Possibly unnecessary open liver surgery

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mpbser
Posts: 429
Joined: Wed Apr 19, 2017 11:52 am

Re: Possibly unnecessary open liver surgery

Postby mpbser » Wed Jan 31, 2018 11:46 am

Thanks for all the positive vibes!

I just saw the surgeon. Everything went great. It was a small open incision, not laparoscopically. But that's OK, it's not much different in the end. The reason it could not be laparoacopic was his girth as he has put on weight in the past few weeks. The entry into his abdomen to get there to "drill down" into the liver was at an angle that just had to be done in open surgery. He did not have to remove the whole lobe because it was far away enough from the blood vessel. He made sure there was clean margins so there's no cancer left. There were some small micro spots that we already knew about on the right side that are likely little cysts but he burned them just to be safe. He will probably be discharged on Saturday assuming all goes well.

The doctor does not think that he can go back to work in a week like he hopes to be able to.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

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Robino1
Posts: 462
Joined: Fri Aug 11, 2017 12:09 pm
Facebook Username: Robin.lawthers
Location: Florida

Re: Possibly unnecessary open liver surgery

Postby Robino1 » Wed Jan 31, 2018 12:05 pm

Congrats on the successful surgery!! Good news indeed! :)
At 54 2014 1st colonoscopy colon cancer detect
Colon resect margins clear. No chemo Stage II
2017
Distend abd, pain in intestines.
CT scan seeding & Ascites
Lap diag - cancer on the omentum
CEA 217; 219
FOLFOX started 6/17
CEA 202
8/29/17 CT melting of tumor.
Latest CT scan shows 2 new tumors and return of ascites.
CEA: (2017)9/30 -109; 10/12 -99.1; 11/4 -90.7; 11/30 -70.7; 12/14 -83.4; (2018)1/4 -73.3; 2/1-84.2; 89.2; 89.8; 88.5; 81.8: 93.5; 107; 119
BRAF V600e

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Shana
Posts: 394
Joined: Sun Jul 30, 2017 9:45 pm
Location: Sonoma, CA

Re: Possibly unnecessary open liver surgery

Postby Shana » Wed Jan 31, 2018 10:50 pm

Good news! Hope he's home soon :)
DX - 12/16
MSS - KRAS wild
Well-differentiated adenocarcinoma at splenic flexure
Stage IV CC with liver mets
5FU - Failed twice - 1/17 and 3/17
Irinotecan + Cetuximab: 8/17
CEA 12/17 - 38.7! 1/18 - 33! 2/18-36.5 3/18-39.8 4/18- 54 (ugh) 5/11/18 -78 :( 5/25/18-63!!!!
CT-Scan 5/18 -mixed -some progression and some shrinkage, possibly pseudo
Irinotecan increased to 200mg on 5/7/18 in response to increased CEA and it's working as of 5/25!

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LPL
Posts: 410
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Possibly unnecessary open liver surgery

Postby LPL » Thu Feb 01, 2018 12:08 pm

Hi mbpser,
Surgery is over - that is good news! :)
The doctor does not think that he can go back to work in a week like he hopes to be able to.

Please take it easy - to heal both inside and outside. And remember NO lifting!
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

mpbser
Posts: 429
Joined: Wed Apr 19, 2017 11:52 am

Re: Possibly unnecessary open liver surgery

Postby mpbser » Fri Feb 02, 2018 9:42 am

Sodium level is low. They haven't been testing his blood glucose as often as they did at our local hospital for his first colectomy. They were giving him insulin to keep his glucose at a steady 100 or so. Here, it is about an average of 150. This bothers me as normal blood glucose is so critical to proper tissue healing. I nearly flipped when the nurse came to give him a full sugar Gatorade. I brought him a Clearfast which has 8% RDV of sodium so when I showed it to her, she was satisfied with him having that.

His catheter is bothering him and making it too uncomfortable to sit for a bowel movement. That stinks because he really could use a poo! The catheter can't come out until the epidural comes out. That hopefully will happen soon.

The nurse just came in and said she was going to give him oral oxycodone now that the epidural IV dilaudid drip had finished. He was getting 10 ml every hour. It's going to be very interesting to see what his pain is like after this runs its course and is out of his system.

This is a huge factor in how well enough he will be to 1) be discharged tomorrow morning like they are talking about and 2) travel the 4 or so hours home. We will see.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

mpbser
Posts: 429
Joined: Wed Apr 19, 2017 11:52 am

Re: Possibly unnecessary open liver surgery

Postby mpbser » Fri Feb 02, 2018 5:06 pm

Husband refused to take oxycodone, as it doesn't ever help him much with pain and blocks up his digestive system. He is now on tylenol and tramadol. Pain hasn't been too bad and he has had sufficient bowel movements so that ileus is not a concern, for the time being. He will definitely be discharged tomorrow, but the decision whether to stay at the hotel or go home will be made in the morning.

We saw his surgeon today. The excision via burning (RFA and argon was used after manual knife excision to ensure negative margins) brought him within 3 millimeters of the blood vessel. Wow.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

mpbser
Posts: 429
Joined: Wed Apr 19, 2017 11:52 am

Re: Possibly unnecessary open liver surgery

Postby mpbser » Sat Feb 03, 2018 9:09 am

Husband will be discharged today at lunchtime but he and I are going to stay at least tonight in the hotel where I have been since Tuesday night. He doesn't want to risk the long, arduous drive home today and would rather play it safe. The forecast for tomorrow calls for snow, so we will likely head out as early as possible in the morning.

Husband's roommate at the hospital has had the same two surgeries by the same two surgeons, only in reverse: liver first then colon. His colon surgery went extremely well. So far, my husband's surgery has gone phenomenally well. Fingers crossed he keeps recovering speedily. We are very thankful husband is to have been in such wonderfully skilled hands.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

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LPL
Posts: 410
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Possibly unnecessary open liver surgery

Postby LPL » Sat Feb 03, 2018 1:34 pm

Mpbser,
That sounds like a good plan!
Hoping this trip home will be different then last time..
Good recovery wishes.
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

AnonSurvivor
Posts: 18
Joined: Fri Oct 16, 2015 12:04 pm

Re: Possibly unnecessary open liver surgery

Postby AnonSurvivor » Mon Feb 05, 2018 5:39 pm

Was this a Dr. Ryan / Dr. Berger (aka the "two Daves") production? Those guys (+ Dr. Hochster at Yale (now at Rutgers)) cured me.

AnonSurvivor

mpbser
Posts: 429
Joined: Wed Apr 19, 2017 11:52 am

Re: Possibly unnecessary open liver surgery

Postby mpbser » Sun Feb 11, 2018 7:09 am

I don't know those doctors, anonsurvivor. They were Dr. Qadan and Dr. Cusack.

I am so glad to be home. I've been so swamped with work for the past week to post an update.

The ride from Boston is so much better on Sunday mornings. Without traffic, we made it back in 3 hours. The surgery did not involve any maneuvering of the liver and his gall bladder was not removed. Originally, he was facing losing 60-70 percent of his liver, but thanks to a great team, that didn't have to happen. Only a couple centimeters from one segment were removed. The experience at Mass General this time around was so much better than the last. What a relief!

Apparently, you can request the floor that you get admitted to. Husband's nursing team on White 7 was so awesome that we have taken note of this in case he ever has to go back. Praying that doesn't happen but I think it will take a miracle. Given the diet he's gradually returning to (yesterday it was chocolate chip muffins, ice cream, fried chicken), I won't be surprised if he has future mets.

Very depressing and, to be totally frank, I've just about had enough.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

NHMike
Posts: 1536
Joined: Fri Jul 21, 2017 3:43 am

Re: Possibly unnecessary open liver surgery

Postby NHMike » Sun Feb 11, 2018 8:36 am

mpbser wrote:I don't know those doctors, anonsurvivor. They were Dr. Qadan and Dr. Cusack.

I am so glad to be home. I've been so swamped with work for the past week to post an update.

The ride from Boston is so much better on Sunday mornings. Without traffic, we made it back in 3 hours. The surgery did not involve any maneuvering of the liver and his gall bladder was not removed. Originally, he was facing losing 60-70 percent of his liver, but thanks to a great team, that didn't have to happen. Only a couple centimeters from one segment were removed. The experience at Mass General this time around was so much better than the last. What a relief!

Apparently, you can request the floor that you get admitted to. Husband's nursing team on White 7 was so awesome that we have taken note of this in case he ever has to go back. Praying that doesn't happen but I think it will take a miracle. Given the diet he's gradually returning to (yesterday it was chocolate chip muffins, ice cream, fried chicken), I won't be surprised if he has future mets.

Very depressing and, to be totally frank, I've just about had enough.


I'm glad you have some good news. I drive into Boston at 4:00 AM if I need to go there during the week as I hate the traffic. Yes, Sundays are hugely better. I think that we all wish that the cancer marathon was over.
6/17: ER rectal bleeding; Colonoscopy
7/17: Stage 3B rectal. T3N1bM0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda +radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8
MSS, KRAS G12D
10/17: 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
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx 8 cycles 12/17-6/18

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Atoq
Posts: 277
Joined: Wed Oct 25, 2017 9:31 am

Re: Possibly unnecessary open liver surgery

Postby Atoq » Sun Feb 11, 2018 9:22 am

mpbser wrote:Given the diet he's gradually returning to (yesterday it was chocolate chip muffins, ice cream, fried chicken), I won't be surprised if he has future mets.


Sounds like then he can only blame himself. Of course life style has something to say, but not that much...

Best

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, updated to stage IV
07.05.18 CAT scan, lung metastasis 11 mm
04.06.18 ileostomy reversal
26.06.18 wedge VATS surgery

Utwo
Posts: 203
Joined: Mon May 23, 2016 10:14 am
Location: T.O.

Re: Possibly unnecessary open liver surgery

Postby Utwo » Sun Feb 11, 2018 10:30 am

mpbser wrote:Given the diet he's gradually returning to (yesterday it was chocolate chip muffins, ice cream, fried chicken), I won't be surprised if he has future mets.
There is no scientific data linking after-surgery diet and a risk of metastasis.

However, considering diminished liver capacity, it probably still makes sense to adjust his diet.

Bon appetit!
58 yo male at diagnosis - T1bN0, 0/15 lymph nodes, low grade/moderately differentiated adenocarcinoma
03/2016 colonoscopy #1: 2 small polyps removed in left colon; CEA = 1.3
04/2016 colonoscopy #2: caecum sessile 3.5 cm polyp piecemeal removed with kind of clear margins
05/2016 CT scan, blood test ...
05/2016 "prophylactic" laparoscopic right hemicolectomy with a few complications (bleeding, leak, infection)
06/2017 CT scan (lower body), colonoscopy OK; CEA = 1.6

mpbser
Posts: 429
Joined: Wed Apr 19, 2017 11:52 am

Re: Possibly unnecessary open liver surgery

Postby mpbser » Sun Feb 11, 2018 12:32 pm

My point related to any additional cancer. As there is plenty of scientific data supporting the role of diet in cancer, it stands to reason that the same applies to post cancer diagnosis recurrence. Sure, might not share origins with the same tumor. Even NCCN guidelines recommend a plant based diet as part of treatment milieu.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

Utwo
Posts: 203
Joined: Mon May 23, 2016 10:14 am
Location: T.O.

Re: Possibly unnecessary open liver surgery

Postby Utwo » Sun Feb 11, 2018 1:40 pm

mpbser wrote:Even NCCN guidelines recommend a plant based diet ...
Could you please provide a link?
58 yo male at diagnosis - T1bN0, 0/15 lymph nodes, low grade/moderately differentiated adenocarcinoma
03/2016 colonoscopy #1: 2 small polyps removed in left colon; CEA = 1.3
04/2016 colonoscopy #2: caecum sessile 3.5 cm polyp piecemeal removed with kind of clear margins
05/2016 CT scan, blood test ...
05/2016 "prophylactic" laparoscopic right hemicolectomy with a few complications (bleeding, leak, infection)
06/2017 CT scan (lower body), colonoscopy OK; CEA = 1.6


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