bitchslapped wrote:Hello Everybody,
There are a few people on here following the story of my BFF, 64, F dx'd w/appendix cancer low grade mucinous neoplasm, 2cm, 0 LN + mucinous carcinoma peritonei or something close to that (spread to peritoneum). There are so many different dx to appendix cancer. Anyway, I intended to share her HIPEC experience, CRS/HIPEC (Cytoreductive Surgery + Hyperthermic Intraperitoneal Chemoperfusion) here on the forum b/c we don't see that many of them on here...recent ones, or much detail. Of course this is all second hand info, so w/b short on some of the details as they are out of state now for the surgery, but intend to share the good, the bad & the ugly as I know it. Might be some editing along the way.
Brief Background:
It took many docs to finally get this dx, laparoscopic surgery to remove appendix + a couple of lesions in peritoneum, one of which was close to the liver. This eliminated her upper right side abdominal pain that she had been experiencing for a few months. She then flew to consult w/Dr. Andrew Lowy, UCSD, Moores Cancer Center @ which time he estimated her PCI (peritoneal cancer index) of under 10, making her a good candidate for HIPEC w/estimate of 5 hr CRS + HIPEC.
Surgery
Bowel prep day before surgery. The procedure took place Fri.,Dec.1, approx 6 hrs total. Disease was limited to the right side of abdomen, lower tumor burden than they typically see, 2 lesions on liver, one upper diaphragm, the balance apparently is removed via stripping out the peritoneum likened to removing wallpaper as described by doc, also removed the omentum. No organs removed, HIPEC portion (chemo bath) approx 45 min - 1hr. Yesterday afternoon (12/2) she was sitting up on the edge of her bed, standing up w/walker, however learned from email from her DH that last night pain from drain tube, low blood pressure, heart rate 180, AFIB. Team of docs got her normalized around 11:30 pm. She does take BP meds. This afternoon (12/3) she is up in a chair, took a couple of steps.
I was a little unnerved by this turn of events, but all seems well for now.
BS
bitchslapped wrote:Surgery
Bowel prep day before surgery. The procedure took place Fri.,Dec.1, approx 6 hrs total. Disease was limited to the right side of abdomen, lower tumor burden than they typically see, 2 lesions on liver, one upper diaphragm, the balance apparently is removed via stripping out the peritoneum likened to removing wallpaper as described by doc, also removed the omentum. No organs removed, HIPEC portion (chemo bath) approx 45 min - 1hr. Yesterday afternoon (12/2) she was sitting up on the edge of her bed, standing up w/walker, however learned from email from her DH that last night pain from drain tube, low blood pressure, heart rate 180, AFIB. Team of docs got her normalized around 11:30 pm. She does take BP meds. This afternoon (12/3) she is up in a chair, took a couple of steps.
I was a little unnerved by this turn of events, but all seems well for now.
BS
bitchslapped wrote:... Anyway, I intended to share her HIPEC experience, CRS/HIPEC (Cytoreductive Surgery + Hyperthermic Intraperitoneal Chemoperfusion) here on the forum b/c we don't see that many of them on here...recent ones, or much detail...
CRS plus HIPEC
Plain Language Summary
Peritoneal malignancy (PM) is an advanced form of cancer found in the peritoneal
cavity – the fluid-filled gap between the walls and the organs contain in the
abdomen. This type of cancer occurs due to dissemination of primary tumour from
the appendix, colon, rectum or ovaries. It is associated with short survival and poor
quality of life.
Cytoreductive surgery (CRS) refers to the destruction of visible tumour throughout
the abdomen. This is then combined with hyperthermic (warm) intraperitoneal
chemotherapy (HIPEC) to increase the effectiveness of the combined treatment.
There is moderate to good quality evidence based on systematic review and meta-
analysis for the clinical effectiveness of CRS plus HIPEC in highly-selected patients
with PM of colorectal origin.
There is poor to very poor data based on case series data available for the clinical
effectiveness of CRS plus HIPEC in highly selected patients with PM of appendiceal
origin. The majority of data for this tumour sub-type was available for patients who
developed pseudomyxoma peritonei, a different disease which was outside of the
scope of this review.
There is moderate to poor quality evidence that quality of life is improved from about
three months following the procedure. Quality of life responses were higher in well
selected patients.
In long-term follow-up, there was conflicting evidence for survivors whether they
have similar QOL to that of a matched group of other cancer survivors, or if
significant physical deficit remains in patients who had CRS plus HIPEC.
There is poor to moderate quality evidence for safety for CRS plus HIPEC. The
evidence available shows that CRS plus HIPEC carries a significant risk of mortality,
morbidity and adverse events.
There is poor quality evidence on recurrence rates following CRS plus HIPEC. The
evidence available suggests a high recurrence rate which required 2nd and 3rd repeat
interventions in the studies assessed.
The evidence on cost effectiveness is limited to a single study. This shows that in
highly selected patients CRS plus HIPEC may be cost effective but that the CI are
large. The approach adopted in this study was based on a deterministic approach to
cost benefit yielding a cost per life year analysis which did not take into account any
data on QOL for this patient group and was based on a cost per life year calculation.
.
Annex (ii) CRS plus HIPEC version final draft 28.10.14 (103 pages)
Ref: http://www.whssc.wales.nhs.uk/document/284802
bitchslapped wrote:Made some edits to above posts as have later learned that additional mytomycin-c chemo was added during HIPEC. Also added subject titles to links.
Update: 12/18) 17 days post HIPEC BFF developed incisional soreness @ navel area, slight downturn of wellbeing 12/19) NP requested pic of area as BFF lives out of state) & called in Rx for antibiotics. Infection was visible on outside, white in appearance (pus), inch or so below navel, extending inch & a half or so, some drainage.
Visited her 12/20, feeling better, no sign of infection.
She is still walking, doing light load of laundry w/o carrying laundry basket. She is not supposed to lift over 5 lbs for next couple of months. No complaints from her, feels Dr. Lowy & staff, & UCSD hospital & staff aftercare outstanding. She is up, dressed, daily walks, resting, taking it easy.
BS
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