Orthotopic living related donor transplantation of the liver right lobe in the treatment of unresectable bilobular liver metastases from colorectal cancer
DOI:
https://doi.org/10.14739/2310-1210.2023.3.278726Keywords:
liver transplantation, rectal adenocarcinoma, liver cancerAbstract
Aim. Тo study the treatment result of unresectable liver metastases from colorectal cancer by the technique of transplantation.
Case report. A man, born in 1963, applied to the Medical Center “Universal Clinic “Oberig” with a diagnosis of rectal adenocarcinoma pT3bN0M1 (hep) G2, synchronous colorectal liver metastases with multifocal bilobar lesions, stage IV after laparoscopic rectal extirpation and adjuvant FOLFIRI + Cetuximab polychemotherapy. Following a thorough examination of the patient, a decision was made to treat by transplanting a liver lobe graft donated by a living related donor (son).
On April 12, 2022, the patient underwent orthotopic living related donor transplantation of the liver right lobe. In the early postoperative period, the patient developed an acute perforated ulcer of the small intestine, and he therefore was reoperated. The postoperative period was severe, but the condition stabilization was achieved with conservative treatment, and on the 38th postoperative day, the recipient was discharged from the hospital in a satisfactory condition.
According to the control abdominal MRI during follow-up examinations, no signs of recurrence or progression were detected, however, 2 isolated metastatic foci in the lung parenchyma were detected bilaterally on the control CT scan of the chest 11 months after the liver lobe transplantation from the living related donor. Resection of metastatic foci was performed and systemic polychemotherapy was prescribed in that regard. Based on the control laboratory and instrumental examinations from 05.05.2023 (CT scan, MRI), there were no signs of the disease recurrence, the level of carcinoembryonic antigen was 1.5 ng/ml.
Conclusions. Liver transplantation is an effective and radical method of treatment for patients with unresectable liver metastases from colorectal cancer. Transplantation using liver lobe from a living related donor in unresectable isolated liver metastases from colorectal cancer has advantages over all other methods and is safe for donors in highly specialized centers with sufficient experience in living related liver transplantation.
References
Adam, R., de Gramont, A., Figueras, J., Kokudo, N., Kunstlinger, F., Loyer, E., Poston, G., Rougier, P., Rubbia-Brandt, L., Sobrero, A., Teh, C., Tejpar, S., Van Cutsem, E., Vauthey, J. N., Påhlman, L., & of the EGOSLIM (Expert Group on OncoSurgery management of LIver Metastases) group (2015). Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer treatment reviews, 41(9), 729-741. https://doi.org/10.1016/j.ctrv.2015.06.006
Bonney, G. K., Chew, C. A., Lodge, P., Hubbard, J., Halazun, K. J., Trunecka, P., Muiesan, P., Mirza, D. F., Isaac, J., Laing, R. W., Iyer, S. G., Chee, C. E., Yong, W. P., Muthiah, M. D., Panaro, F., Sanabria, J., Grothey, A., Moodley, K., Chau, I., . . . Adam, R. (2021). Liver transplantation for non-resectable colorectal liver metastases: the International Hepato-Pancreato-Biliary Association consensus guidelines. Lancet Gastroenterol Hepatol, 6(11), 933-946. https://doi.org/10.1016/S2468-1253(21)00219-3
Butte, J. M., Gonen, M., Allen, P. J., Peter Kingham, T., Sofocleous, C. T., DeMatteo, R. P., Fong, Y., Kemeny, N. E., Jarnagin, W. R., & D'Angelica, M. I. (2015). Recurrence After Partial Hepatectomy for Metastatic Colorectal Cancer: Potentially Curative Role of Salvage Repeat Resection. Annals of surgical oncology, 22(8), 2761-2771. https://doi.org/10.1245/s10434-015-4370-1
Dueland, S., Guren, T. K., Hagness, M., Glimelius, B., Line, P D., Pfeiffer, P., Foss, A., & Tveit, K. M. (2015). Chemotherapy or liver transplantation for nonresectable liver metastases from colorectal cancer? Annals of surgical oncology, 261(5), 956-960. https://doi.org/10.1097/SLA.0000000000000786
Fernandez, F. G., Drebin, J. A., Linehan, D. C., Dehdashti, F., Siegel, B. A., & Strasberg, S. M. (2004). Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Annals of surgical oncology, 240(3), 438-447; discussion 447-450. https://doi.org/10.1097/01.sla.0000138076.72547.b1
Garajova, I., Balsano, R., Tommasi, C., Dalla Valle, R., Pedrazzi, G., Ravaioli, M., Spallanzani, A., Leonardi, F., Santini, C., Caputo, F., Riefolo, M., Giuffrida, M., & Gelsomino, F. (2020). Synchronous and metachronous colorectal liver metastases: impact of primary tumor location on patterns of recurrence and survival after hepatic resection. Acta bio-medica : Atenei Parmensis, 92(1), e2021061. https://doi.org/10.23750/abm.v92i1.11050
Grut, H., Solberg, S., Seierstad, T., Revheim, M. E., Egge, T. S., Larsen, S. G., Line, P. D., & Dueland, S. (2018). Growth rates of pulmonary metastases after liver transplantation for unresectable colorectal liver metastases. The British journal of surgery, 105(3), 295-301. https://doi.org/10.1002/bjs.10651
Hagness, M., Foss, A., Egge, T. S., & Dueland, S. (2014). Patterns of recurrence after liver transplantation for nonresectable liver metastases from colorectal cancer. Annals of surgical oncology, 21(4), 1323-1329. https://doi.org/10.1245/s10434-013-3449-9
Hagness, M., Foss, A., Line, P. D., Scholz, T., Jorgensen, P. F., Fosby, B., Boberg, K. M., Mathisen, O., Gladhaug, I. P., Egge, T. S., Solberg, S., Hausken, J., & Dueland, S. (2013). Liver transplantation for nonresectable liver metastases from colorectal cancer. Annals of surgical oncology, 257(5), 800-806. https://doi.org/10.1097/SLA.0b013e3182823957
Hernandez-Alejandro, R., Ruffolo, L. I., Sasaki, K., Tomiyama, K., Orloff, M. S., Pineda-Solis, K., Nair, A., Errigo, J., Dokus, M. K., Cattral, M., McGilvray, I. D., Ghanekar, A., Gallinger, S., Selzner, N., Claasen, M., Burkes, R., Hashimoto, K., Fujiki, M., Quintini, C., . . . Sapisochin, G. (2022). Recipient and Donor Outcomes After Living-Donor Liver Transplant for Unresectable Colorectal Liver Metastases. JAMA surgery, 157(6), 524-530. https://doi.org/10.1001/jamasurg.2022.0300
Hoti, E., & Adam, R. (2008). Liver transplantation for primary and metastatic liver cancers. Transplant international, 21(12), 1107-1117. https://doi.org/10.1111/j.1432-2277.2008.00735.x
Kwong, A. J., Kim, W. R., Lake, J. R., Smith, J. M., Schladt, D. P., Skeans, M. A., Noreen, S. M., Foutz, J., Booker, S. E., Cafarella, M., Snyder, J. J., Israni, A. K., & Kasiske, B. L. (2021). OPTN/SRTR 2019 Annual Data Report: Liver. American journal of transplantation, 21 Suppl 2, 208-315. https://doi.org/10.1111/ajt.16494
Line, P. D., Hagness, M., Berstad, A. E., Foss, A., & Dueland, S. (2015). A Novel Concept for Partial Liver Transplantation in Nonresectable Colorectal Liver Metastases: The RAPID Concept. Annals of surgical oncology, 262(1), e5-9. https://doi.org/10.1097/SLA.0000000000001165
Manfredi, S., Lepage, C., Hatem, C., Coatmeur, O., Faivre, J., & Bouvier, A. M. (2006). Epidemiology and management of liver metastases from colorectal cancer. Annals of surgical oncology, 244(2), 254-259. https://doi.org/10.1097/01.sla.0000217629.94941.cf
Mathe, Z., Tagkalos, E., Paul, A., Molmenti, E. P., Kobori, L., Fouzas, I., Beckebaum, S., & Sotiropoulos, G. C. (2011). Liver transplantation for hepatic metastases of neuroendocrine pancreatic tumors: a survival-based analysis. Transplantation, 91(5), 575-582. https://doi.org/10.1097/TP.0b013e3182081312
Mazzaferro, V., Llovet, J. M., Miceli, R., Bhoori, S., Schiavo, M., Mariani, L., Camerini, T., Roayaie, S., Schwartz, M. E., Grazi, G. L., Adam, R., Neuhaus, P., Salizzoni, M., Bruix, J., Forner, A., De Carlis, L., Cillo, U., Burroughs, A. K., Troisi, R., . . . Metroticket Investigator Study, G. (2009). Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. The Lancet. Oncology, 10(1), 35-43. https://doi.org/10.1016/S1470-2045(08)70284-5
Moris, D., Tsilimigras, D. I., Chakedis, J., Beal, E. W., Felekouras, E., Vernadakis, S., Schizas, D., Fung, J. J., & Pawlik, T. M. (2017). Liver transplantation for unresectable colorectal liver metastases: A systematic review. Journal of surgical oncology, 116(3), 288-297. https://doi.org/10.1002/jso.24671
Nozawa, H., Sunami, E., Nakajima, J., Nagawa, H., & Kitayama, J. (2012). Synchronous and metachronous lung metastases in patients with colorectal cancer: A 20-year monocentric experience. Experimental and therapeutic medicine, 3(3), 449-456. https://doi.org/10.3892/etm.2011.443
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: a cancer journal for clinicians, 71(3), 209-249. https://doi.org/10.3322/caac.21660
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
