Who Should Undergo Transplant for Metastatic Colorectal Cancer?: A Shift in Treatment Paradigm
Menée sur 89 patients présentant des métastases hépatiques ayant pour origine un cancer colorectal, cette étude évalue l'intérêt, du point de vue de la survie globale, d'une embolisation de la veine porte en combinaison avec une résection hépatique par rapport à une greffe de foie
The outcomes of transplant for metastatic disease in the early days of liver transplantation were dismal. Early recurrence was common and 3-year survival was unusual. These results, coupled with a shortage of cadaveric organs for transplant, led to an abandonment of transplant as a treatment option for colorectal liver metastases. In this issue of JAMA Surgery, Dueland and colleagues present data that see this treatment in a new light.In this prospective series of 50 patients treated by liver transplant for colorectal metastases, the 5-year survival for patients with low tumor burden (<10 lesions; largest tumor <5.5 cm; n = 21) was 72.4%. Patients with high tumor load (>9 tumors, largest tumor >5.5 cm) receiving liver transplant had a 5-year survival of 33.4%. These data, although preliminary, are intriguing and would encourage renewed evaluation of transplant as a therapy for colorectal liver metastases either in the form of trials or registries.
JAMA Surgery , éditorial, 2020