Update - Advice urgently needed - liver resection now or lat

[Stanfordmom]

Hi All,

Happy New Year! Wish you all health and happiness in the new year!

Anyhow, I got my scan done at Sloan last week, and DR. DeMatteo ( my liver surgeon) talked to me about possible PVE (portal vein embolization) and liver resection soon. Since the majority of my mets are on my right lobe so my right lobe will be resected completely. I have a few on the left lobe that can be wedged away easily but one met is sitting close to an important blood vessel on the left side. he said he could try RFA or IRE during the surgery but cannot guarantee getting rid of that one completely. So the worse case I will be left one met on the left lobe, and further chemo or liver regeneration might get it a little away from the blood vessel. The he might be able to cut it out.

The alternative will be continue systemic and HAI pump chemo for two months and re-evaluate. There are two risks here: more chemo might damage liver's regeneration ability and chemo might stop working and the mets might be bigger next time. Then I might lose this one opportunity for liver resection.

I know you guys are not physicians, but please any thoughts or advice would be welcome!

Thank you all so much!

Sha

[lpas]

Did the doctor provide any stats on how likely further chemo is to affect regeneration? I'm no expert but it feels like getting that left side met to a more resectable status offers your best shot at a possible cure. For me I think it would depend on the likelihood of more chemo impacting the regeneration.

[pukalania]

Hi Sha,
I will just share our experience you can see what may work best for you...

My hubby had a few 7-8 mets in liver in 2012..one sitting on that portal veine..first he did avastin and xeliri for 3 months...then had liver resection for all of the mets..the one sitting on the vein got burned...during surgery all was checked and clear margins were determined..he was NED for 7 months while on xeloda- celebrex maintenance

then he had an infection and 4-5 liver mets popped up again..couple at resection site despite clear margins..he did a bunch of chemo after folfox and avastin..just xeloda and celebrex...irinotecan and 5FU...they shrank a bit but still were there..finally got zapped with SBRT a year later...

today they are still there even after SBRT..because of all the surgeries he had in the past and SBRT is not a good idea to do a resection again and in his case that didn't help too much in the beginning...

i think i'd still have chosen surgery tho to try to get rid of it as afirst option if you are physically strong to do that...if in your case you don't need chemo to shrink stuff a bit more...why not surgery...liver regenerates and if things keep popping up there are always more options ..once you hit it with radiation it gets harder to do surgery..if not impossible so gives you more options in the future

hope this helped
good luck

[tnt23]

My daughter did a 2 part resection at MD Anderson with a PVE. She did 4 rounds of Folfox with Avastin. They did a wedge resection on her left side that had one met - 10 days later did the PVE and six weeks later took out the entire right lobe -had five Mets there total of 70 per cent of her liver removed. I can't recommend action for you. All I can say is her doctor wanted to get her just enough chemo to stop any more Mets from occurring- show shrinkage- and get her to surgery asap. He was concerned that too much chemo would impact regeneration after the PVE. She barely made the regeneration percentage for the second surgery by 2 percent. She did 8 rounds of chemo after. She is currently ned. Thoughts and prayers are with you as you determine the right plan for you.

[juliej]

Sha, if it was me I would go for the resection now. The "worse case" (one leftover met) isn't that bad and the "best case" (Dr. D manages to RFA or IRE the single troublesome met during surgery) is too wonderful not to take a chance. I appreciate the honesty of MSKCC surgeons as I'm sure you do. But you wouldn't believe how many stories I've heard where the surgeon said something was "maybe" and it turned out to be doable. MSK surgeons are the best in their field and this might turn out to be the only liver surgery you'll need. Plus, more FUDR could damage the liver's regeneration ability. All my surgeries involved some degree of "taking a chance" and I don't regret any of them. All best to you - whatever you decide!

xoxoxo,
Julie

[Bev G]

Sha,

I echo exactly what Julie said. Going for it while the going is good seems the most prudent to me. Wishing you very good luck.

Bev

[andy21]

Sha,

I'll leave the answer to more experienced forum members, just wanted to convey very best wishes to you on your journey and hope that things turn in your favor.

[plastikos]

Hi Sha, go for the resection while its an option. It'll offer the best chance of potential cure.

[Maia]

Resection.
Just try and don't be off from systemic treatment for too long until and after the surgery MHO. If you're not offered that by your doctors, you probably can take at least celebrex (which is an anti-inflamatorie and pain killer -makes sense after a surgery), PSK, etc. on your own. Of course, cimetidne, peri-operative ("won't hurt, may help").
Just because you asked for direct input : )

[Easyflip]

My docs all think resect when you can. You want to reduce tumor burden which lowers chance of spread.

[Stanfordmom]

Thank you so much for your advice and good wishes. I emailed Dr. D. last night that I'd like to go with the PVE and surgery now. They are trying to set the appointments for me now!

Tnt23, what kind of chemo schedule your daughter had around PVE and liver resection? Thanks a lot!

Sha

[KWT]

Just go for it! That's great, weren't you told in the beginning no chance for surgery?

[tnt23]

She was on Folfox with Avastin. When she was given the go ahead for surgery, she had to go off chemo for 4 weeks due to taking Avastin. She did not go back on chemo until 5 weeks after her second surgery. She was very fortunate that she had no cancer growth during the breaks. Best wishes and prayers for a successful surgery.

[Decorina]

I have had two. The colon cancer moved on to my right lung, but no more in my liver. I would say go for it now.

[CM35]

Good luck, Sha! It looks like you have already made your decision... (It's the same one I would have made! ). You are in the best of hands, Dr D was my liver surgeon, too and so far, so good! I am so happy for you!

Colleen