Possibly unnecessary open liver surgery

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LPL
Posts: 343
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Possibly unnecessary open liver surgery

Postby LPL » Thu Jan 25, 2018 1:59 pm

Mbpser,
Good to here it went well.
About the antibiotic pre surgery. I don’t think my DH got that either. I had read and thought they would always do that - and I was aftaid that they would give him Fluoroquinolones
https://floxiehope.com/2013/06/20/what- ... -toxicity/
So I wrote to the surgeon and asked ”please not that kind of antibiotic”. Yes I have heard that it is an important (one of a kind) sometimes but to me, given as a ’precaution’, it felt like too big a gun..
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

ashima2016
Posts: 35
Joined: Thu Dec 01, 2016 10:56 am

Re: Possibly unnecessary open liver surgery

Postby ashima2016 » Fri Jan 26, 2018 1:17 pm

Your hubby is so lucky to have a supportive spouse. Good luck with the surgery. Boston is a charming city, I enjoyed it every time I was there. Quincy market is one of the must visit place. :)

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Shana
Posts: 227
Joined: Sun Jul 30, 2017 9:45 pm
Location: Sonoma, CA

Re: Possibly unnecessary open liver surgery

Postby Shana » Fri Jan 26, 2018 5:04 pm

Mpbser,

You are awesome and I agree with ashima, your husband is lucky and blessed to have your support!

After reading your posts and the info that you share, I thought "I need a wife...lol"

My husband is unfortunately clueless in regards to medical procedures and terminology. I am thankful that my daughters are capable and supportive.

My condolences on the loss of your brother, never easy during normal times and unimaginable with everything you're dealing with right now. Wishing you and your DH the very best in his upcoming surgery. I hope he gets some more of that lobster mac n cheese as soon as it's doable!
DX - 12/16
MSS - KRAS wild
Stage IV CC with liver mets
5FU - Failed twice - 1/17 and 3/17
Irinotecan + Cetuximab: 8/17 - 2 wks on, 1 wk off to lessen side effects
CEA 12/17 - 38.7! 1/18 - 33! 2/18-36.5
CT-Scan 9/1/17. Shrinkage of liver mets (4 measurable) and no bowel blockage
CT=Scan 12/1/17 Shrinkage of liver mets continue, no blockage

Removal of primary tumor and resection still on back burner. Have to be able to be OFF chemo one month prior and one month after surgery and evaluate benefit vs risk.

TXLiz
Posts: 246
Joined: Thu Sep 22, 2016 3:31 pm

Re: Possibly unnecessary open liver surgery

Postby TXLiz » Fri Jan 26, 2018 6:53 pm

I was supposed to have a complete hysterectomy a few weeks ago, and I postponed it due to the illness of my son.

My surgery was to be open, due to the nature of my abdomen after 3 abdominal surgeries including the colon resection. The surgeon said, she doesn’t know what’s inside after all the prior surgeries.

Sorry for your pain and that of your husband, and these difficult health issues. It super sucks. My best for you both.
Vomiting and blockage 9/19/16 46 y F
R hemi colectomy 9/20/16
Stage 3 B CRC, located in cecum
3 out of 16 lymph nodes positive
perineural invasion/lymphovascular invasion
infiltrating, mod differentiated adenocarcinoma with a mucinous component
separate tumor nodules present in pericolonic adipose tissue
MSI-high
Baseline PET scan clear 9/16 CEA 0.5
FOLFOX 10/16- 3/17
April 16th, CT scan clear. CEA 1.1
Lynch "inconclusive"
Colonoscopy 10/5/2017 clear

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CRguy
Posts: 9406
Joined: Sun Feb 10, 2008 6:00 pm

Re: Possibly unnecessary open liver surgery

Postby CRguy » Fri Jan 26, 2018 7:44 pm

mpbser wrote:On a completely different note, I was curious why the surgeon did not prescribe antibiotics pre-surgery.

LPL wrote:About the antibiotic pre surgery. I don’t think my DH got that either. I had read and thought they would always do that - and I was aftaid that they would give him Fluoroquinolones ....


Just a medical reply to these two separate issues here :

Unless there is existing infection or reasonable presumption of incipient infection, for a sterile surgery there should be no requirement for pre-op antibiotics.
For potentially problematic surgeries, known to be "at risk" for complications, pre-op antibiotics would be considered.
Most surgeries we as patients here have been exposed to, would require post-op medications which are actually started IV during the pre-op preparation stage before the surgeons actually start their work.

Fluoroquinolones are great antibiotics in the proper setting ... BUTT they have specific contraindications in older patients and juveniles and certain other settings, so yes ... may not be needed even then, UNTIL indicated in which case ....GIVE'M !

Cheers all
Hope all the patients get what they need and it WORKS !
CRguy

(( disclaimer : I have had most of the "major RAMBO-cillin" type antibiotic meds during my Journey, including Fluoroquinolones and am still here to chat about it ! AND as a Vet have used the fluoro's for a lotta years and kind of have to take the Floxie website with a grain of salt. IF used properly they are like any other med we are exposed to and they come with pluses and minuses. Fear mongering sites do nothing to educate us to the real situation I am afraid ... JMO
and please don't get me started on anti-vaxxers :twisted: :mrgreen: :mrgreen: :mrgreen: ))
Caregiver x 3
Stage IV A rectal cancer/lung met
10 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

Beckster
Posts: 211
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Possibly unnecessary open liver surgery

Postby Beckster » Fri Jan 26, 2018 7:49 pm

mpbser wrote:Surgery is looming. We leave for Boston next Tuesday. I will drop off my husband very early Wednesday. I have requested a private room but the hospital does not guarantee he will have one. The cost is $483 per night out of pocket. That's quite a bit out of our budget but I am far more concerned about him resting up and healing. When we spoke about the possibility of getting a private room, he said that he doesn't want to spend the money. I will pay for it, if need be. However, he has to sign an agreement when he checks in the morning of surgery. Since I won't be with him, I need to alert him to this in case he objects to the paperwork. I will try discussing this again in a couple nights.

Beansmama's passing has really shaken me up. I am so worried about this surgery, although I know he is in good surgeon's hands. I have so many questions and I am frustrated that I can't ask them. With the number of questions I have, the doctor would require a visit, something we don't have time for.

My little brother died January 5th in a fatal hit and run accident. He was like a son to me. I have a very high stakes, high stress meeting in Boston the day after husband's surgery (2/1). The only good thing about that is that I will happen to need to be in Boston that time anyway. I have depositions scheduled for February 7th, the last day possible per court order, for one of my cases. I don't know if my husband will be ready to journey home by then. I don't know if my life could get any more stressful. It's a nightmare!


mpbser...Good luck in Boston. I will be sending positive vibes your way! On another note, so sorry to hear about your brother. My little brother too was killed in a car accident. I was like his mother. It has been 30 years and there is not a day that goes by that I do not think of him. It does get better, but you never forget.

Beckster
57/Female
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Tumor type: Adenocarcinoma
Tumor size: 3.5 cm x 2.5 x 0.7 cm
Tumor grade: G3 (surgical) G2 (pre-op)
TNM: T3N0M0/IIA
lymph nodes: 0/24
Lymphovascular invasion
Surgical margins: clear
Lynch- Negative
12/27/2016 - Capeox, anaphylactic reaction to oxaliplatin on first infusion-discontinued
1/2/17 to 6/9/17- Xeloda monotherapy
6/26/17, 12/12/17 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8
Clear Colonoscopy 10/17 :D

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LPL
Posts: 343
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Possibly unnecessary open liver surgery

Postby LPL » Sat Jan 27, 2018 11:02 am

CRguy wrote:
Fluoroquinolones are great antibiotics in the proper setting ... BUTT they have specific contraindications in older patients and juveniles and certain other settings, so yes ... may not be needed even then, UNTIL indicated in which case ....GIVE'M !

I’m sorry CRguy if the Floxie website that I posted is a site you disapprove of.
This quote below comes from FDA
An FDA safety review has shown that fluoroquinolones when used systemically (i.e. tablets, capsules, and injectable) are associated with disabling and potentially permanent serious side effects that can occur together. These side effects can involve the tendons, muscles, joints, nerves, and central nervous system.

https://www.fda.gov/Drugs/DrugSafety/ucm500143.htm

Please note that I did say in my post:
“Yes I have heard that it is an important (one of a kind) sometimes but to me, given as a ’precaution’, it felt like too big a gun..”
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

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CRguy
Posts: 9406
Joined: Sun Feb 10, 2008 6:00 pm

Re: Possibly unnecessary open liver surgery

Postby CRguy » Sat Jan 27, 2018 1:19 pm

No problem.
I just personally dislike some types of sites, but the information is important and needs to be discussed here with our members, so thanks for bringing it up on the forum.

Cheers
CR
Caregiver x 3
Stage IV A rectal cancer/lung met
10 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

mpbser
Posts: 357
Joined: Wed Apr 19, 2017 11:52 am

Re: Possibly unnecessary open liver surgery

Postby mpbser » Sat Jan 27, 2018 5:09 pm

Thanks for weighing in, everyone. We haven't heard about the pathology results from Wednesday's biopsy, but I hope we find out Monday! Even if the one spot is benign, that doesn't mean it won't be open surgery. It would then depend on how much shrinkage in the cancerous tumor has occurred and whether it is at least 1 cm from the blood vessel. I guess the surgeon won't really be able to tell until he is on the operating table.

Beckster, Yeah, I was like a mom to my little brother, too. It has been excruciating. https://www.nbcnewyork.com/on-air/as-se ... 65463.html
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 Pre-op; 2.1 2 days Post-op; ~2.2 ave
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

mpbser
Posts: 357
Joined: Wed Apr 19, 2017 11:52 am

Re: Possibly unnecessary open liver surgery

Postby mpbser » Mon Jan 29, 2018 2:51 pm

Great news this morning from liver surgeon. The right lobe mass is benign!!! This means that surgery will most likely be laparoscopic and wedge. The surgeon does not think the entire lobe has to be removed but it all depends on how close the tumor is to the blood vessel when husband is on the operating table in less than 48 hours. Fingers crossed for easy surgery and swift recovery!!!
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 Pre-op; 2.1 2 days Post-op; ~2.2 ave
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

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Shana
Posts: 227
Joined: Sun Jul 30, 2017 9:45 pm
Location: Sonoma, CA

Re: Possibly unnecessary open liver surgery

Postby Shana » Mon Jan 29, 2018 3:23 pm

Wonderful news!

Wishing him a successful surgery and speedy recovery!
DX - 12/16
MSS - KRAS wild
Stage IV CC with liver mets
5FU - Failed twice - 1/17 and 3/17
Irinotecan + Cetuximab: 8/17 - 2 wks on, 1 wk off to lessen side effects
CEA 12/17 - 38.7! 1/18 - 33! 2/18-36.5
CT-Scan 9/1/17. Shrinkage of liver mets (4 measurable) and no bowel blockage
CT=Scan 12/1/17 Shrinkage of liver mets continue, no blockage

Removal of primary tumor and resection still on back burner. Have to be able to be OFF chemo one month prior and one month after surgery and evaluate benefit vs risk.

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Robino1
Posts: 345
Joined: Fri Aug 11, 2017 12:09 pm
Facebook Username: Robin.lawthers
Location: Florida

Re: Possibly unnecessary open liver surgery

Postby Robino1 » Mon Jan 29, 2018 3:42 pm

Excellent news. That should aid in your husband's mental state. :)
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 CEA 219
FOLFOX started 6/17
CEA 202 Not genetic
8/29/17 CT excellent melting of tumor.
12/8/17 Markedly decr ant peritoneal nodularity since 8/29/17 compat w/ marked posi respns to therapy
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 Damnit
BRAF V600e

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susie0915
Posts: 701
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Possibly unnecessary open liver surgery

Postby susie0915 » Mon Jan 29, 2018 3:57 pm

Such great news!
58 yrs old Dx @ 55
5/15 DX T3N0MO/ 2A
6/15 5 wks chemo/rad
7/15 sigmoidoscopy/scar tissue left
8/15 Pet scan NED
9/15 LAR
0/24 nodes
10/15 Bowel blockage. surgery,early ileo rev, c-diff inf :(
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nod onc feels scar tissue
7/17 no change lung nodule
10/17 Clear pel/abd CT
11/17 CEA<.5
1/18 CT/Lung no change in 4mm nodule or scarring/inflammation

mpbser
Posts: 357
Joined: Wed Apr 19, 2017 11:52 am

Re: Possibly unnecessary open liver surgery

Postby mpbser » Mon Jan 29, 2018 6:10 pm

Indeed, he is very happy and relieved! :D
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 Pre-op; 2.1 2 days Post-op; ~2.2 ave
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

User avatar
LPL
Posts: 343
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Possibly unnecessary open liver surgery

Postby LPL » Mon Jan 29, 2018 6:36 pm

Great news :)
and Good Luck with the surgery!
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


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