Open AccessLiver transplantation versus liver resection for colorectal liver metastasis: a survival benefit analysis in patients stratified according to tumor burden score
Author(s) -
Lanari Jacopo,
Hagness Morten,
Sartori Alessandra,
Rosso Eugenia,
Gringeri Enrico,
Dueland Svein,
Cillo Umberto,
Line PålDag
Publication year - 2021
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13981
Subject(s) - medicine , liver transplantation , metastasis , overall survival , gastroenterology , cohort , colorectal cancer , oncology , transplantation , cancer
Summary Liver transplantation (LT) for colorectal liver metastasis (CRLM) may provide excellent survival rates in patients with unresectable disease. High tumor load is a risk factor for recurrence and low overall survival (OS) after liver resection (LR). We tested the hypothesis that LT could offer better survival than LR in patients with high tumor load. LR performed at Padua University Hospital for CRLM was compared with LT for unresectable CRLM performed both at Oslo and Padua. High tumor load was defined as tumor burden score (TBS) ≥ 9, and inclusion criteria were as in the SECA‐I transplant study. 184 patients were eligible: 128 LRs and 56 LTs. 5‐year OS after LR and LT was 40.5% and 54.7% ( P = 0.102). In the high TBS cohort, 5‐year OS after LR and LT was 22.7% and 52.2% ( P = 0.055). In patients with Oslo score ≤ 2 and TBS ≥ 9 (13 LR; 24 LT) the 5‐year OS after LR and LT was 14.6% and 69.1% ( P = 0.002). The corresponding disease‐free survival (DFS) was 0% and 22.9% ( P = 0.005). Selected CRLM patients with low Oslo score and high TBS could benefit from LT with survival outcomes that are far better than what is achieved by LR.