The concept of using advanced surgical protocols (eg, liver resection complemented by both systemic and hepatic artery pump chemotherapy and liver transplantation) to treat liver metastases from CRC could result in transforming the condition from a fast-moving and fatal disease to a chronic condition with prolonged patient survival. The investigators speculate that by extending patient survival through aggressive surgical and locoregional therapies, novel and more effective systemic therapies will develop and increase survival.
Liquid Biopsy Technology
Assessment of free circulating tumor DNA and mutations in patients with liver malignancy is an initiative under way through the Liver Cancer Program. Time will be needed to determine the true advantage and applicability of this technology, but hopefully it will result in improved efficiency compared with current tumor biomarkers, allowing for the identification of a subset of patients who may benefit the most from these advanced surgical protocols.
Investigators anticipate that liver transplant and hepatic artery chemotherapy pump protocols will complement each other. Directing chemotherapy to the liver via an implantable pump will help limit disease to the liver over time. When chronic liver disease from long-term chemotherapy toxicity develops, salvage liver transplantation would be the next step to consider.
Hagness M, Foss A, Line PD, et al. Liver transplantation for nonresectable liver metastases from colorectal cancer. Ann Surg. 2013;257(5):800-806. doi: 10.1097/SLA.0b013e3182823957.