Question for those who became liver resectable

[BrianMc7]

For those who weren't initially a candidate for a liver resection and then later became one, who made the decision that you were now a candidate for a resection? Your onc? a liver surgeon? ??? Just wondering how this decision is made.

Thanks,
Brian

[ForDad]

Hi Brian,

In my dad's case, the oncologist and surgeon both participated in the decision. After seven rounds of chemo, our oncologist ordered a CT scan, and he thought that my dad would be a candidate for resection. He consulted with the surgeon, and our surgeon agreed.

What was tricky about my dad's liver was that one of his tumor was very close to the vena cava. It would have been the surgeon's final call whether he would attempt the surgery or not, but the oncologist was very involved throughout.

I really appreciate how our surgeon and oncologist are communicative with each other and with us. I hope you also have a great team working on your behalf!

Best wishes,
Sue

[andy21]

What is resectable for one surgeon may not be resectable for another.
It's great to find the best possible surgeon.

In my own experience, the best surgeons are those who have done liver transplants since they know much more about hepatic arteries.
So try to find an onco surgeon who has also done Liver transplants.

[ConnieSPK]

I concur with Andy21. I had the good fortune to have to have a skilled liver transplant doctor.

Connie K.

[stars9979]

Someone had a BRILLIANT post on a similar thread which completely explained the process....

Its not about size persay, as anytime they resect they must cut 5 cm outward in all directions, so it also in regards to location on the liver or colon, any arteries or anything else near it as well.

I totally didnt do it as justice as the previous person.... I will tyr to find that post.

[stars9979]

FOUND IT:

Report this postReply with quoteRe: what is the max tumor size to be deemed surgical?
by SkiFletch » Thu Jul 31, 2014 8:46 am

The size of the tumor on a scan is not the determining factor for surgical candidacy. The largest factor for determining resectability is the distance from the edge of the tumor (in the scan) to an organ/vessel/structure that is NOT removable. I'll take some time to explain why, cause if you understand it, you might accept the decision easier.

The visible size of the tumor on CT is smaller than the actual coverage of invasive cancer cells. A met does not grow like a perfect sphere with clean lines of demarcation. If you cut one out and look at it under a microscope, one can see the "edges" of the tumor infiltrate a long way into "healthy" tissue. It's a swirling, tendrily pattern that happens at a cellular level, something even the best CT scanners in the world can't see. The length of this cellular-level infiltration can be anywhere from 1cm, to as much as 4cm from the edge. Generally, a surgeon attempts to get at LEAST 5cm away from the "visible edge" of the tumor to prevent microscopic cells from surviving the surgery, and re-forming a met. This is why you hear they want to get "good margins" when doing surgery. If microscopic cancer cells remain in the margin, the met WILL come back, just a matter of time.

So you mention your mother's liver tumor is in section 7 of the liver. That is all the way to the right, rear, and top of the organ. If her tumor is near the surface of the liver, it's do-able for the surgeon. It's always trickier with the rear segments, but essentially the surgeon chops a wedge out, done. If it's deep within section 7, further to the front and left and say within 3cm of the hepatic artery... Then it's not so simple as the surgeon has to assume that the hepatic artery segment is infiltrated with cancer cells and needs to be removed. They then have to consider removing section 8 as well, and perhaps even the whole right lobe if it's very much too low and close to the main hepatic artery, not just the upper branch of it. That's not an easy open-shut decision as regeneration of an entire lobe is never a sure thing, and the right lobe is the largest portion of the liver.

So, bottom line, there is no specific size of tumor that is operable or not. It's all about the distance from other required vessels/structures/organs.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

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

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[MonaL]

In my dad's case, it was the surgeon. Dad was pushing for surgery, onc said he wasn't a candidate. Dad's age, late seventies, may have had something to do with this. Finally the onc consulted the surgeon that said if the tumor responded to chemo after 3 rounds, he would operate. Thankfully, it responded. He had a met in each lobe, but I don't recall the exact details.

[CM35]

My oncologist was boderline/non committal about whether I was a candidate for a liver resection. So, I went to a major cancer center for a surgical opinion. 6 weeks later I was on the operating table. Never hesitate to get a 2nd opinion if you are not comfortable with what your current doctor is telling you. Another thing - my oncologist who was unconvinced I was a good candidate for surgery, was not offended in the least that I went for a 2nd opinion. I think they are pretty used to it with advanced cases with less than awesome prognosis.