Liver Transplantation for Nonresectable Colorectal Liver Metastases: Ten-year Follow-up and Assessment of Curative Rate in the SECA-II Study.

Abstract

To determine if stringent selection criteria could result long-term overall survival and to determine the proportion of patients that most likely were cured by the transplantation. Liver transplantation is a potentially curative option for patients with nonresectable colorectal liver metastases, but optimal patient selection criteria remain undefined. SECA-II study is a prospective controlled cohort study of liver transplantation for patients with nonresectable liver-only metastases included from April 2012 to November 2023 at Oslo University Hospital. The primary endpoint was overall survival, with secondary endpoints; disease-free survival and survival after relapse. Final analysis is reported on January 1st, 2025. Twenty-five patients were included. Median post-transplant observation time for patients still alive was 97.2 months. Median relapse-free survival, overall and postrecurrence survival was 24.3, 128.2, and 62.9 months, respectively. Twelve patients (48%) had a relapse and the primary site of relapse was pulmonary metastases in 6 patients. Twelve patients have no relapse after median 74 months (range: 13-122 mo) with 10 patients observed for more than 4 years. Four of these 12 patients have been observed for 10 years or more, with 4 others for more than 5 years, without relapse. Three patients have no evidence of disease for 93, 36, and 7 months after surgical treatment of a relapse. A maximum of 15 of the 25 liver-transplanted patients might obtain cure by the liver transplant. Selected colorectal cancer patients with nonresectable liver-only metastases may obtain long-term survival after liver transplantation. Liver transplantation for highly selected patients with nonresectable liver metastases might in some patients be a curative treatment even after a relapse.