorectal liver metastases. In this study, we evaluate the role of two-stage hepatectomy in combination with a left-lateral living donor liver transplantation.MethodsPatients with irresectable liver metastases having a stable disease or tumor regression after at least 8 weeks of systemic chemotherapy without an extrahepatic tumor burden (except resectable lung metastases) are suitable for study inclusion. A randomization is not planned since the control arm (systemic chemotherapy) is well established and the superiority of the transplantation procedure has to be expected.The surgical treatment consists of two steps: in a first operation, a left hemihepatectomy in the recipient will be performed. At this place, the left lateral liver lobe (segments II and III) of a living donor will be transplanted. To induce a growth of the graft, a portal vein ligation will be performed. Approximately after 2 weeks, the removal of the right hemiliver will be conducted if the control imaging shows a sufficient growth of the graft.ResultsThe patient recruitment is ongoing. In total, three patients have been already transplanted with this protocol. Up to now, they are tumor-free and in good clinical health.DiscussionWith the design of the LIVER-T(W)O-HEAL study, it might be possible to offer patients with otherwise irresectable colorectal liver metastases a curative treatment option. The key point of this study will be, most probably, the patient’s selection.Trial registrationRegistered at Clinical Trials; NCT03488953; registered on April 5, 2018Electronic supplementary materialThe online version of this article (10.1186/s12957-018-1549-5) contains supplementary material, which is available to authorized users.

Current Treatment of Colorectal Liver Metastasis as a Chronic Disease

“…Currently, several worldwide studies are recruiting patients for the evaluation of LTx in the treatment of CRLM. More recently, a German group has launched a study based on the RAPID-Concept, which includes patients with unresectable CRLM, with stable disease or tumor regression after at least 8 weeks of systemic chemotherapy and without extrahepatic tumor growth (73).…”

Two‐Stage Recipient Hepatectomy and Left Liver Transplantation to Minimize Risks in Adult‐to‐Adult Living Donor Liver Transplantation: New Concepts

“…First, all articles concentrate on colorectal cancer liver metastases. (2,3,8) Nonetheless, the concept can be extended to neuroendocrine tumors and hepatocarcinoma in patients without significant portal hypertension and with a favorable liver anatomy.…”

“…(1) Third, partial LT is reportedly performed with left lateral sectors (segments 2-3) from deceased or living donors. (2,3) However, the preservation of a vascular pedicle that can be anastomosed requires the division of segment 4 vessels so that segment 4 is completely devascularized and bound to atrophy. Sensibly, the donor procedure should entail a proper LH (segments 2-4) because segment 4 in the donor is useless, whereas in the recipient, it adds precious mass and impacts the need for graft inflow modulation.…”

“…(1) In contrast, a 2-stage approach appears to be a true game changer for the technical hurdles of LDLT. (2,3) On the basis of these assumptions, we recently performed our first case of a 2-stage total hepatectomy coupled with a left liver LDLT, the details of which are extensively reported in Tables 1-3 and the Supporting Materials. With this communication, we report our technical strategy and give a general insight into this topic.…”

„Standard Changing News Onkologie“ in der Tumorchirurgie

“…Im Eurotransplant-Bereich ist diese Indikation bislang nicht akzeptiert.Eine Alternative stellt die Leber-Lebendspende unter Berücksichtigung der höchsten Spendersicherheit mittels einer von unserem Zentrum beschriebenen Technik der zweizeitigen Hepatektomie in Kombination mit einer auxilliären Lebersegmenttransplantation dar[7]. Gemeinsam mit dem Transplantationszentrum in Jena wurde eine deutsche Pilotstudie initiiert[8], in welche derzeit Patienten eingeschlossen werden. Bislang wurden 6 Patienten dem Protokoll entsprechend transplantiert, die Studie ist nach wie vor offen und Patienten können vorgestellt werden.…”