Recovery time after liver resection

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Rock_Robster
Posts: 72
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Recovery time after liver resection

Postby Rock_Robster » Mon Mar 11, 2019 7:56 pm

Hi all, I had my liver resection last week (open surgery, 3 segments, about 25% in total), and I feel very lucky that I could and that it all went really well. My next step is long course chemoradiation on my primary tumour, but I understand I need to heal first.

So for those of you that have had liver surgery, how long until you could recommence therapy?

My Google-fu is failing me here and I can’t see much research around this. I’m keen to get back on the horse ASAP, but also don’t want to jeopardise healing.

Thanks!
Male 37 years; Melbourne, Australia
10/2018 Dx: 3.5 cm rectal adenocarcinoma, 10 cm from verge. Well/mod diff (G1-2), T3bN1bM1a.
3 enlarged local lymph nodes and 4 liver lesions.
MSS, MMR-proficient, mutated in NRAS (G13R).
CEA: Oct-18 = 12; Nov-18 = 14, Mar-19 = 2.4
11/18 - 6 rounds neoadjuvant FOLFOX
12/18 - DVT, started clexane
3/19 - Liver resection, R0
4-5/19 - Long-course pelvic chemoradiation (45 Gy w/ Xeloda)

AmyG
Posts: 92
Joined: Tue Dec 25, 2018 8:08 pm

Re: Recovery time after liver resection

Postby AmyG » Mon Mar 11, 2019 8:13 pm

How is your recovery going thus far?

I'm supposed to be having an open resection as well after 6 cycles and have no idea what to expect other than a 5-7 day hospital stay. I've only had the one surgery ever to remove my primary tumor but that was laparoscopic.

Care to share all the details?
42 dx @ 9wks pregnant w/baby #8 8/18
Originally thought to be stage 2, no lymphnodes involved 9/18
Spot on liver found prior to bowel resection 9/18
Liver biopsy, it's malignant 12/18
Stage IV, 1 liver met 4.7cm
2019 plan is to deliver baby early and start FOLFOX w/Avastin

Rock_Robster
Posts: 72
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Recovery time after liver resection

Postby Rock_Robster » Mon Mar 11, 2019 8:31 pm

Hi Amy, so far it’s been much better than I expected. I went in last Wednesday and walked out yesterday, day 5. I had a fair bit of pain on waking up, but they hit that hard and has been manageable ever since. I did have some minor lung deflation and fluid build-up on the right side, which apparently happens during longer surgeries (esp after chemo), but breathing and coughing exercises have stayed on top of that. It’s really important to take enough painkillers so you can breathe properly and do your rehab exercises, otherwise you can end up with other un-fun complications. My hospital had a good ERAS program, and I also borrowed some tips from MSK’s website.

I was quite interested in the research around avoiding surgery-induced metastasis, so I’ve been doing what I can to prioritise painkillers which aren’t immunosuppressive, and a few other things. That has meant some interesting discussions with anaesthetists, but we got there!

The wound is large but quite tidy; I’ve got a check with GP tomorrow then with surgeon in 2 weeks. Appetite-wise I’ve had to adjust to smaller, frequent meals, with lots of protein to support liver regeneration and avoid losing much muscle mass. Now I’m just focusing on eating, resting and keeping moving to try to keep any issues at bay and get back to treatment!

Let me know if anything else specific I can tell you about.
Male 37 years; Melbourne, Australia
10/2018 Dx: 3.5 cm rectal adenocarcinoma, 10 cm from verge. Well/mod diff (G1-2), T3bN1bM1a.
3 enlarged local lymph nodes and 4 liver lesions.
MSS, MMR-proficient, mutated in NRAS (G13R).
CEA: Oct-18 = 12; Nov-18 = 14, Mar-19 = 2.4
11/18 - 6 rounds neoadjuvant FOLFOX
12/18 - DVT, started clexane
3/19 - Liver resection, R0
4-5/19 - Long-course pelvic chemoradiation (45 Gy w/ Xeloda)

martd
Posts: 89
Joined: Tue Nov 21, 2017 3:48 pm
Location: Phoenix, Az

Re: Recovery time after liver resection

Postby martd » Mon Mar 11, 2019 9:50 pm

I resumed folfox about two and a half weeks after my first resection. That surgery was laparoscopic. Removed 3 Mets then 3 days later PVE surgery.
49 y/o male dx 11/2017 crc
Stage 4 with 17 liver Mets, cea 490
RAS, BRAF WT
12 rounds folfox , avastin
5/18 cea 2.8 liver resection and pve
7/18 part 2 liver resection, remove right side of liver
Surgical site mrsa infection, wound vac
8/18 cea .9 cCR, rectal tumor is gone
Rectal surgery postponed, watch and wait
10/18 clear scan CEA .7
01/19 clear scan CEA .9
04/19 clear scan CEA .9

Rock_Robster
Posts: 72
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Recovery time after liver resection

Postby Rock_Robster » Mon Mar 11, 2019 10:08 pm

Thanks martd - that sounds fast! I think someone mentioned a 4-6 week recovery but perhaps I can restart treatment somewhere during that window as well.
Male 37 years; Melbourne, Australia
10/2018 Dx: 3.5 cm rectal adenocarcinoma, 10 cm from verge. Well/mod diff (G1-2), T3bN1bM1a.
3 enlarged local lymph nodes and 4 liver lesions.
MSS, MMR-proficient, mutated in NRAS (G13R).
CEA: Oct-18 = 12; Nov-18 = 14, Mar-19 = 2.4
11/18 - 6 rounds neoadjuvant FOLFOX
12/18 - DVT, started clexane
3/19 - Liver resection, R0
4-5/19 - Long-course pelvic chemoradiation (45 Gy w/ Xeloda)

Milk Tea
Posts: 27
Joined: Wed Feb 13, 2019 1:14 pm

Re: Recovery time after liver resection

Postby Milk Tea » Mon Mar 11, 2019 10:47 pm

A few weeks after the surgery, my husband’s big L shape incision opened up in two places and I had to pack in fresh gauze in those two open wounds twice daily to help healing. Both open wounds closed up nicely after a few weeks. Because of that, it was almost 10 weeks after his open liver surgery, he started first mop up chemo. It was originally scheduled for 6 weeks after surgery.
Wife to DH
09/2016: Dx at 50, CC Ascending colon, 10+ liver Mets
KRAS-Mut G12V, MSS, CEA 8
09/2016: Nearly blocked, Emergency colon surgery (LAR)
FOLFOXIRI+Avastin: 6 before and 6 after liver resection
01/2017: Liver resection, open, both lobes, 40% total liver cut, tumors either cut out or microwave ablation burn, all tumors are out
02/2017-01/2019 : Clean CT every 3-4 months, CEA between 2-3
06/2017-Present: Maintenance Chemo: Xeloda + Avastin

Rock_Robster
Posts: 72
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Recovery time after liver resection

Postby Rock_Robster » Mon Mar 11, 2019 10:50 pm

Thanks Milk Tea, that’s very helpful. Glad it all worked out ok with the wound.
Male 37 years; Melbourne, Australia
10/2018 Dx: 3.5 cm rectal adenocarcinoma, 10 cm from verge. Well/mod diff (G1-2), T3bN1bM1a.
3 enlarged local lymph nodes and 4 liver lesions.
MSS, MMR-proficient, mutated in NRAS (G13R).
CEA: Oct-18 = 12; Nov-18 = 14, Mar-19 = 2.4
11/18 - 6 rounds neoadjuvant FOLFOX
12/18 - DVT, started clexane
3/19 - Liver resection, R0
4-5/19 - Long-course pelvic chemoradiation (45 Gy w/ Xeloda)

Pyro
Posts: 197
Joined: Mon Oct 12, 2015 7:40 pm
Location: Tucson, AZ

Re: Recovery time after liver resection

Postby Pyro » Tue Mar 12, 2019 7:17 am

I had multiple open liver surgeries, as I recall it was about 6 weeks after surgery I resumed chemo/rad. The open ones definitely take longer to heal. I was in the hospital for about u days each liver surgery, the surgeries were a breeze compared to my colon surgery, but that was done fully open as well.
Last edited by Pyro on Tue Mar 12, 2019 7:20 am, edited 1 time in total.
Aug 2015- Diag Stage 4 CC with mets to liver (38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not a surgery candidate for liver
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MDA liver surgery, Dr. Vauthey
Mar 2016 -30% of left lobe rem, PVE
May 2016 - 70% of liver rem
Jun 2016-Rad
Jan 2017-perm colost @MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Rad
Mar 2019 - Keytruda, CEA @30(3), shit still here

Rock_Robster
Posts: 72
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Recovery time after liver resection

Postby Rock_Robster » Tue Mar 12, 2019 7:19 am

Thanks Pyro, makes sense
Male 37 years; Melbourne, Australia
10/2018 Dx: 3.5 cm rectal adenocarcinoma, 10 cm from verge. Well/mod diff (G1-2), T3bN1bM1a.
3 enlarged local lymph nodes and 4 liver lesions.
MSS, MMR-proficient, mutated in NRAS (G13R).
CEA: Oct-18 = 12; Nov-18 = 14, Mar-19 = 2.4
11/18 - 6 rounds neoadjuvant FOLFOX
12/18 - DVT, started clexane
3/19 - Liver resection, R0
4-5/19 - Long-course pelvic chemoradiation (45 Gy w/ Xeloda)

Gravelyguy
Posts: 152
Joined: Thu Jul 05, 2018 6:03 pm

Re: Recovery time after liver resection

Postby Gravelyguy » Tue Mar 12, 2019 5:35 pm

I started mop up chemo 6 weeks after my Combo liver and rectal resection. I had done short course radiation just before surgery so not sure if they might wait longer to do post surgery radiation. Glad it went well and you are home!

Dave
6/17 dx mCRC t3n1m1 very low rectal tumor 2 liver Mets 1.3 cm and .9 cm

6/17 begin 4 rounds Folfox w/Vectibix
9/17 short course radiation
10/17 rectal and liver resection LAR with coloanal anastomosis (no rectum left)
11/17-3/18 8 rounds Folfox
6/18 still NED!! Takedown
8/28/18 still NED! CEA .8 new low for me
10/18/18 colonoscopy clear
12/12/18 clear scans, CEA .9 still NED!

Butt
Posts: 10
Joined: Mon Mar 11, 2019 10:48 pm

Re: Recovery time after liver resection

Postby Butt » Tue Apr 02, 2019 9:21 pm

Chemo started 4 weeks after the surgery. You need a lot of protein in recovery. I was permitted to drive after I stopped narcotics. A month later I could do a full day at work, buy groceries after work and do laundry upon arriving home. So it was a month after my energy got back. Please feel free to ask if there are any questions. Butt.

Rock_Robster
Posts: 72
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Recovery time after liver resection

Postby Rock_Robster » Tue Apr 02, 2019 9:56 pm

Thanks all - it’s 4 weeks to the day today and I’m feeling pretty good. Off painkillers, eating lots, driving and back in the gym today. Still have some abdominal and residual shoulder pain, which is annoying but manageable. Definitely have some tired days, but nothing compared to FOLFOX! Radiation due to start in next 1-2 weeks. Thanks all for the info!
Male 37 years; Melbourne, Australia
10/2018 Dx: 3.5 cm rectal adenocarcinoma, 10 cm from verge. Well/mod diff (G1-2), T3bN1bM1a.
3 enlarged local lymph nodes and 4 liver lesions.
MSS, MMR-proficient, mutated in NRAS (G13R).
CEA: Oct-18 = 12; Nov-18 = 14, Mar-19 = 2.4
11/18 - 6 rounds neoadjuvant FOLFOX
12/18 - DVT, started clexane
3/19 - Liver resection, R0
4-5/19 - Long-course pelvic chemoradiation (45 Gy w/ Xeloda)

kandj
Posts: 242
Joined: Sun Sep 27, 2015 11:29 am

Re: Recovery time after liver resection

Postby kandj » Wed Apr 03, 2019 12:32 am

Rock_Robster wrote: Still have some abdominal and residual shoulder pain, which is annoying but manageable.


Keep an eye on that. Referred shoulder pain can be due to fluid in the abdomen or other issues. If it is not getting better, ask for imaging. DH had shoulder pain pop up about 2 weeks post liver resection and blew it off. It did not get better and came to a head about 3 weeks after the resection. It was a liver abscess that could have killed him. Probably not that for you, but keep an eye on it.
wife to DH, dx 8/15 stage IV @36
Told unresectable liver Mets
Primary resection and HAI pump placed Dec 2015 at MSKCC, FUDR started Dec 2015
Liver resection 5/19/2016 15-20 mets removed (surgeon lost count, but it hopeful he got it all!)
Recurrence 7/2017 4 Liver mets and one possible lung met
Radiation on liver Mets 12/17
Lung met 10/18
46 rounds of chemo 8/15-5/18
VATS on lung met 11/18 started xeloda

Rock_Robster
Posts: 72
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Recovery time after liver resection

Postby Rock_Robster » Wed Apr 03, 2019 12:49 am

Thanks kandj, indeed that is my worry too - they mentioned on a recent CT that I still had a bit of fluid & gas in my abdomen which is unusual this far out, and I guess could be related. The strange thing is it’s very transient - 80% of the time I have no pain, then occasionally it will ramp up to something fairly severe, then fade away again. Seems to be worse after eating or sometimes exercise (I guess all things that could irritate the area a bit). It’s also on the opposite shoulder so a bit unusual for liver injury. I have my surgeon’s mobile now and was told to call if it gets bad again, so I’ll be doing that!
Male 37 years; Melbourne, Australia
10/2018 Dx: 3.5 cm rectal adenocarcinoma, 10 cm from verge. Well/mod diff (G1-2), T3bN1bM1a.
3 enlarged local lymph nodes and 4 liver lesions.
MSS, MMR-proficient, mutated in NRAS (G13R).
CEA: Oct-18 = 12; Nov-18 = 14, Mar-19 = 2.4
11/18 - 6 rounds neoadjuvant FOLFOX
12/18 - DVT, started clexane
3/19 - Liver resection, R0
4-5/19 - Long-course pelvic chemoradiation (45 Gy w/ Xeloda)

kandj
Posts: 242
Joined: Sun Sep 27, 2015 11:29 am

Re: Recovery time after liver resection

Postby kandj » Wed Apr 03, 2019 12:58 am

DH's wasn't bad all the time either. It was pain at night, when he would lay down. Went on for about a week like that. Even flew home like that. He spiked a fever a few days later and the rest is history. It probably is residual fluid irritating nerves for you. Just make sure to call if it gets worse. Every day should be a little better than the day before.
wife to DH, dx 8/15 stage IV @36
Told unresectable liver Mets
Primary resection and HAI pump placed Dec 2015 at MSKCC, FUDR started Dec 2015
Liver resection 5/19/2016 15-20 mets removed (surgeon lost count, but it hopeful he got it all!)
Recurrence 7/2017 4 Liver mets and one possible lung met
Radiation on liver Mets 12/17
Lung met 10/18
46 rounds of chemo 8/15-5/18
VATS on lung met 11/18 started xeloda


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