Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell Medicine.
Centre for Liver Disease and Transplantation, Columbia University Medical Center.
Curr Opin Organ Transplant. 2019 Apr;24(2):175-181. doi: 10.1097/MOT.0000000000000623.
The aim of this review is to discuss existing data on liver transplantation for colorectal liver metastasis, emerging controversies, and future directions.
Contemporary experience with transplanting patients with liver metastasis from colon cancer is mainly derived from European centers, with a large proportion being from a single institution (SECA study), made possible in part by a relatively high donor pool. The initial results prove to be encouraging by demonstrating an overall survival advantage over unresectable patients with liver-limited disease managed with chemotherapy only. Recurrence patterns, however, suggest a need for better patient selection and treatment sequencing optimization. In North America, the main barriers in establishing similar protocols result from national liver graft shortage, which represents an issue of competing resources when indications have yet to be well defined. Evolving strategies in transplantation, such as the utilization of marginal liver grafts and living donor liver transplantation might constitute potential solutions.
Evidence suggests a potential survival benefit of liver transplantation for a subset of patients with unresectable liver-limited CRLM. Further prospective trials are needed to clarify the role and feasibility of this treatment strategy in oncotransplantation.
本综述旨在讨论结直肠癌肝转移肝移植的现有数据、新出现的争议和未来方向。
接受结直肠癌肝转移肝移植的当代经验主要来自欧洲中心，其中很大一部分来自单一机构（SECA 研究），这在一定程度上得益于相对较高的供体库。最初的结果令人鼓舞，证明与仅接受化疗治疗的无法切除的肝局限性疾病患者相比，总体生存率有优势。然而，复发模式表明需要更好的患者选择和治疗顺序优化。在北美，建立类似方案的主要障碍源于国家肝供体短缺，这在适应症尚未明确的情况下代表了资源竞争的问题。移植中不断发展的策略，如边缘供肝和活体供肝移植的利用，可能构成潜在的解决方案。
有证据表明，对于一部分无法切除的肝局限性 CRLM 患者，肝移植可能有生存获益。需要进一步的前瞻性试验来阐明这种治疗策略在肿瘤移植中的作用和可行性。
