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World J Clin Oncol. Dec 24, 2021; 12(12): 1193-1201
Published online Dec 24, 2021. doi: 10.5306/wjco.v12.i12.1193
Role of liver transplantation in the management of colorectal liver metastases: Challenges and opportunities
Panagiotis T Tasoudis, Ioannis A Ziogas, Sophoclis P Alexopoulos, John J Fung, Georgios Tsoulfas
Panagiotis T Tasoudis, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
Ioannis A Ziogas, Sophoclis P Alexopoulos, Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN 37232, United States
John J Fung, Department of Surgery, University of Chicago Medicine Transplant Institute, Chicago, IL 60637, United States
Georgios Tsoulfas, Department of Transplant Surgery, Aristotle University School of Medicine, Thessaloniki 54622, Greece
Author contributions: Tasoudis PT and Ziogas IA wrote the paper; Alexopoulos SP, Fung JJ, Tsoulfas G critically revised the manuscript for important intellectual content.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Georgios Tsoulfas, FACS, FICS, MD, PhD, Associate Professor, Department of Transplant Surgery, Aristotle University School of Medicine, 66 Tsimiski Street, Thessaloniki 54622, Greece. tsoulfasg@gmail.com
Received: June 23, 2021
Peer-review started: June 23, 2021
First decision: July 27, 2021
Revised: June 27, 2021
Accepted: November 26, 2021
Article in press: November 26, 2021
Published online: December 24, 2021
Abstract

The liver is the most common site of colorectal cancer metastasis. Complete resection of the metastatic tumor is currently the only treatment modality available with a potential for cure. However, only 20% of colorectal liver metastases (CRLM) are considered resectable at the time of presentation. Liver transplantation (LT) has been proposed as an alternative oncologic treatment for patients with unresectable CRLM. This review summarizes the published experiences of LT in the setting of unresectable CRLM from the previous decades and discusses the challenges and future horizons in the field. Contemporary experiences that come mostly from countries with broader access to liver grafts are also explored and their promising findings in terms of overall survival (OS) and disease-free survival (DFS) are outlined along with their study design and methods. The rationale of establishing specific patient selection criteria and the dilemmas around immunosuppressive regimens in patients undergoing LT for CRLM are also highlighted. Additionally, this review describes the findings of studies comparing LT vs chemotherapy alone and LT vs portal vein embolization plus resection for CRLM in terms of OS and DFS. Last but not least, we present current perspectives and ongoing prospective trials that try to elucidate the role of LT for CRLM.

Keywords: Colorectal cancer, Colorectal liver metastases, Liver transplantation, Transplant oncology, Liver cancer, Oslo score

Core Tip: Despite the discouraging results of the previous decades, reports from the recent era showed promising results and reemerged the idea of liver transplantation (LT) for colorectal liver metastases (CRLM). Documentation of patient selection criteria and stronger evidence from ongoing prospective trials may reinforce the implementation of LT as an oncologic treatment for CRLM.