60% Liver Resection

[camicom]

Hello all, I have 35 liver METS covering roughly 60% of my liver. The other 40% has just a few small ones that can be ablated. I am about 9 months out from doing 9 cycles of Folfox with a 40% reduction in growth. I currently am taking Xeloda as maintenance. My largest met is about 1.4cm, most are under 1.0cm. I have had 2 scans since I stopped Folfox and all METS are stable. I talked to a liver surgeon who wanted to do almost an 85% resection after embolizing the tumor free 15% to around 35%. The tumor board turned it down. I have since got a 2nd opinion who says they will do the resection ablating the remaining tumor on the clean 40%, and taking the rest. I am going to get a 3rd opinion on Tuesday.

I realize this is really my only chance to live and extended period of time. I know chemo has its limitations, and at some point, the tumors will likely activate again and start progressing. I would really like your opinions and how difficult a surgery it is, and how is the recovery on a resection. I had an extended right hemicolectomy and would thing, while the resection is a more difficult operation, the recovery would be easier, I don't know maybe I'm wrong.

Thanks in advance for whatever input of advice you can give me.

[stu]

I can share my mum’s experience and what I observed if that helps .

Way back in 2009 my mum had a spread from segments 4 through to 8 . She had six cycles of chemo and a brilliant response. One tumour alone was 5 cm . She had a combined bowel resection and four wedge resections in her liver . After two weeks she made great progress .
Unfortunately she had another immediate recurrence and went onto have another six cycles of chemo . Again another great outcome . This time she was referred through to a centre of clinical excellence and they offered to remove 73% of her liver by getting creative around the main blood supply !
She was warned that surgery would be considerably more extensive than the wedge resections and her recovery very different. I would have said that was a reasonable analysis. She immediately gained three stones of fluids straight after her resection. The liver has apparently a role in producing a protein that pushes the fluid through the body ( or something like that!) This process was compromised and she required help with a diuretic to assist with that for a while .
She was able to come home after 11 days but needed help around the house for about another two weeks . Around the sixth week she was able to go on a small holiday . It took about a full four months to be back to her normal self . She never had any post op chemo . She was 69 at the time of surgery .
Her small liver actually started regenerating very quickly . It is an odd shape now but functioned well . Just this last scan she has an aneurysm in her portal vein ! I think but apart from that it’s been fantastic and still functioning well .
The only long term issue has been with her platelets. They stayed low after her liver resection.
The surgical consultation was very thorough before the surgery . Certainly no sugary coating but weighing it up my mum felt it was a window of opportunity. The first liver resection reduced the tumour burden the second liver resection eliminated the diseases . Two steps to Ned for her .
Her oncologist was not supportive of surgery at the time as he felt she responded so well to chemo . The surgeon felt the conditions were right with the liver to proceed. Others may have deliberated longer but my mum had made her mind up by the end of the consultation in the full knowledge of the risks involved. She favours surgery over chemo anyway .

I know these decisions are complex so I wish you well .
Different country so do you have to get the tumour board to agree?
All the very best with your decision.
Stu

[camicom]

I can share my mum’s experience and what I observed if that helps .

Way back in 2009 my mum had a spread from segments 4 through to 8 . She had six cycles of chemo and a brilliant response. One tumour alone was 5 cm . She had a combined bowel resection and four wedge resections in her liver . After two weeks she made great progress .
Unfortunately she had another immediate recurrence and went onto have another six cycles of chemo . Again another great outcome . This time she was referred through to a centre of clinical excellence and they offered to remove 73% of her liver by getting creative around the main blood supply !
She was warned that surgery would be considerably more extensive than the wedge resections and her recovery very different. I would have said that was a reasonable analysis. She immediately gained three stones of fluids straight after her resection. The liver has apparently a role in producing a protein that pushes the fluid through the body ( or something like that!) This process was compromised and she required help with a diuretic to assist with that for a while .
She was able to come home after 11 days but needed help around the house for about another two weeks . Around the sixth week she was able to go on a small holiday . It took about a full four months to be back to her normal self . She never had any post op chemo . She was 69 at the time of surgery .
Her small liver actually started regenerating very quickly . It is an odd shape now but functioned well . Just this last scan she has an aneurysm in her portal vein ! I think but apart from that it’s been fantastic and still functioning well .
The only long term issue has been with her platelets. They stayed low after her liver resection.
The surgical consultation was very thorough before the surgery . Certainly no sugary coating but weighing it up my mum felt it was a window of opportunity. The first liver resection reduced the tumour burden the second liver resection eliminated the diseases . Two steps to Ned for her .
Her oncologist was not supportive of surgery at the time as he felt she responded so well to chemo . The surgeon felt the conditions were right with the liver to proceed. Others may have deliberated longer but my mum had made her mind up by the end of the consultation in the full knowledge of the risks involved. She favours surgery over chemo anyway .

I know these decisions are complex so I wish you well .
Different country so do you have to get the tumour board to agree?
All the very best with your decision.
Stu

Thank you so much for your response.

[martd]

I had 17 tumors. Most were on the right side of my liver. I ended up having a 3 part resection. The first surgery they resected the 3 tumors on the left side then shortly after another surgery, portal vien embolization which stops the blood flow to the right side diverting it all to the left side which helps it regenerate even more. The hope is the left side will then grow to a size to survive removing the entire right side. Everything went well. Have you looked into HAI pump? MSK in New York is probably the best with HAI.