Liver transplantation (LT) for unresectable colorectal liver metastases (CRCLM) has gained momentum globally in recent times. The Fixed Term Working Group (FTWG) of  NHS Blood and Transplant (NHSBT) Liver Advisory Group (LAG) in the United Kingdom has recommended that liver transplantation may be undertaken for isolated and unresectable CRCLM within the scope of a national clinical service evaluation programme, that began in the fourth quarter of 2022.
 
This survey intends to obtain information from centres across the country about the specifics of their surgical/ oncological practice and estimate the overall number of patients that may be eligible for study recruitment. Questions have been designed to gather data from recruiting centres over a two- year period starting from the 1st of April 2020.

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1. Are you aware of the UKCOMET National Service evaluation?

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2. What is the name of your department and trust?

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3. Based on your knowledge of current literature, do you believe that a service evaluation on LT for unresectable CRCLM will be beneficial to patients?

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4. How many patients with colorectal cancer have been diagnosed with unresectable CRCLM in the past two years?

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5. How many patients with isolated, unresectable CRCLM patients seen at your centre in the past two years currently have the primary tumour in situ?

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6. In the event that LT may be a treatment option for patients with unresectable CRCLM, would you consider early resection of an asymptomatic primary?

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7. If you disagree with resecting an asymptomatic colorectal primary in these patients, can you state your reason(s)?

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8. Do you think that a two-year period of sustained response to chemotherapy (CT) is an acceptable duration to judge tumour biology before consideration for LT?

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9. If you disagree, what in your opinion is the right duration of sustained response before consideration for LT in these patients?

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10. What is the best imaging modality  in patients with T3/T4 primaries, given the risk of peritoneal disease that could preclude transplant?

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11. Currently, previously resected liver metastases are not considered for LT by the FTWG. Do you agree with their recommendation?

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12. Based on the following criteria, how many patients seen in the last two years may be eligible for the UKCOMET service evaluation from your centre?


UKCoMET Inclusion criteria

- Histologically verified primary adenocarcinoma in colon or rectum that has been fully resected at least 3 months before listing, with microscopically negative resection margins (including CRM of ≥ 1mm).

- Isolated synchronous/ metachronous CRCLM on CT and liver MR with no liver resection option, based on the outcome of local MDT and sanctioned by Independent National Panel.

- At least 30% sustained response to induction CT over a 2- year period, based on RECIST criteria; Disease progression/ second line therapy will lead to ‘reset’ of clock.

- No signs of extra hepatic metastatic disease or local recurrence in PET- CT within 4 weeks of listing meet.

- No signs of extra- hepatic metastatic disease or local recurrence according to CT and MR (thorax/abdomen/pelvis) scan within 4 weeks prior to the listing meet

- No signs of local recurrence on colonoscopy / CT colonography within 12 months prior to listing meet

- No evidence of peritoneal recurrence on diagnostic laparoscopy and/ or MR abdomen and pelvis with DWI in two planes, in case of T3 or more tumours, within 4 weeks of listing meet.

- Good performance status, ECOG 0 or 1. 

- Hb >10g/dl, Serum Bilirubin < 5 x upper normal level, Serum Creatinine < 1.25 times ULN, albumin above lower range of normal

- Signed, informed consent as per Good Clinical Practice

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13. Based on the following criteria, how many of the above patients will be excluded from the service evaluation?

UKCoMET Exclusion Criteria

- Weight loss >10% the last 6 months

- Patient BMI > 30

- Any second primary malignancies, except non-melanoma skin cancers

- Prior extra hepatic metastatic disease or local relapse.

- Sequentially increasing serum CEA assays

- Patients who have not received standard operative treatment for the primary CRC.

- Patients who have undergone palliative resection of primary CRC tumour

- Patients with complete clinical response of primary tumours, without radical resection.

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