Liver transplantation is a feasible treatment for inoperable liver metastasis in colorectal cancer patients

In this study, researchers examined the long term survival of patients with colorectal cancer (CRC) liver metastasis after liver transplantation.

Many CRC patients develop metastasis (spread of the cancer to other organs) after first diagnosis. Liver metastasis is common, and is often considered inoperable or non-resectable (unsuitable for surgery since removal of the tumor is not feasible without destruction of the liver). Chemotherapy is currently the only treatment for patients with non-resectable liver metastasis. Unfortunately, chemotherapy is not curative, and 5 year survival rates remain low.

Liver transplantation could help these patients. Liver transplantation for CRC liver metastasis is currently not available due to the limited number of donor organs and disappointing results in previous trials. However, transplantation techniques have improved dramatically in recent years and new research may provide more encouraging results.

Researchers followed 21 CRC patients with non-resectable liver metastasis who received a liver transplant. After one year, overall survival among these patients was 95%. After 3 years survival was 68%, and the 5 year survival rate was 60%.

However, Only 35% of patients were completely disease-free after 1 year. Disease recurrence was common, but metastatic recurrence occurred mostly to the lungs, and was removable by additional surgery. The best predictors of survival were small tumor size and a long time period between first colorectal surgery and liver transplantation.

This study concluded that liver transplantation increases overall survival compared to standard chemotherapy, and can be used as a practical treatment strategy for non-resectable CRC liver metastasis.

After organ transplantation, patients must receive immunosuppressive treatment that prevents their immune system from rejecting the new organ. This treatment also prevents the immune response against cancer cells, which might explain the high rate of disease recurrence in this study.

This study involved only a small number of patients. Results should be replicated in larger studies, and the feasibility of transplantations compared to the availability of donor organs should be analyzed before liver transplantations are considered for common practice.

Consult with your physician regarding liver transplantations in the treatment of liver metastasis.