Surgery on liver - what to expect?

janie1
janie1 Member Posts: 753 Member
in Colorectal Cancer #1
Hey there. I was on Folfox & Avastin for 5 treatments. Pet scan shows all tumors in liver (at least 15) are not lighting up. Onc. says they're gone, and suggests i have whole Rt. Lobe of liver removed. Rt. lobe had at least 12 tumors, left lobe 3 or 4. Met with surgeon today. Still have to have an MRI. I think he is probably good, but I didn't get to ask a whole lot of questions. He leaves a lot of that to his PA. Even if I can have the Rt. lobe removed, with there having been tumors in the left lobe....are my chances just a little better, or considerably much better????????? He told me there are no guarantees, which I understand, but, wish he could have said something a little more upbeat. Question - did anyone have similar experience, and what is NEXT?????????? Would i do follow-up chemo, even though nothing shows on pet scan. I wanted to ask if it would be wise to put in a HAI pump, just in case. Not sure if only having a left lobe, there would be a risk of overdoing the chemo. I know they don't do HAI pumps here, so would have to go to Sloan. He said I should regain about 85% of liver function in 3 months....i think that is what he said. Any info from anyone is greatly appreciated. (My onc gave me a big bear hug....but surgeon was....not sure how to describe him.....not as enthusiastic.) My onc recommended him (not in same group...and a different hospital). This surgeon is sending all my records to MD Anderson to get their feedback (he was trained there). Is that a good thing???? Thanks.

Comments

  • lesvanb
    lesvanb Member Posts: 905
    #2
    liver surgery
    Hi there

    You are in a tough situation trying to get the best info to make a complicated decision for which your doctors have the best info. I think it's good to have 2nd and 3rd opinions. Having records sent to MD Anderson is a good start since it's a major NCCN hospital.

    I can tell you my story. I was dx stage 4 rectal cancer with one met to the liver (Rt. lobe) 5/08. I had an LAR and then one month later had a Rt lobe liver resection. The intent was for a cure. The liver surgery was more difficult to recover from, it's a big deal surgery though the LAR is too, but I have done very well. All liver functions currently are normal. I work, lift weights, ride horses etc. However, 4 mets, each in a different lobe, showed up in my lungs 6/10 for which I had stereotactic radiation 1/11. A cure is still possible but frankly if I can live well while keeping cancer at bay that's been working for me. I have been off chemo since 5/09 and nothing else has shown up elsewhere including my liver (Pet/CT 6/11). I do have inflammation from the radiation/and or infection still in my lungs, though nothing has shown up in a lung culture, but lungs are improving slowly.

    Good luck with your decision. Please feel free to ask more questions.

    all the best, Leslie
  • PhillieG
    PhillieG Member Posts: 4,866 Member
    #3
    Hi Janie
    Your PET scan results look good. As far as your lobes go, I'm not a doctor (nor do I play one on TV) but I would guess that if you had your right lobe removed, the chances of any cancer returning from your right lobe would be reduced dramatically. The liver is a remarkable organ. It's the only one that regenerates itself. It may not return to full size but I understand that it can return to full functionality. I had 60-70% of mine removed as you know from PM's we've exchanged and it's working fine.

    There's a good chance they would recommend followup chemo. I did that and it worked out well for me. Results vary and all that stuff. Maybe with the right lobe removed, an HAI pump would not be needed. When I had mine put in I still had active tumors in my liver that they could not remove during surgery so that was the thinking behind my plan.

    I do not think it's a bad idea to get more feedback from other surgeons so if he's sending your records to MD Anderson I would welcome their comments.
    I hope this helps.
    -phil
  • mom_2_3
    mom_2_3 Member Posts: 953 Member
    #4
    Janie
    Good news that you responded so well to the chemo. I think in a perfect world you would want to try for wedge removals of the three residual areas on the left lobe. If that can't be done, removing the right lobe now and then waiting for re-generation of your liver and then have 3 residual spots removed might be appropriate. But, like Phil, I only play a doctor on TV and not in real life.

    Make sure the surgeon specializes in hepatobiliary surgery and consider surgical opinion at MSK if you are evenly remotely considering HAI. it is probable that this liver surgery could preclude you ever having the pump put in at a future time.

    Hugs to you,
    Amy
  • janie1
    janie1 Member Posts: 753 Member
    #5
    mom_2_3 said:

    Janie
    Good news that you responded so well to the chemo. I think in a perfect world you would want to try for wedge removals of the three residual areas on the left lobe. If that can't be done, removing the right lobe now and then waiting for re-generation of your liver and then have 3 residual spots removed might be appropriate. But, like Phil, I only play a doctor on TV and not in real life.

    Make sure the surgeon specializes in hepatobiliary surgery and consider surgical opinion at MSK if you are evenly remotely considering HAI. it is probable that this liver surgery could preclude you ever having the pump put in at a future time.

    Hugs to you,
    Amy

    Thank you
    Leslie, thanks so much for your input. Phil, had to lol about your comment that the chance of recurrance "from" the rt. lobe (after having it removed) would be zero. Thanks, i get it. Amy, thanks as always. I doubt that this particular surgeon will want to also do wedge removals in the left lobe at the same time. But, i, too am wondering what could be done at a later date on the left lobe, after regeneration of the right. Always good to hear of possibilities. One encouraging thing... the surgeon brought up the point that there may be a possibility of doing RFA in the left lobe at the same time. So he is considering things. I did bite the bullet, however, and filled out the online form to Sloan yesterday. They called and asked for records and scan reports. I wish we could do a first consult by phone, after they look at the records, but they said that wasn't possible. So, i may be headed for the Big Apple soon. Would really like to know what their plan would be at this point.
  • pscott1
    pscott1 Member Posts: 207 Member
    #6
    Hey Janie! I went today for
    Hey Janie! I went today for MRI to see what the status is on my liver. I'm getting my 5th treatment of Folfox w/Avastin this Friday. The radiologist said that my doctor will know the results on my MRI tomorrow. If you remember, I also had 15 lesions on my liver. I am very hopeful that I will have great results like you. I am so happy for you that the lesions are gone! Congratulations!! Keep your fingers crossed for me! :)

    My best,

    Pam
  • PhillieG
    PhillieG Member Posts: 4,866 Member
    #7
    janie1 said:

    Thank you
    Leslie, thanks so much for your input. Phil, had to lol about your comment that the chance of recurrance "from" the rt. lobe (after having it removed) would be zero. Thanks, i get it. Amy, thanks as always. I doubt that this particular surgeon will want to also do wedge removals in the left lobe at the same time. But, i, too am wondering what could be done at a later date on the left lobe, after regeneration of the right. Always good to hear of possibilities. One encouraging thing... the surgeon brought up the point that there may be a possibility of doing RFA in the left lobe at the same time. So he is considering things. I did bite the bullet, however, and filled out the online form to Sloan yesterday. They called and asked for records and scan reports. I wish we could do a first consult by phone, after they look at the records, but they said that wasn't possible. So, i may be headed for the Big Apple soon. Would really like to know what their plan would be at this point.

    Sloan
    I would really think that if you are headed up from down there and that they wanted your records that they will go over things and be ready to talk with you and answer questions. I had Dr William Jarnigan as my liver surgeon. Great doctor, nice guy too.
    Keep me/us posted please...
    -p
  • Nana b
    Nana b Member Posts: 3,030 Member
    #8
    pscott1 said:

    Hey Janie! I went today for
    Hey Janie! I went today for MRI to see what the status is on my liver. I'm getting my 5th treatment of Folfox w/Avastin this Friday. The radiologist said that my doctor will know the results on my MRI tomorrow. If you remember, I also had 15 lesions on my liver. I am very hopeful that I will have great results like you. I am so happy for you that the lesions are gone! Congratulations!! Keep your fingers crossed for me! :)

    My best,

    Pam

    MY ONC insisted that my
    MY ONC insisted that my liver surgeon take out the mets that he could no longer see. I am very happy that he insisted! They can be under the surface as one of mine was, and then he found another.
  • eileencas
    eileencas Member Posts: 3
    #9
    Please get a second and a
    Please get a second and a third opinion on the liver lobectomy. My father had the surgery a few months back and did not make it. I am not trying to discourage you from having the surgery. The surgeon we saw had a great reputation and was so positive that we didn't seek a second opinion. He told us everything we wanted to hear and made it like it would be a piece of cake. In retrospect, I feel he mislead us. I wished afterwards that some people on the board would have posted poor results so we would have thought harder about our decision and gotten another opinion, which is why I am posting. Also, we are not sure if his death was a result of the surgery or mistakes that were made post surgery (infection) and we are still looking into it. It may be a good thing that your surgeon is cautious. I wish you and everyone on this board the best of luck with their treatment.
  • lisa42
    lisa42 Member Posts: 3,625 Member
    #10
    Hi Janie
    I had a liver resection in May 2008. I had my entire right lobe removed (along with the gallbladder) and had a wedge resection out of the left lobe at the same time. I had gone from 12 visible tumors on scans in my liver down to 3 visible tumors after 10 treatments of Folfox/Avastin. At that time, the 3 tumors were visible on the CT portion, but were no longer lighting up on the PET. I still had many subcentimeter tumors in my lungs at that time & I know some surgeons wouldn't do a liver resection then because of that, but the lung tumors were no longer lighting up on the PET then. My oncologist said they were "dead". After my resection, I learned that they actually ended up removing six tumors instead of just the three that were visible on the scan. The surgeon said that happens sometimes- that due to the location of some tumors, they don't always show up on scans. Even though nothing in the liver was lighting up on the PET, all six removed tumors were biopsied and were found to still be positive for cancer- so I was glad they were removed.

    I really think I should have been put on chemo for a while following the liver surgery, but my onc didn't put me on anything.

    I hesitate to tell you that I have had a recurrence since then, just because I don't want to discourage you. Perhaps if I had chemo afterwards, it wouldn't have happened or at least not so quickly. Three months later on my next scan, things were lighting up again in my lungs and in the liver too- along with three new spots.
    Now- I had many tumors at one time in the part of my liver that still remained, so I knew at the time that I did have a good chance for recurrence there. Do I regret having the surgery since I had a recurrence anyhow? Absolutely not! I don't doubt that I would have been much worse off now if I hadn't had the resection then. Now, I am on chemo and am still here, in fact it will be four years since my diagnosis on Aug. 7th.

    Hopefully, you will not have any recurrence of any kind- this is giving you the best shot at being totally NED (no evidence of disease), so I say go for it! Talk to your onc about doing chemo or not after surgery. Because of my experience, I would say it would probably be a good idea to go for it, but of course I'm not a doctor and everyone is different.

    Take care!!
    Lisa
  • janie1
    janie1 Member Posts: 753 Member
    #11
    lisa42 said:

    Hi Janie
    I had a liver resection in May 2008. I had my entire right lobe removed (along with the gallbladder) and had a wedge resection out of the left lobe at the same time. I had gone from 12 visible tumors on scans in my liver down to 3 visible tumors after 10 treatments of Folfox/Avastin. At that time, the 3 tumors were visible on the CT portion, but were no longer lighting up on the PET. I still had many subcentimeter tumors in my lungs at that time & I know some surgeons wouldn't do a liver resection then because of that, but the lung tumors were no longer lighting up on the PET then. My oncologist said they were "dead". After my resection, I learned that they actually ended up removing six tumors instead of just the three that were visible on the scan. The surgeon said that happens sometimes- that due to the location of some tumors, they don't always show up on scans. Even though nothing in the liver was lighting up on the PET, all six removed tumors were biopsied and were found to still be positive for cancer- so I was glad they were removed.

    I really think I should have been put on chemo for a while following the liver surgery, but my onc didn't put me on anything.

    I hesitate to tell you that I have had a recurrence since then, just because I don't want to discourage you. Perhaps if I had chemo afterwards, it wouldn't have happened or at least not so quickly. Three months later on my next scan, things were lighting up again in my lungs and in the liver too- along with three new spots.
    Now- I had many tumors at one time in the part of my liver that still remained, so I knew at the time that I did have a good chance for recurrence there. Do I regret having the surgery since I had a recurrence anyhow? Absolutely not! I don't doubt that I would have been much worse off now if I hadn't had the resection then. Now, I am on chemo and am still here, in fact it will be four years since my diagnosis on Aug. 7th.

    Hopefully, you will not have any recurrence of any kind- this is giving you the best shot at being totally NED (no evidence of disease), so I say go for it! Talk to your onc about doing chemo or not after surgery. Because of my experience, I would say it would probably be a good idea to go for it, but of course I'm not a doctor and everyone is different.

    Take care!!
    Lisa

    Thanks, Lisa
    You work on your birthday, too? You are so nice. I do want to get aggressive with this as scary as it is. Thanks very much. Joan

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