From the Department of Surgery, Division of General Surgery (Rajendran, McGilvray, Cattral, Ghanekar, Gallinger, Sapisochin).
Multi-Organ Transplant Program, University Health Network Toronto, Ontario, Canada (Classen, McGilvray, Cattral, Ghanekar, Selzner, Winter, Sapisochin).
J Am Coll Surg. 2023 Aug 1;237(2):231-242. doi: 10.1097/XCS.0000000000000734. Epub 2023 May 3.
Living donor liver transplantation (LDLT) is an attractive option for patients with unresectable, bilobar colorectal liver metastases (CRLM). However, it is not available in most centers beyond study protocols. This study describes the interim experience with LDLT for CRLM at a large North American transplant and hepatobiliary center. f.
Adults with unresectable CRLM, receiving systemic chemotherapy, were recruited into a prospective clinical trial. Data on demographics, referral patterns, and clinical characteristics were extracted from October 2016 to February 2023. Patients were divided into 3 groups: transplanted, resected, and control (excluded with continuation of systemic chemotherapy). Overall survival and recurrence-free survival were compared.
Eighty-one referred patients were assessed for LDLT: 7 received transplants, 22 underwent resection, and 48 were controls. All had similar preassessment baseline characteristics. Median time from initial assessment to transplantation was 15.4 months. The control population had significantly worse postassessment overall survival than the transplanted population (p = 0.002) and resected population (p < 0.001). The median postoperative follow-up duration was 21.4 months (resection) and 14.8 months (LDLT). There was no difference in overall survival between the transplanted and resected populations (1-year 100% vs 93.8%; 3-year 100% vs 43.3%, p = 0.17). However, recurrence-free survival was superior in the LDLT group (1-year 85.7% vs 11.4%; 3-year 68.6% vs 11.4%, p = 0.012).
Most patients with unresectable CRLM referred for LDLT are deemed ineligible for trial inclusion. However, the excellent oncologic outcomes in patients who meet criteria for LDLT supports its role in highly selected populations. Future results after the trial's completion will inform long-term outcomes.
对于无法切除的双侧结直肠癌肝转移(CRLM)患者,活体肝移植(LDLT)是一种有吸引力的选择。然而,在大多数中心,这种方法并不适用于超出研究方案的情况。本研究描述了在一家大型北美移植和肝胆中心进行 LDLT 治疗 CRLM 的中期经验。
接受系统化疗的无法切除的 CRLM 成人患者被纳入一项前瞻性临床试验。从 2016 年 10 月至 2023 年 2 月,从人口统计学、转诊模式和临床特征等方面提取数据。患者分为 3 组:移植组、切除组和对照组(因继续接受系统化疗而排除)。比较总生存期和无复发生存期。
对 81 例接受 LDLT 评估的患者进行评估:7 例接受移植,22 例接受切除,48 例为对照组。所有患者的基线特征相似。从首次评估到移植的中位时间为 15.4 个月。对照组的患者在评估后的总生存期明显差于移植组(p=0.002)和切除组(p<0.001)。术后中位随访时间为 21.4 个月(切除组)和 14.8 个月(LDLT 组)。移植组和切除组的总生存期无差异(1 年 100% vs 93.8%;3 年 100% vs 43.3%,p=0.17)。然而,LDLT 组的无复发生存率更高(1 年 85.7% vs 11.4%;3 年 68.6% vs 11.4%,p=0.012)。
大多数接受 LDLT 评估的无法切除的 CRLM 患者被认为不符合试验纳入标准。然而,符合 LDLT 标准的患者的优异肿瘤学结果支持其在高度选择的人群中的作用。试验完成后的未来结果将提供长期结果的信息。