Liver Transplantation for Hepatic Metastases from Colorectal Cancer: Current Knowledge and Open Issues

SIMPLE SUMMARY: Over 40% of patients with colorectal cancer will develop liver metastases during the course of their disease. While resectable liver-limited colorectal liver metastases (CRLM) are potentially curable, prognosis is dismal for patients with unresectable disease. Liver transplantation can greatly improve survival in selected patients with unresectable CRLM. This article provides an overview of the current status of liver transplantation for CRLM, open issues and future directions for research. ABSTRACT: More than 40% of patients with colorectal cancer present liver metastases (CRLM) during the course of their disease and up to 50% present with unresectable disease. Without surgical interventions, survival for patients treated with systemic therapies alone is dismal. In the past, liver transplantation (LT) for patients with unresectable CRLM failed to show any survival benefit due to poor selection, ineffective chemotherapeutic regimens, unbalanced immunosuppression and high perioperative mortality. Since then and for many years LT for CRLM was abandoned. The turning point occurred in 2013, when the results from the Secondary Cancer (SECA I) pilot study performed at Oslo University were published reporting a 60% 5-year overall survival after LT in patients with unresectable CRLM. These results effectively reignited the interest in LT as a potential therapy for CRLM, and several trials are undergoing. The aims of this article are to give a comprehensive overview of the available evidence on LT for CRLM, discuss the open issues in this rapidly evolving field, and highlight possible ways to address the future of this fascinating therapeutic alternative for selected patients with CRLM.