Stoyanova M, Mircheva I, Chulkov I, Karamiteva M, Goranova Z, Simeonova V, Zashev M, Velikova T, Peruhova M. Current perspectives and guidelines on liver transplantation for metastatic colorectal cancer. World J Transplant 2025; 15(4): 104945 [DOI: 10.5500/wjt.v15.i4.104945]
Corresponding Author of This Article
Miroslav Zashev, MD, Assistant Professor, Chief Physician, Department of General Surgery, Heart and Brain Hospital, Zdrave 1 Str, Burgas 8000, Bulgaria. zashev.md@gmail.com
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Gastroenterology & Hepatology
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 18, 2025 (publication date) through Nov 19, 2025
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World Journal of Transplantation
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Stoyanova M, Mircheva I, Chulkov I, Karamiteva M, Goranova Z, Simeonova V, Zashev M, Velikova T, Peruhova M. Current perspectives and guidelines on liver transplantation for metastatic colorectal cancer. World J Transplant 2025; 15(4): 104945 [DOI: 10.5500/wjt.v15.i4.104945]
World J Transplant. Dec 18, 2025; 15(4): 104945 Published online Dec 18, 2025. doi: 10.5500/wjt.v15.i4.104945
Current perspectives and guidelines on liver transplantation for metastatic colorectal cancer
Mirela Stoyanova, Irena Mircheva, Ivan Chulkov, Madlena Karamiteva, Zvezdina Goranova, Viktoria Simeonova, Miroslav Zashev, Tsvetelina Velikova, Milena Peruhova
Mirela Stoyanova, Irena Mircheva, Ivan Chulkov, Madlena Karamiteva, Zvezdina Goranova, Viktoria Simeonova, Milena Peruhova, Department of Gastroenterology, Heart and Brain Hospital, Burgas 8000, Bulgaria
Miroslav Zashev, Department of General Surgery, Heart and Brain Hospital, Burgas 8000, Bulgaria
Tsvetelina Velikova, Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
Author contributions: Stoyanova M, Peruhova M, and Velikova T wrote the majority of the manuscript; Chulkov I, Goranova Z, Mircheva I and Stoyanova prepared the tables; Zashev M wrote the part related to the surgical techniques. Karamiteva M and Simeonova V provided critical revision, designed the manuscript outline, and coordinated the writing of the paper.
Supported by the European Union-NextGenerationEU, through the National Recovery and Resilience Plan of the Republic of Bulgaria, No. BG-RRP-2.004-0008.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Miroslav Zashev, MD, Assistant Professor, Chief Physician, Department of General Surgery, Heart and Brain Hospital, Zdrave 1 Str, Burgas 8000, Bulgaria. zashev.md@gmail.com
Received: January 7, 2025 Revised: March 3, 2025 Accepted: April 14, 2025 Published online: December 18, 2025 Processing time: 316 Days and 16.9 Hours
Abstract
Colorectal cancer (CRC) is the third most common cancer globally, with 20%-25% of patients diagnosed at stage IV, significantly affecting overall survival (OS). Only 14% of stage IV patients survive for 5 years with palliative chemotherapy. However, the role of liver transplantation (LT) in the management of CRC liver metastasis (CRCLM) is an evolving area of interest. Recent advancements in oncologic outcomes and clinical understanding have prompted the re-evaluation of LT as a viable treatment option for CRCLM. A promising result from some prospective pilot studies reported a 5-year OS rate of 60% after LT for patients with CRCLM. Key factors influencing eligibility include tumor biology, absence of extrahepatic disease, and the patient's performance status. By synthesizing the latest research findings, we aim to provide a comprehensive overview that summarizes the most relevant data related to the clinical outcomes of patients who underwent LT for CRCLM. We aim to provide a comprehensive overview by synthesizing the latest research findings. This review discusses the inclusion criteria and eligibility for LT in CRCLM, which are of great importance to patient outcomes.
Core Tip: It is a well-established fact that more than 40% of patients with colorectal cancer (CRC) develop liver metastasis during the disease course despite all the surveys leading to more suitable systemic treatments, efficient chemotherapy, and surgical resections. liver transplantation (LT) could be a treatment option for patients with unresectable CRC liver metastasis without extrahepatic involvement. The initial assessment and proper selection of suitable patients is mandatory for better outcomes for these patients. It turns out that to be candidates for an LT, patients have to meet strict criteria described in the two prospective studies, SECA-I and SECA-II. Despite the proven benefits of LT for non-resectable colorectal liver metastases, this method is still not widely used worldwide due to a lack of policy and healthcare reforms in many countries.
