Colorectal cancer is the third most common malignancy worldwide. Metastases are present at diagnosis in 15–30% of patients, and 20–50% develop them during treatment. The liver is the most frequent site of spread. Recently, liver transplantation has emerged as a novel option for selected patients with unresectable colorectal liver metastases. A 50-year-old man with stage IIIC rectal adenocarcinoma received neoadjuvant radiochemotherapy with capecitabine followed by abdominoperineal resection and adjuvant capecitabine. Despite treatment, imaging revealed liver metastases, which were resected laparoscopically. Pathology examination confirmed metastatic adenocarcinoma consistent morphologically with the primary tumor, with negative surgical margins. Between July 2021 and April 2022, new metastases were treated with thermal ablation, but shortly thereafter a new unresectable lesion was found in segment VIII. The patient received FOLFIRI plus cetuximab, with partial response after six cycles. In May 2023, he underwent orthotopic liver transplantation from a deceased donor at the Department of General, Transplant, and Liver Surgery, Medical University of Warsaw. This was one of the first cases of liver transplantation for colorectal cancer metastases in Poland and the first one using a telemedicine platform during qualification. No recurrence has been observed since transplantation, and the patient remains in complete remission to date. Despite advances in induction therapies, most patients with unresectable liver metastases require palliative systemic treatment, the efficacy of which is limited. This case highlights the potential of liver transplantation as a breakthrough treatment option in selected patients. Further studies are needed to evaluate its efficacy in broader patient populations.
Ziółek et al. (2026) studied this question.