Introduction Colorectal liver metastases remain a major cause of cancer-related mortality, and curative treatment is traditionally limited to patients eligible for hepatic resection. However, many patients present with technically unresectable liver-only disease despite favorable tumor biology and good response to systemic chemotherapy.
Introduction
Colorectal liver metastases remain a major cause of cancer-related mortality, and curative treatment is traditionally limited to patients eligible for hepatic resection. However, many patients present with technically unresectable liver-only disease despite favorable tumor biology and good response to systemic chemotherapy. In recent years, liver transplantation has re-emerged as a potential treatment strategy for carefully selected patients with unresectable colorectal liver metastases.
Problem Statement
Although promising survival outcomes have been reported with liver transplantation in selected metastatic colorectal cancer patients, widespread adoption remains limited by donor organ scarcity, concerns regarding recurrence and uncertainty regarding long-term oncologic benefit compared with modern systemic therapy alone.
Summary
This study demonstrates that liver transplantation using a living-donor RAPID approach provides a substantial survival advantage over chemotherapy alone in carefully selected patients with unresectable colorectal liver metastases. Eligible patients had liver-confined disease with stable disease or tumor regression following systemic therapy, reflecting strict biologic selection criteria. Patients undergoing transplantation achieved markedly superior long-term survival compared with patients who could not proceed because of donor unavailability, supporting transplantation as a potentially curative strategy in highly selected metastatic colorectal cancer. The RAPID technique, involving staged partial liver transplantation with delayed hepatectomy, also highlights an innovative approach to expanding transplant feasibility while minimizing donor burden. Although recurrence remained common after transplantation, recurrent disease was often compatible with prolonged post-recurrence survival, suggesting that transplantation may meaningfully alter disease trajectory even when recurrence occurs. Importantly, the study reinforces the growing concept that tumor biology and treatment responsiveness may be more relevant than traditional metastatic classification alone when considering advanced surgical or transplant-based oncologic strategies. Overall, these findings strengthen the evolving role of liver transplantation in transplant oncology and support living-donor transplantation as a feasible pathway to expand access for selected patients with unresectable colorectal liver metastases.
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