How to minimize surgical complications

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Ranunculaceae
Posts: 5
Joined: Thu Dec 28, 2017 10:49 am

How to minimize surgical complications

Postby Ranunculaceae » Thu Dec 28, 2017 10:58 am

34 year old on pre-op folfox + panitumumab for stage 4, surgery to be scheduled in a couple of months. Going to have ascending colon resection (no stoma), small liver resection and a pretty massive lymph node dissection (many positive nodes around the ascending colon and retroperitoneal). Any tips on reducing the chance of adhesions/complications and recovery from surgery? Anything I can do beforehand to prepare?
34 year old female
Stage IV Colon Cancer Aug 23, 2017
Adenocarcinoma of the right ascending colon with extensive lymph node involvement and a solitary liver metastasis.
Preop chemo starting with 2 cycles of CAPOX in Sept 2017 (hospitalized for reaction to Capecitabine) switching to FOLFOX with panitumumab x 6 cycles.
Open hemicolectomy and liver resection Feb 1, 2018. Nearly complete response, scattered tumor cells at primary tumor site and in 2/32 lymph nodes.
Ongoing FOLFOX for 6 more cycles.

NHMike
Posts: 1106
Joined: Fri Jul 21, 2017 3:43 am

Re: How to minimize surgical complications

Postby NHMike » Thu Dec 28, 2017 12:56 pm

Ranunculaceae wrote:34 year old on pre-op folfox + panitumumab for stage 4, surgery to be scheduled in a couple of months. Going to have ascending colon resection (no stoma), small liver resection and a pretty massive lymph node dissection (many positive nodes around the ascending colon and retroperitoneal). Any tips on reducing the chance of adhesions/complications and recovery from surgery? Anything I can do beforehand to prepare?


I did a lot of core strength training between chemo and radiation and surgery. Also did a lot of walking and some running. I think that these helped with recovery and lack of pain from open surgery. Strength overall is helpful as you have to depend on other body parts to compensate for surgery weaknesses.

Learn about the preop routine and get your logistics in order.

Use a board-certified colorectal surgeon at a high-volume cancer center. There are papers out there on statistical differences between these places and others. Don't use a general surgeon.

Support helps (people to drive you, bring your things to you after surgery, etc).
6/23/17: ER rectal bleeding; Colonoscopy
7/13: Stage 3B rectal. T3N1bM0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/31-9/8: Xeloda 3,400 mg/day+radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8; 11/30: 0.6; 12/20 1.4
MSS, KRAS G12D
10/6: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/30: LAR, Temp Ileostomy, Path Complete Response
12/20: Started CapeOx

User avatar
Atoq
Posts: 165
Joined: Wed Oct 25, 2017 9:31 am

Re: How to minimize surgical complications

Postby Atoq » Thu Dec 28, 2017 1:58 pm

I also had open surgery three weeks ago and had very little pain (stopped medication after 5 days, was home on day 6) and recovered very fast thanks to my core muscles that were well trained. Adhesions are difficult to control, it seems to depend mainly on the ability of the surgeon and on whether you had previous surgery.

Good luck! Soon facing new surgery as well.

Claudia
45 year old, mother of 2
Dx rectal cancer October 2017
At least T3N2aMX (suspect metastasis to one lung 8 mm)
Lynch negative
Neoadjuvant chemoradiotherapy Xeloda + 25x2 Gy
05.12.17 laparotomic surgery for blockage, colostomy
25.01.18 laparotomic lar, hysterectomy, ileostomy
05.03.18 core needle biopsy of lung

Basil
Posts: 239
Joined: Thu Mar 16, 2017 12:33 pm

Re: How to minimize surgical complications

Postby Basil » Thu Dec 28, 2017 7:44 pm

The best thing you can do is find the best surgeon possible. What he/she does is going to have the greatest impact on your recovery. I realize it’s late for that now.

On the lymph node issue, I didn’t know how many would be removed during my TME and was surprised when it was 42 - especially because I was stage iii with only one suspicious node to begin with. But my surgeries went great from my point of view, with no complications and quick recoveries.

Not to hijack the thread, but I’d be interested in knowing if anyone has any thoughts on removing 42 nodes during surgery. That number seems a lot higher than other cases. I’ll ask my onc about it at my next appointment but it’s been something I’ve been wondering about.
40 y/o male, kids 6&9
Dx 3/16/17, rectal cancer S3,t3,n1,m0
PROSPCT trial (FOLFOX in lieu of chemorad)
FOLFOX 4/5/17 - 6/26/17
LAR 7/31/17, temp ileo
pathological complete response
Adjuvant chemo cancelled (IDEA Study)
Ileo reversed 9/25/17
NED

e_enyedy
Posts: 8
Joined: Sat Nov 25, 2017 5:28 pm

Re: How to minimize surgical complications

Postby e_enyedy » Thu Dec 28, 2017 9:02 pm

According to the post-op report, I had 32 nodes removed during surgery (sigmoid colectomy)
(Everything came back negative)

E
77 yrs male (73 at Dx)
2/13 Dx Carcinoma, Sigmoid Colon
3/13 Sigmoid Colon Hemicolectomy,( 12"+)
3/13 Pathology Staging: T1N0M0; no follow-up chemo
5/15 Recurrence: in pre-sacral space -no other mets detected (Instantly became Stage IV)
5/15 Started 8 sessions of Folfox + Avastin
11/15 Finished chemo, PET/CT: NED
11/15 Started Xeloda+ Avastin every 3 weeks. Still Doing it.
Still NED -(Hope treatment keeps working)

jep
Posts: 56
Joined: Sun Jun 11, 2017 7:45 pm

Re: How to minimize surgical complications

Postby jep » Fri Dec 29, 2017 8:48 am

Wishing you a successful surgery! I agree with all posters, but would like to add that even with a board certified CR specialist, there can be serious complications. My husband's surgeon is board certified and excellent and I truly believed he saved my husband's life during his emergency surgery. More than 7 months later, my husband is still grappling with a fistula and surgical drain. I think my husband's surgery was very complicated....there was more spread than expected, but they did get it all. I've posted about this before, but we wish we had not rushed to solid foods as quickly as we did. The nurses and docs seemed ok with him eating solids when he seemed ready, but that (in my opinion) seemed to lead to many complications. I wish we had stuck with a high protein liquid diet for much longer....we'll never know if his recovery would have been different, but it's worth mentioning....we truly wish you all the best....when is surgery?
jep
Husband DX Stage IV CC on May 16, 2017
47 years old
Tumor Location: recto-sigmoid
Tumor type: Adenocarcinoma
Tumor size: 7.4 cm
Tumor grade: G3
TNM code: T3N2M1
Positive lymph nodes: 8 out of 20
Baseline CEA value: .9
LVI: present
Perineural invasion: present
Surgical margins: clear (w/in microns)
Primary surgery type: LAR
Folfox (August 2017-January 2018)

Ranunculaceae
Posts: 5
Joined: Thu Dec 28, 2017 10:49 am

Re: How to minimize surgical complications

Postby Ranunculaceae » Sat Dec 30, 2017 10:50 pm

I won’t have a choice about my surgeon at this point, but everyone I’ve mentioned his name to has said he’s skilled and he’s the head of the quality control committee for general surgeons in our area. One oncologist called him a “cowboy” hopefully that’s good? I need an aggressive surgery for a shot at cure! He’s general but oncology specialized which is best for me because it means he can do the liver resection as well in one go. Still waiting to hear if I will have surgery soon or wait till after chemo (4 cycles left). He wants everything to shrink enough that he can do it all laparoscopically, but one lymph node conglomerate was still over 3cm on my last ct.
34 year old female
Stage IV Colon Cancer Aug 23, 2017
Adenocarcinoma of the right ascending colon with extensive lymph node involvement and a solitary liver metastasis.
Preop chemo starting with 2 cycles of CAPOX in Sept 2017 (hospitalized for reaction to Capecitabine) switching to FOLFOX with panitumumab x 6 cycles.
Open hemicolectomy and liver resection Feb 1, 2018. Nearly complete response, scattered tumor cells at primary tumor site and in 2/32 lymph nodes.
Ongoing FOLFOX for 6 more cycles.

User avatar
ocstacy
Posts: 230
Joined: Mon Jun 19, 2017 11:29 pm
Facebook Username: stacy

Re: How to minimize surgical complications

Postby ocstacy » Fri Jan 12, 2018 2:33 am

The best thing you can do is find the best surgeon possible. What he/she does is going to have the greatest impact on your recovery. I realize it’s late for that now.


I searched and searched for the best colorectal surgeon for my mother. He was Chief surgeon and I read the reviews from his patients with lots of good reviews. We had to drive far, but all worth it if you want the best of the best. My mother's surgeon and his surgery team were able to remove all of Cancer, and she is now cancer free. They call it Near Path response. She is doing clean up chemo now. Make sure to ask your surgeon for the pre-surgery drink. https://ensure.com/nutrition-products/e ... -surgeryIt is supposed to help with the recovery. Took my mom two months to feel good again. She had to go back to the ER as she had a block and leak. She had to get on antibiotics.
Caregiver/daughter to dear mother age 78, dx 5/09/17 because of me!! :wink:
Rectal CA Stage 3 low-grade adenocarcinoma- 6 cm
Neoadjuvant start 7/10/17 ended 08/16/17
3D Lap. surgery @ Keck USC, Dr. Sang Lee 10/17/17 temp ileostomy
11/1 back @ hospital due 2 abscess/hernia - back home 11/06/17 antibiotics
NO LYMPHS INVOLVED! NEAR PATHOLOGICAL RESPONSE! YAY! :shock:
No Cancer!! YAY!
Chemo Xeloda post-surgery following reversal 05/2018
Me: Colonoscopy age 38. 08/17 Benign polp. internal hemmy's post partum


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