I got my wife's para aortic lymph nodes removed after several turndowns in 2011. There are several hurdles and they are as much or more about defensive medicine, skill, experience and adequate multimodal treatment planning, as any possible net surgical benefit/risk to you. We found a highly rated surgeon who had removed para-aortic lymph nodes many times for ovarian cancer patients and was willing to invest in our story.
First, surgeons and oncologists typically presume that p-LN have multiple metastatic sites or seedlings and that you will be on chemo for life anyway, with or without a surgery. So surgically futile in their eyes. What they fail to realize, is which chemo for control of fewer and smaller sites can be a huge difference. Of course our brand of oral chemo only cost $150-$200/mo in 2011 and oncologists couldn't be bothered either. (actually they actively ostracized any dr who did since the 1980s - it would destroy their IV services - I've been cited several examples by drs who were there). The off label generic drugs and immune supplements, ha-ha, oncs always laugh first. By the weeks before surgery, any time I talked with surgeons or insurance, I carefully called this a solitary p-LN site because there were papers by 2011 that showed some success with surgery on solitary para-aortic LN sites. ("it's operable", they may need a little guidance)
Second, they worry about the proximity of the major blood vessels. An MDA alum, a thoracic surgeon, turned me down. He cited concern that there might be involvement of the node(s) with the major vessel. I re-interviewed a week later, and told him our radiologist (with some MDA associations) said that the mass was separated - the surgeon changed his tune and said yes. However, with the surgical team at another hospital, the lead surgeon had said no insurmountable problem in any case and was prepared to remove involved mets and repair the major vessel if necessary !
Third they are worried about surprises. Since my wife had earlier peritoneal involvement they were especially concerned that about disqualifying mets being found during the surgery, an "open and close" situation. I cited the advantages my wife had had chemo wise, and her scans' absence of evidence of spread. In actual fact, the physical mass was a lot larger than the scans showed, and what the drs assumed was a solitary node, was an LN cluster with extensions - bad news in their eyes - but the surgery was already done.
Fourth, we ran various (milder) cancer related treatments as close to surgery as possible, hours and days, not weeks or months, before and after. We even got the surgical team to accept cimetidine for the surgery itself as a replacement drug to the usual proton pump inhibitor.
In 2011, this took homework, practice on interviewing skills, and shaping perceptions with several sets of drs. Each option was explored with multiple opinions and papers and it paid off. The surgeon did require us to interview their oncologists on both chemo and radiation since surgery was usually last in consideration.
Last edited by rp1954
on Sun Dec 03, 2017 8:19 pm, edited 1 time in total.
watchful, active caregiver for stage IVb CC since early 2010. immuno"Chemo forever," for mCRC