Background: The most important pillar of a curative treatment of colorectal liver metastases is surgical liver resection. If the complete removal of the liver metastases is successful, a 5-year survival of 55-67% is achievable, but in many patients a complete resection of the liver metastases is not possible, mostly because the location of the metastases within the liver makes a radical resection impossible, which explains the increasing interest in transplantation in these patients. Initial attempts at liver transplantation for colorectal liver metastases have failed, also due to significant non-tumor-related perioperative mortality.
More recently, the Oslo transplantation program achieved a 5-year survival rate of 60% in a group of 21 patients with non-resectable colorectal liver metastases, which was significantly higher than the expected results with systemic therapy alone. However, 96% of the patients developed a tumor recurrence within the first 18 months, which is why the curative approach of transplantation was initially questioned. Through improved patient selection, however, the survival of the patients could be significantly improved. Depending on the degree of selection, a high percentage of patients remain recurrence-free even in the long term. The lack of donor organs is essential for the continuing reluctance to transplant, and here the indication must be placed in comparison to other established diseases requiring transplantation.
Due to the shortage of post-mortem donor organs, the RAPID procedure (resection and partial transplantation of a liver segment from a deceased donor with delayed total hepatectomy) was introduced as a possible alternative. The RAPID procedure represents a fusion of two sophisticated surgical techniques of the ALLPS technique and an accessory split liver transplantation. Although the RAPID procedure has shown promising results, the basic problem of organ shortage remains, so that living liver donation must be increasingly used.
RAPID MUC study protocol
Who comes into question? In the RAPID-MUC study, selected patients with bilobaric, non-resectable liver metastases of colorectal cancer can be included without further extrahepatic manifestations. In addition, the following criteria, among others, must be met:
1) a primary tumor removed in sano,
2) a response to first-line chemotherapy and
3) a CEA<80 ng/ml.
Prof. Dr. med. Markus Guba
Clinic for General, Visceral and Transplant Surgery, LMU Klinikum
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