Dr. Kazunari Sasaki and Team Collaborate to Perform Liver Transplant for Colorectal Cancer Patient, Offering New Hope for Extended Survival

Stanford Abdominal Transplantation surgeon Dr. Kazunari Sasaki recently performed a liver transplant for a patient diagnosed with colorectal cancer with multiple liver metastases, the first case of its kind done in the state of California. 

Despite initial success with chemotherapy, the patient’s tumor marker levels increased after treatment was paused, requiring continued chemotherapy. Following a referral from Dr. Brendan Visser, a HPB surgeon at Stanford, the patient was evaluated and determined to be a suitable candidate for liver transplantation by Dr. Sasaki.

Historically, liver transplants for patients with colorectal cancer liver metastases were not considered viable candidates for transplant due to poor outcomes. However, recent advancements in chemotherapy and research from institutions like the University of Oslo have demonstrated the potential for significantly improved survival. In 2023, a French study further supported these findings, showing that liver transplantation offers better long-term survival compared to systemic chemotherapy alone. While the procedure does not guarantee a cure, it provides a significant survival advantage and can allow patients to discontinue chemotherapy temporarily, improving their quality of life.

Advances in chemotherapy and multidisciplinary cancer care have made this treatment possible. Dr. Sasaki noted that integrating chemotherapy, radiation, resection, ablation, and transplantation into a comprehensive strategy has been key to the emergence of liver transplantation as a viable option for colorectal cancer liver metastases.

“The patient’s post-surgical recovery has been remarkable,” said Dr. Sasaki. “He was discharged just five days after the procedure, which exceeded his expectations of a longer hospital stay. His next steps include ongoing monitoring and care.” 

Dr. Sasaki explained that good candidates for this procedure typically have unresectable disease that has shown a good response after multiple cycles of chemotherapy. Ideally, after demonstrating a positive response, the patient's tumor size and tumor markers should remain stable for three to six months. Dr. Sasaki also highlighted the importance of the Oslo score in evaluating candidates: "A patient with an Oslo score of 0-1 tends to have favorable outcomes,” says Dr. Sasaki. The Oslo score is based on four factors: carcinoembryonic antigen (CEA) level less than 80, tumor size less than 5.5 cm, good response to chemotherapy, and primary tumor resection more than one year prior.

The Stanford Abdominal Transplantation team is eager to continue exploring this emerging treatment option. Dr. Sasaki shared, "We already have a second candidate for liver transplantation for colorectal liver metastases, and we are excited to expand this indication to help more patients in similar situations."

Dr. Sasaki credited the success of the case to the collaborative efforts of a multidisciplinary team, including Dr. Brendan Visser in the Division of General Surgery and Dr. Tara Ghaziani in the Division of Gastroenterology and Hepatology.