PVE Followed By Liver Resection!

[camicom]

Hello all, still kicking. Its been over 3 years since my Stage 4 diagnosis and I'm still going. Unfortunately the latest round of chemo didn't help, so now its time to make some tough decisions. A liver resection has always been a maybe option for me because the majority of the tumors are on the right side of my liver. The issue in the past has been the left side of my liver is likely not big enough to support me. After my first y90 treatment on the RS, my left side grew quite a bit. Well FF to now, I have decided to take the plunge, first with a PVE and then a resection, assuming the PVE works.

I would just like to get your feedback on your experience and recovery. First on the PVE then the resection. I was told, its usually a 5-7 hospital stay then a 4-8 recovery. Also, how many tubes do you have stuck in you after surgery. I assume a catheter, but what others?

Thanks in advance you guys...keep fighting.

[Rock_Robster]

I had a PVE which was fine - short anesthetic and a little sore, kind of felt like I’d been punched in the side for a day or so.

The liver resections(s) are obviously much larger, and will depend a lot on how much liver you’re having removed, and whether it’s open or laparoscopic? Mind were about 25% each and open; I was in hospital for 4-5 days each time, pretty useless for about 2 weeks. By 4 weeks I felt a lot better, and after 6 weeks back to work (desk job). Good pain meds are essential, along with breathing and walking exercises to reduce complications. Ask if you hospital has an ERAS program (Enhanced Recovery After Surgery), if not you can always do your own.

I had a urinary catheter (removed immediately), one drain (removed after a few days), an arterial line in my arm and central line in my neck (both removed when I left ICU), an IV line (removed when I went to oral painkillers), a pain buster local anaesthetic infusion (removed after 2 days), and nasal oxygen cannula (removed after a few days).

My broader question is around a PVE in your case. The challenge with a PVE is you usually have to wait at least 4-8 weeks afterwards for the full hypertrophy response, and you’ll likely also be off chemo for at least a month after a liver resection. The PVE itself can also create a pro-metastatic environment in the liver, with increased blood flow, inflammation, etc. Unfortunately quite a few patients (myself included) experience disease progression during the PVE phase which means resection can’t be completed. The usual way to reduce the risk of this is have “systemic control” of disease via chemotherapy beforehand. However you mentioned your chemo “didn’t work” - do we take this to mean you currently have progressive disease? In this case the risk of progression during PVE is likely higher again.

This is a tricky situation as I do think having the PVE and resection is likely your best path to NED and long-term survival. However often you only really get one shot at this procedure, so you want to give it the best chance of success. Given it sounds like you’ve had FOLFOX (good response) and have progressed on Xeloda monotherapy (probably unsurprising), you could weigh up the benefits of perhaps trying FOLFIRI before the PVE to reduce the risk of metastatic spread. Of course the risk of this is if you don’t respond to the FOLFIRI, then progression could rule out the resection.

Good luck whatever you decide and may you have the best outcome possible.

[camicom]

Thanks so much for your reply. I just had Y90 done, which should hold the tumors in check during and after the PVE. Sorry I didn't put that in the original post. I stopped doing my 3rd round after 3 treatments since I was having progression. Folfox worked great the first 2 times I did it, just not this time. I still have not done Folfiri yet, but Im at the point where I think drastic measures are in order LOL. The are going to remove approx 50% of my liver, which from what I've heard is a pretty big deal.

It is going to be an open procedure also.