Is surgery always the best option?

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floss32
Posts: 25
Joined: Sun Jul 25, 2010 6:55 am

Is surgery always the best option?

Postby floss32 » Wed Jul 23, 2014 2:35 pm

Hello again, it's been a while. My father was diagnosed June 2010. He has been off chemo since November 2013. His last CEA showed an increase from 4 to 13. So then oncologist ordered a PET scan but you only get three in your lifetime with the new changes in Medicare and he only has one left. So than the onc decided on a CT in case down the road we need the PET. The results from the CT showed only a slight increase in one tumor 4.5 cm, the other one feels it is scarring from the first surgery and no other changes. His original liver surgeon said there was nothing more he could do. The tumor was to close to a major blood supply. The onc sent us to another hospital for another opinion. Dr #2 told us he does not qualify for interventional radiology procedures, to risky and a lot of scar tissue present. But Dr #2 said he could do surgery felt very confident and would do ablation remove 6cm around that 4.5 tumor.
I read a lot on here that people want to become operable, because this is the best chance for survival?
How many times can one do surgery on the liver?
My main concern are complications from this surgery. My Dad's quality of life is very good. He works full time, looks great very healthy. Will this really extend his life vs. not doing the surgery and just doing more chemo?
Any statistics showing the advantage to doing surgery on recurrences a second time vs. just leaving things as they are?
I feel like I have so many questions and just don't know how to ask them. Maybe there are no answers. My gut tells me not to let him have the surgery. Any advice welcome......

michelle c
Posts: 1929
Joined: Wed Dec 02, 2009 3:58 am

Re: Is surgery always the best option?

Postby michelle c » Wed Jul 23, 2014 2:43 pm

I understand that surgery is the best chance for a cure.
May 25 2009 Dx with CC (sigmoid colon) 2 days after my 44th b'day
CEA prior to surgery 4.7
Jun 3 2009 LAR - Stage III 3/10 lymph nodes
Jul 6 - Dec 10 2009 - 12 cycles FOLFIRI
Genetic testing - inconclusive for Lynch
Jul 2012 port removed & hernia repair

michelle c
Posts: 1929
Joined: Wed Dec 02, 2009 3:58 am

Re: Is surgery always the best option?

Postby michelle c » Wed Jul 23, 2014 2:45 pm

ooops sorry, 3 times, don't know what happened :D
May 25 2009 Dx with CC (sigmoid colon) 2 days after my 44th b'day
CEA prior to surgery 4.7
Jun 3 2009 LAR - Stage III 3/10 lymph nodes
Jul 6 - Dec 10 2009 - 12 cycles FOLFIRI
Genetic testing - inconclusive for Lynch
Jul 2012 port removed & hernia repair

floss32
Posts: 25
Joined: Sun Jul 25, 2010 6:55 am

Re: Is surgery always the best option?

Postby floss32 » Wed Jul 23, 2014 2:51 pm

He is Stage 4-this is a chronic condition with no cure. Especially if he has had a recurrence after the first surgery. Right? What if surgery kills him?

KWT
Posts: 3214
Joined: Thu Jul 11, 2013 7:22 pm

Re: Is surgery always the best option?

Postby KWT » Wed Jul 23, 2014 3:01 pm

Third times a charm Michelle :wink:

SkiFletch
Posts: 6361
Joined: Mon Dec 07, 2009 3:39 pm
Facebook Username: Michael Fletcher
Location: Buffalo, NY

Re: Is surgery always the best option?

Postby SkiFletch » Wed Jul 23, 2014 3:20 pm

floss32 wrote:I read a lot on here that people want to become operable, because this is the best chance for survival?
How many times can one do surgery on the liver?
My main concern are complications from this surgery. My Dad's quality of life is very good. He works full time, looks great very healthy. Will this really extend his life vs. not doing the surgery and just doing more chemo?
Any statistics showing the advantage to doing surgery on recurrences a second time vs. just leaving things as they are? .


Yes, surgery offers the best chance for longer term survival and longer term remission, even the low possibility of a cure.

Only a liver surgeon is really qualified to answer the question of how many liver surgeries one can tolerate. Without the removal of major blood vessels, the liver CAN regenerate if given enough time, and multiple liver surgeries is not only possible but I've seen it done a bunch around here. When you have to remove entire lobes and/or most of the major blood vessel supply for the liver, that's when repeat surgical possibility can be limited. None of us are either qualified to answer how that translates specifically to your dad, nor do we even have his scans/history/etc. It CAN be done, but only his surgeons can give you a good idea about whether it SHOULD be done.

None of us have a crystal ball to say any of the following definitively; 'Your dad will sail through surgery, be cured, and live a long life;' 'Your dad will have massive complications from surgery and die a week later;' 'Chemo would have been better because of his adverse reaction to surgery;' 'Surgery would have been better because his tumors became resistant and didn't respond to chemo;' etc, etc. There are so many iterations here, it's almost dizzying and none of us can predict the future. The best we can do is relay the basic reality that surgery offers the "best" chance for longterm treatment success, though it's not an open and shut decision. Your father should discuss with his Drs whether HE specifically is at more or less risk for surgical complications based on his age, history, and tumor location. I'm 34, healthy, and have lots to live for. If I personally had one liver tumor that a surgeon said he could remove, I'd have him chop it out right away. The risk is worth the longterm reward for me. Dunno how old your father is, but that reward might not be so long anyways depending on the rest of his overall health. I wish I could give you a concrete answer, I just can't. The best suggestion I think I can offer is to have your dad ask himself the following after really discussing with his surgeon his personal risks; "Given the risks, if I choose to NOT do the surgery, and the cancer comes back, will I regret that decision?"

Lastly, the data indicate relatively similar survival rates between 1st and 2nd resections given the same number and size of tumors. Especially when both surgeries involve single, solitary mets.
11/13/09 5cm Stage IV 9/25 lymph nodes w/2cm peritoneal met at 29 YoA
12/15/09 LA right hemi-colectomy
6/16/10 Folfox FINISHED
8/10/10 Prophylactic HIPEC
10/9/10 got Married :D
Still NED and living life to the fullest

"Can any one of you by worrying add a single hour to your life."

User avatar
Rob in PA
Posts: 2022
Joined: Wed Dec 09, 2009 9:16 pm
Location: Pennsylvania

Re: Is surgery always the best option?

Postby Rob in PA » Wed Jul 23, 2014 3:57 pm

I had 70% ish of my liver resected and it grew back fine with no recurrence in the liver. Doc told me back then that if it did come back, he'd keep doing surgery on it as long as the liver was healthy enough to do it.

Rob
dx 11/07 crc IIIb @ 39
Xelox/Rad/ temp colostomy
LAR/J-pouch/ temp ileo
Folfox-8
Failed reversal
2/09 liver mets; liver resect/ileo reversal
Folfiri/Avastin - 12
2/11 5 lung mets
Folfiri/Avastin 2011
SBRT 3/12
Lung met 5/13/ said NO to more chemo
SBRT 8/13
2 lung mets 5/14, VATS 8/14, NED

floss32
Posts: 25
Joined: Sun Jul 25, 2010 6:55 am

Re: Is surgery always the best option?

Postby floss32 » Wed Jul 23, 2014 7:47 pm

Surgery it is- August 6th. We met with his Oncologist today and he said to go for it. This is his best option at this time. My Dad turns 66 on August 1st. He did recommend another CT, the last one taken May 28,2014. Just 2 months ago. He said with surgery it was a good idea to take another. I guess my gut should not always be listened to. Thank you for your responses. SkiFletch, glad to see you back and congratulations on your beautiful daughter! God bless.....here we go again!

floss32
Posts: 25
Joined: Sun Jul 25, 2010 6:55 am

Re: Is surgery always the best option?

Postby floss32 » Sun Sep 14, 2014 10:22 am

Impression:
IMPRESSION:
1. Since the July 31, 2014 CT, intrahepatic infiltrative mass has
enlarged. There is also new free fluid with rim enhancement adjacent to
the liver. Moreover, several lymph nodes just above the diaphragm, are
larger as well. One perihepatic lymph node has also enlarged. Segmental
intrahepatic ductal dilatation is either stable or has progressed.
Findings are concerning for progressive neoplastic metastatic disease.
2. Portal vein and hepatic vein evaluation is limited in this single phase
postcontrast CT. However, main portal vein is patent.

Translate please, Findings are concerning=bad news. We don't see the Oncologist till Wednesday and I need to know more so I am mentally prepared and don't breakdown in front of my Dad on that day. This was the CT he had on 8/27 after his resection on 8/6/14. Recovered well and is back full- time at work. Was back to work part time a week after surgery. He has not had chemo for a while, over 6 months. Any words of wisdom appreciated! Thanks

justin case
Posts: 4269
Joined: Sun Sep 04, 2011 8:26 am
Location: Katy, Texas

Re: Is surgery always the best option?

Postby justin case » Sun Sep 14, 2014 1:43 pm

Isn't it a little too soon after surgery to worry about inflammation, and other things, that could be associated with such surgery?
If I was 66, I would not hesitate to retire, and take a few moments for myself.
Michael
7/11 diagnosed Stage 2 colon and rectal cancer
chemo/rad
lar/temp ilio
Reversal & port removal
21 round of chemo Folfox 9tx, 5fu 12 tx
Last treatment July 2012

Girl111
Posts: 234
Joined: Fri Dec 06, 2013 4:43 pm

Re: Is surgery always the best option?

Postby Girl111 » Sun Sep 14, 2014 3:26 pm

Has anyone who developed liver mets or any mets read their ct report ?

I wanted some input please . The radiologist has stated ..... New liver lesion in segment 6 of 15 mm.

Appearances keeping with disease progression .

What I want to know is that if met is suspected / seen on scan do they actually use the word metsases or do they generally word it as the above ?
Dad diagnosed stage 3 cc nov 13
Bowel resection march 14
Started xeloda
1 liver met and 1 node ( small)
Started irinotecan - failed
Poss nano knife now and oxyplatin
Hope the chem works !


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