First of all, the good news is that you have lots of options
. That's a great position to be in, even though I agree with you that the decision-making process is unnerving!
Spazzyjanet wrote:My highly respected local surgeon wants to go with an aggressive resection and ablatement of my liver, and believes that he can do it in a way that will substantially limit the risk of it coming back.
The highly respected second opinion surgeon does not think it's possible to resect/ablate everything in one surgery, and believes that doing a partial resection and installing an HAI pump is my best chance to rule out recurrence.
The stats on recurrence in the liver after a resection aren't good. Somewhere in the vicinity of 80% of patients have a recurrence in the first year. I'm not sure what gives the local surgeon his confidence in it not recurring, although I like his aggressive approach.
The second-opinion is more realistic to me. HAI pumps have been proven to prevent recurrences in the majority of patients who have them. The advantage to a second resection is that the remaining mets would be smaller (and likely dead) by that time, which would provide an extra degree of confidence in the outcome.
Spazzyjanet wrote: On the other hand I also worry that defaulting to the HAI pump is more of a "treat this like a chronic disease" versus a "cure" mentality. I am 40 and am not quite ready to give up on an approach that could potentially cure me and allow me to grow old and retire one day. Getting to 50 with a pump would be amazing, but I don't want to go down a road now that could limit my chances for cure long-term.
Getting an HAI pump is not treating it like a chronic disease. It is implanted, at least at MSKCC, with a "cure" mentality. As soon as your liver stays clear for a few years, the pump is removed. A strategy involving a two-stage liver resection with the addition of an HAI pump might be a smart move in terms of getting to long term survival. I speak as someone who has an HAI pump; I am convinced I am alive today because of it. I also had an aggressive liver resection and have remained clear since my treatment ended. I am due to have the pump removed in a few months.
You have lots to think about here, especially with possible peritoneum involvement. An extensive liver resection plus an impromptu HIPEC procedure sounds daunting. The second approach - MRI of peritoneum and laparoscopic exam - sounds safer. But I know how you feel. It's hard to give up a sure thing (liver resection and HIPEC) if the second approach means no HAI pump.
Could you have the MRI/laparoscopic and then make your decision? If they see peri-mets, you could go back to the first surgeon and see if they'll still do the resection + HIPEC. The pump would be out of the running then, I guess. (Although I know patients at MSK who have peri-mets and the HAI pump.) But you would at least know what you were dealing with. If they didn't see any peri-mets, then both options would be wide open for you.
Hope this helps!