Postby mpbser » Mon Aug 28, 2017 11:56 am
Fax to Albany doctor, b/c there are issues with the phone line:
I am reaching out to you because my husband needs liver surgery.
To try to make a long story short, he was diagnosed with adenocarcinoma of the colon after being admitted to the hospital (SVMC in Bennington) with congestive heart failure February 27 to March 1. The CHF was due to acute anemia which was being caused by a blood at the left/descending colon where the tumor was located and had invaded through the intestinal lining. CT scan and pathology from April 12th colonoscopy confirmed malignancy. The colonoscopy was incomplete due to the obstruction.
M---- had a nuclear stress test on May 2nd and the above-mentioned heart catheterization around May 10th to clear him for a May 19th hemi-colectomy performed by Dr. John Cope SVMC. His ejection fraction had improved from the February 28th 30% to 40%, so his cardiologist, Dr. Scott Rogge at SVMC, cleared him for the procedure. While performing the LAP resection, Dr. Cope discovered one or two small masses (I can’t recall exactly what he said he saw back at that time) on the liver. He took a wedge biopsy from the left lobe which came back with positive malignancy. Also, 9 out of the 54 removed nodes were positive.
On June 17th, M---- had a PET scan which found masses at the transverse-right colon juncture as well as on the liver. He had an abdominal MRI on June 30th which indicated two masses on the liver: one on the left lobe where the wedge biopsy was taken and one on the right lobe.
In the following month, Dana Farber performed genetic testing and M---- decided to be a patient at Mass General for his primary oncology advisement and treatment guidance. After much delay in scheduling appointments with Mass General’s oncologist Dr. Zhu, colorectal surgeon Dr. James Cusack, and liver surgeon Dr. Motaz Qadan, he finally had a LAP sub-total colectomy at Mass General on August 21th.
The plan was to do the LAP colon resection and LAP “chip” of the right liver lobe and LAP RFA of the small (.5 cm) left lobe mass all at the same time. Unfortunately, when Dr. Qadan ultrasounded the liver and did a visual inspection, he saw that either 1) the left lobe mass had increased in size since the June 30th liver MRI and was too large to remove with the “chip” process as it is located right up against a blood vessel or 2) the MRI imaging imprecisely showed its dimensions. The LAP liver procedure was aborted but the colectomy was performed.
The plan moving forward appears to be that M----will recover from last week’s surgery, then have a couple months of chemotherapy, and then will have open liver surgery. If the chemo has shrunk the tumor, then if it is small enough, the “chip” method could be used for its removal. Although RFA had been originally planned for the right lobe mass last week, because the goal had been just to do a laparoscopic procedure (M----’s preference at the time with the information available at the time), since he would be opened up this time, chip/surgical removal of that spot would now make sense.
Dr. Qadan also suggested another possibility of removing the left lobe in its entirety because he also saw numerous small spots scattered on the left lobe.
The reason we are reaching out to you is that M-----’s post-operative recovery at Mass General was horrific and we are now debating the wisdom of returning there for the liver surgery. In particular, he was discharged 1) before he was able to be sufficiently monitored for pain and nausea control once out of the hospital and 2) with an excruciatingly painful 5 hour car ride back to Bennington to one of our residences. Although I had inquired about the travel issue, it was woefully addressed and a cascade of events subsequent to that painful car ride on Thursday has led to him having small bowl obstruction consequent to the need for opiates to control the pain. He is currently inpatient at SVMC under Dr. Cope’s care.
We have an appointment to see Dr. Zhu at Mass General on September 12th. We hope to also see Dr. Qadan at that time as well. If we decide against Mass General, and would like you to perform his surgery, we would appreciate an appointment perhaps September 14th or 15th for a consultation. I would also want all the records from Mass General and SVMC to be sent to you beforehand.
I look forward to hearing from you or your office.
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED