Liver transplantation (LT) has rarely been used to treat unresectable gastrointestinal stromal tumor (GIST) metastases, according to a comprehensive literature review recently published in the International Journal of Surgery.
“Although its [LT] application has a solid theoretical basis, its use understood as a radical extension of a standard resection can only be recommended within prospective studies by groups with considerable experience in both GIST and transplantation care,” Fernández et al concluded.
Collaboration between the University Hospital of Virgen de la Arrixaca and the Biomedical Research Institute of Murcia in Spain identified 15 cases of LT in patients with nonresectable GIST with liver metastases, with nearly half (n=8) dated prior to 2002. The overall survival was 86.6% after a mean follow-up of 52.4 months. Disease-free survival was 53.3%.
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Most (84.6%) patients were women and the mean patient’s age was 41.6 years (age range, 16-63 years). The primary tumor was mainly located in the stomach (n=6) and duodenum (n=6). The remaining 3 cases referred to jejunoileal, rectovaginal, and mesenteric GISTs. Except for 1 case, all primary tumors were initially removed.
In 12 cases the procedure was performed with a deceased donor, whereas the remaining 3 cases were performed with a living donor. Seven cases included data regarding the mutational status.
According to the authors, the already available expertise in using LT for the management of colorectal liver metastases and neuroendocrine tumors liver metastases could be advantageous to better understand its potential role in GIST metastases.
“The current interest in LT is due to the availability of very effective chemotherapy, better image characterization of metastatic lesions, more precise knowledge of [colorectal liver metastases] tumor biology, better overall LT results, and the potential role of molecular targeted therapy,” they said.
Fernández JÁ, Alconchel F, Gómez B, Martínez J, Ramírez P. Unresectable GIST liver metastases and liver transplantation: a review and theoretical basis for a new indication. Int J Surg. 2021;94:106126. doi:10.1016/j.ijsu.2021.106126