Likely Liver Resection Coming. Need advice please:)

[camicom]

Hello,

Just finished 3 months of FOLFOX, and had about a 30-40% reduction in all of my tumors according to the latest MRI. My liver surgeon had said a reduction in size would probably qualify me for a resection. 60% of my liver carries 33 of the 35 tumor, with 2 small ones in the 40%. He talked about taking the 60% and either ablating or removing the 2 remaining small ones.

I know multiple people on the forum have had liver resections. Would you please let me know what to expect post op? I had an open extended right Hemicolectomy and tolerated it very well. While I realize the liver resection is a more difficult operation, I would assume the recovery is probably a little easier than a colon resection(less moving parts) barring complications.

Any info or stories would be greatly appreciated:)

[ginabeewell]

I had three surgeries - the first a colon resection / HAI pump placement; the second a liver resection where they removed 10-15% and the second a liver resection where they removed 60%.

Each was progressively harder than the last. The final one really kicked my ass - but I can't tell you if that's because they removed 60% of my liver after two previous surgeries and 19 rounds of chemo and my body was just spent and couldn't bounce back. Or if that was just because of the surgery itself. I had to go back to the hospital and install drains back in, and those hung around for a few extra months. My surgery was mid-October and I didn't go back to work until the week after Thanksgiving (and even then I didn't feel ready). I think the previous two had me out for 2-3 weeks.

The only advice I would give is to be in the best physical shape you can be in as I am pretty sure that is what made my first surgery an easier recovery. I did lots of ab strengthening exercises that I was just not able to do for the next two.

[Rock_Robster]

Hi camicom, great news and congrats that you’re able to have a resection!

I had 25% removed via open procedure, after 6 cycles of FOLFOX. There were two aspects to this I found:

- the first is healing from the liver trauma and reduced volume. I was very tired for about 2 weeks, and feeling fine by about 4 weeks. Apparently about 90% of the lost liver volume regenerates in the first 3-4 weeks, so you’ll need lots of extra nutrition (esp. protein) during this time, and expect to be tired!). Small meals often worked best for me, and protein drinks.

- The wound itself. In most cases it’s fairly large, and fairly high in the abdomen. Apparently this typically makes it more painful than lower wounds like a colectomy or ULAR. I was sore for about 6 weeks (and slept reclined for the first ~2 weeks), but the painkillers did a good job and it certainly wasn’t intolerable, just a bit sore. Also you won’t be able to lift heavy or drive for several weeks at least (same as a colectomy really).

The good news is after about 6 weeks I would say I was almost 100% normal. No ongoing issues or fatigue, and just a neat scar. I found this part very different to my rectal surgery, which had a long adjustment period afterward.

My doc told me that the complication rate of liver resections is low, but if they happen they tend to be fairly serious. Whereas with colorectal surgery complications are very common, but tend to be less critical. So the good news is once you’re past the higher risk period, you’re probably in the clear.

After my op I spent 24 hours in a high dependency unit, then about 4 days on a normal ward (should have been 3 but I had some shoulder pain I was convinced was a PE, lol. It wasn’t). I’m a (relatively) young and fit guy, and after surgery I still had some effusion in my lungs. Because of the high wound you tend to breathe more shallowly after surgery, so don’t muck about with the walking and breathing exercises - get on top of them early and stay there. Ask for more painkillers to help you walk/breathe, if necessary. This is not the time to be dealing with pneumonia as well!

Best of luck!
Rob

[camicom]

Thanks so much for the replies. Glad to see you're doing well.

[jsbsf]

DH is following in rock_robsters steps in large part. He hasn’t had the rectal surgery yet, but had a microwave ablation on 2/5 and a laparoscopic resection on 2/11.

The MWA required only one needle. If the lesion is spherical, the heat can radiate from the center and cover the entire area. Otherwise, they may require more than one needle to treat a single lesion. That lesion technically disappeared, so the procedure was completed with a fair amount of confidence. He was out the next day, and recovered very quickly. They originally planned an open surgery where resecting this lesion would be far more invasive.

He got something called a stress test. This was actually the day he was still in hospital the day after his MWA. They wanted to make sure his heart was strong enough for the upcoming laparoscopic surgery. They injected something into his veins. He said shortly after, it felt like he ran a marathon. Fortunately they determined they could move forward.

The resection surgery was laparoscopic. It required 3 small incisions to remove a small tumor on the surface. My sister had her gall bladder removed, and I feel like their experiences were similar. He was out the next day. Strangely, he had the shoulder pain rock_robster described, and the surgeon specifically asked him if he had that. He also had a biopsy (4th incision) where they noticed a strange spot - turned out to be a burn mark from the previous MWA, from when the needle is extracted. The pain from the biopsy was the worst, followed by the shoulder pain, and lastly the pain from where they removed the tumor.

He had to apply some antibacterial type substance the morning before surgery, and he had to drink something - I wish I remember now what it was for.

One thing they mentioned was if they found cancer in his spleen or gallbladder, removing those organs would be included in the procedure. So, he might have woken up to learn either or both those organs were removed. He had to sign a consent form for this prior to surgery. They swabbed his nose as a way to minimize the chance for MRSA.

Pain was considerable for the first couple days. It gradually diminished, and I’d say completely subsided after two to three weeks. The shoulder pain returned to a smaller degree after he reconvened chemo, but only lasted about a day. So far, he’s had only 2 infusions since surgery, and that pain came back each time. It’s been a month and a half now, and other than the shoulder pain those two times, it’s as if nothing ever happened.

[Rock_Robster]

Since shoulder pain has come up a couple of times I’ll add some detail on this from my experience. It’s very common and usually comes from the phrenic nerve being irritated during the procedure. The phrenic nerve runs down the neck and shoulder to innervate the diaphragm, so any procedure which interferes with the diaphragm (particularly left lobe resections) can cause this. It’s more common on the right shoulder, but can also occur in the left shoulder (as mine was).

If you have a laparoscopic procedure, it can also be caused or worsened by the CO2 gas they use irritating the nerves.

The bad part is it can be pretty uncomfortable, and sometimes it’s hard to get relief (painkillers helped me a bit, but actually a head pack was the most relieving). The good news is that it is common and not usually a sign of anything bad, and tends to improve significantly over time. Once I knew mine wasn’t an embolism then it really didn’t bother me as much and I just got on with healing.

Good luck,
Rob