Chirurgia del Fegato a Firenze!

Dal 1° Marzo 2023, Chirurgia del Fegato sarà all'Università di Firenze
AOUC Azienda Ospedaliero-Universitaria Careggi - Largo Brambilla, 3 - 50134 Firenze

Prima serie mondiale di trapianto di fegato per metastasi da tumore del colon

Il gruppo dell’Università di Oslo, Norvegia, pubblica la prima serie al mondo di pazienti trapiantati per metastasi epatiche non resecabili da tumore del colon retto.

La presenza di metastasi al fegato era stata, fino a questo momento, una controindicazione assoluta all’esecuzione del trapianto.

L’articolo apre una nuova frontiera nel campo della trapiantologia oncologica.

La referenza bibliografica per questo evento è:

Morten Hagness, Aksel Foss, Pål-Dag Line, Tim Scholz, Pål Foyn Jørgensen, Bjarte Fosby, Kirsten Muri Boberg, Øystein Mathisen, Ivar P. Gladhaug, Tor Skatvedt Egge, Steinar Solberg, John Hausken, Svein Dueland: Liver transplantation for nonresectable liver metastases from colorectal cancer. In: Annals of Surgery, vol. 257, no. 5, pp. 800 – 806, 2013, ISSN: 15281140, (Cited by: 182).

Abstract

OBJECTIVE: The objective of this pilot study was to investigate the potential for long-term overall survival (OS) after liver transplantation for colorectal liver metastases (CLMs). BACKGROUND: Patients with nonresectable CLMs have poor prognosis, and few survive beyond 5 years. CLMs are currently considered an absolute contraindication for liver transplantation, although liver transplantation for primary and some secondary liver malignancies shows excellent outcome in selected patients. Before 1995, several liver transplantations for CLMs were performed, but outcome was poor (5-year survival rate: 18%) and liver transplantation for CLMs was abandoned. Since then, the survival rate after liver transplantation in general has improved by almost 30%. On the basis of this, a 5-year survival rate of about 50% after liver transplantation for CLMs could be anticipated. METHODS: In a prospective pilot study, liver transplantation for nonresectable CLMs was performed (n = 21). Main inclusion criteria were liver-only CLMs, excised primary tumors, and at least 6 weeks of chemotherapy. RESULTS: Kaplan-Meier estimates of the OS rate at 1, 3, and 5 years were 95%, 68%, and 60%, respectively. Metastatic recurrence of disease was common (mainly pulmonary). However, a significant proportion of the recurrences were accessible for surgery, and at follow-up (after median of 27 months; range, 8-60), 33% had no evidence of disease. Hepatic tumor load before liver transplantation, time from primary surgery to liver transplantation, and progressive disease on chemotherapy were identified as significant prognostic factors. CONCLUSIONS: OS exceeds by far reported outcome for chemotherapy, which is the only treatment option available for this patient group. Furthermore, OS is comparable with liver resection for resectable CLMs and survival after repeat liver transplantation for nonmalignant diseases. Selection strategies based on prognostic factors may further improve the outcome (ClinicalTrials.gov: NCT01311453). Copyright © 2013 by Lippincott Williams & Wilkins.

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Chirurgia del Fegato all'Università di Firenze!

Chirurgia Epato-Bilio-Pancreatica

AOUC Azienda Ospedaliero-Universitaria Careggi
Largo Brambilla, 3 – 50134 Firenze

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