Liver Transplantation for Colorectal Liver Metastasis
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MACHINE PRESERVATION OF THE LIVER (C MILLER AND C QUINTINI, SECTION EDITORS)
Liver Transplantation for Colorectal Liver Metastasis Jacopo Lanari 1,2 & Svein Dueland 3 & Pål-Dag Line 1,3,4,5 Accepted: 7 October 2020 # The Author(s) 2020
Abstract Purpose of Review Accumulating evidence suggest that selected patients with nonresectable liver only metastases from colorectal cancer can be offered liver transplantation with acceptable outcome. This review provides an update on the scientific literature. Recent Findings The SECA-I study showed an estimated 5-year survival of 60% in a heterogenous patient population and guided the development of the first clinical selection criteria. In the sequel SECA-II trial, an estimated 5-year survival of 83% was obtained. A recent study shows that an Oslo score of 0–2, a metabolic tumor volume below 70 cm3 on PET-CT or Fong score of 0–2 at time of listing, can stratify patients with superior survival. Recurrence is common, but about 70% are slow-growing lung metastases, whereof the majority are resectable. Summary Liver transplantation for colorectal liver metastasis is an option in highly selected patients. Futile use of grafts can be avoided by applying stringent selection criteria. Keywords Colorectal cancer . Disease-free survival . Liver transplantation . Overall survival
Introduction Colorectal cancer (CRC) is the third most common malignancy worldwide with a particular high prevalence in the developed countries [1]. For the last decennials, there has been an increase in cases in the younger age groups [2, 3]. Almost 50% of CRC patients will develop metastasis, and the liver is the most often involved organ. The only treatment option providing potential long-term survival for colorectal This article is part of the Topical Collection on Machine Preservation of the Liver * Pål-Dag Line [email protected] 1
Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
2
Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation Unit, University of Padova, Padua, Italy
3
Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
4
Institute of Clinical Medicine, University of Oslo, Oslo, Norway
5
Division of Surgery, Inflammatory Diseases and Transplantation, Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet; P O Box 4950 Nydalen, NO-0424 Oslo, Norway
liver metastasis (CRLM) is hepatic resection. The outcomes in terms of overall survival rates (OS) following liver resection are variable, ranging from about 30 to 60% at 5 years. Prognostic factors influencing OS are metastatic tumor load in terms of number of liver metastases and maximal size of the largest lesion, plasma CEA levels, mutational status of the RAS oncogenes, node status of the primary, presence of extrahepatic metastases, and sideness (right sided versus left sided) of the primary tumor [4–8]. Well-s
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