Current Literature

Living Donor Liver Transplant Potentially Beneficial for Unresectable Liver Metastases

Rajendran L, Claasen M PAW, McGilvray, ID, et al. Toronto Management of Initially Unresectable Liver Metastases from Colorectal Cancer in a Living Donor Liver Transplant Program. J Am Coll Surg. 2023, in press.

Colorectal cancer is the third-most common cancer diagnosed in North America, and nearly half of patients diagnosed with the disease will present with metastatic lesions or develop metastases during follow up. Improvements in adjuvant therapies have resulted in an increased proportion of patients who are eligible for surgical treatment of metastatic disease.

Liver transplantation has been used as a treatment for unresectable colorectal liver metastases, but deceased donor liver transplant is not permitted for this disease due to scarcity of donor organs and the resultant long wait periods for transplantation. Living donor liver transplant (LDLT) offers a viable treatment option for patients with unresectable liver metastases from colorectal cancer.

This article described the experience of a single center with expertise in LDLT. 81 patients who were receiving chemotherapy were assessed for LDLT, and seven underwent the procedure; resection was performed in 22 patients and 48 patients continued treatment with chemotherapy (control group). Overall survival was equivalent in the resection and LDLT groups and significantly higher in both groups compared with patients assigned to the control group.

Recurrence-free survival was significantly improved in the LDLT group. The one patient who died after LDLT succumbed because of an occult pulmonary metastasis. The authors concluded that LDLT is a potentially beneficial treatment option for patients with unresectable colorectal liver metastases.

Editorial

Subramanian V, Dhanireddy K. Living Donor Liver Transplant for Liver Metastases from Colorectal Cancer. J Am Coll Surg. 2023, in press.

In the editorial that accompanied the article, authors Vijay Subramanian, MD, and Kiran Dhanireddy, MD, FACS, agreed with the potential benefit of LDLT. In addition, they emphasized the need for consideration of the ethics of transplantation for metastatic disease and recommended additional carefully performed trials.

Study Supports Effectiveness of Surgical Treatment of Complicated or Persistent Diverticulitis

Santos A, Mentula P, Pinta T, et al. Quality-of-Life and Recurrence Outcomes Following Laparoscopic Elective Sigmoid Resection vs Conservative Treatment Following Diverticulitis: Prespecified 2-Year Analysis of the LASER Randomized Clinical Trial. JAMA Surg. 2023. doi: 10.1001/jamasurg.2023.0466

Treatment of patients with recurrent diverticulitis episodes, complicated diverticulitis, and/or persistent pain due to diverticular disease can be conservative (fiber supplementation, dietary therapy) or surgical (sigmoid resection). Evidence supporting one or the other approach is mostly derived from observational studies. The LASER randomized trial, conducted in five institutions in Finland, provided outcomes data on patients assigned to conservative treatment (n = 44) or surgical therapy (laparoscopic sigmoid resection, n = 41).

Outcomes of interest were Gastrointestinal Quality of Life Scores (GIQLI), complications, and recurrent disease rates at 2 years of follow up. The per-protocol data analysis showed that GIQLI was significantly higher in the surgery group compared with the conservative treatment group. The rate of recurrent diverticulitis was significantly higher in the conservative group, while overall complication rates were similar in the two comparison groups. Surgical treatment occurred in 18% of patients initially assigned to the conservative treatment group during the follow up interval. The authors concluded that surgical treatment of complicated or persistent diverticulitis was an effective option that should be included in shared decision-making discussions with patients.

Editorial

Hill SS, Davids JS. The Benefits of Surgery for Diverticular Disease—Have We Met the Burden of Proof? JAMA Surg. 2023. doi: 10.1001/jamasurg.2023.0476 [published Online First: 20230419]

In the editorial that accompanied the article, authors Susanna S. Hill, MD, MSCI, and Jennifer S. Davids, MD, FACS, noted that interpretation of these data is limited due to the small sample size and high crossover rate. However, despite these limitations, the evidence presented is valuable and should be used when determining treatment strategies in clinical practice.