OBJECTIVE to report the first case of resection and partial liver segment 2-3 transplantation with delayed total hepatectomy (RAPID) from living donor in a patient affected of irresectable colorectal liver metastases (i-CRLM) BACKGROUND:: A renaissance of liver transplantation (LT) for i-CRLM has been recently observed. The Norwegian SECA trial demonstrated a 5-year overall survival rate of approximately 60%, notwithstanding early tumor recurrence. The RAPID technique was recently introduced as alternative to whole deceased donor LT, but it is limited by poor availability of splittable organs and many organisational aspects. In this context left lateral living donor LT may be the ideal solution. METHODS Report about the technique and results of living donor RAPID procedure. TECHNIQUE A 49 years old woman affected with i-CRLM from adenocarcinoma of right colon, underwent a left hepatectomy with ligation of right portal vein maintaining the right hepatic artery patent. Subsequently, the left lateral lobe from her son was implanted as auxiliary partial orthotopic LT. Two weeks later completion of hepatectomy was performed. RESULTS The donor postoperative course was uneventful. The recipient developed postoperatively a slight small for size syndrome which spontaneously resolved. No graft dysfunction and no rejection were observed. At POM 5 micrometastases occurred in bones and lungs, which were treated with radiotherapy and chemotherapy, respectively. Almost 2 years later the patient is alive, in good general condition, although slight progression of bone and lung metastases. CONCLUSIONS LT poses a valid treatment option for i-CRLM. In times of organ paucity, "living donor-RAPID" procedure may represent a paradigm shift in the management of i-CRLM.

中文翻译：

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不可切除的结直肠肝转移管理的范式转变：活体供体辅助部分原位肝移植与两阶段肝切除术（LD-RAPID）的结合。

目的报告第一例活体供体的全肝延迟切除术（R-APID）在无法切除的结直肠肝转移（i-CRLM）患者中的切除和部分肝部分2-3移植的临床背景：：肝移植的复兴（LT） ）最近被发现用于i-CRLM。挪威SECA试验显示，尽管肿瘤早期复发，其5年总生存率仍约为60％。最近引入了RAPID技术作为整个已故捐赠者LT的替代方法，但由于可拆分器官的可用性较差以及许多组织方面受到限制。在这种情况下，左侧活体供体LT可能是理想的解决方案。方法报告有关活体供体RAPID程序的技术和结果。技术一名49岁的女性因右结肠腺癌受i-CRLM感染，接受了左肝切除术，结扎了右门静脉，维持了右肝动脉的专利。随后，她儿子的左外侧叶被植入作为辅助部分原位LT。两周后完成肝切除术。结果供体术后过程平稳。接受者术后自发消退的大小综合症略小。没有观察到移植物功能障碍和排斥反应。在POM 5处，骨骼和肺部发生微转移，分别经放疗和化学疗法治疗。大约2年后，尽管骨骼和肺转移发生了轻微进展，但该患者还活着，身体状况良好。结论LT为i-CRLM提供了有效的治疗选择。在器官匮乏的时期，“活体供体-RAPID”程序可能代表了i-CRLM管理的模式转变。