Next stop Liver resection

menright

I received my MRI results yesterday and things look good for the next step which is liver resection surgery. The plan is to remove the right lobe.

Prior to surgery, my oncologist is setting up a visit to Sloan Kettering to verify my plan and provide a second opinion. It is interesting that they are prompting this, not me. I'm not sure what to think, but it seems to be a good idea. NYC is only a 2-hr drive.

As I understand it, liver surgery is my path to a cure. Wish me luck.

I welcome any and all comments or suggestions about how to prepare for liver surgery. Should happen within 1 month.

Mike

lisa42

you can do this!
Hi Mike,

I had my liver surgery in May '08. I had about 45% of my liver removed- the entire left lobe and a wedge resection of the right. I really probably didn't do a lot ahead of time to prepare for it except for what you're doing now- asking around and finding out what other people experienced with it. Being underweight wasn't an issue for me (I'm not huge, but I would like to lose about 15 lbs) but, if being underweight from treatment is an issue for you, you might want to work on putting on weight now in preparation for being in the hospital. My surgeon told me I would probably lose up to 20 lbs from the whole things. I never did though- I actually gained about 10 lbs in the hospital- LOL- probably from fluid retention at the time, but the weight stayed on! The ironies of life- I can't even lose weight from surgery or while on chemo! I guess, though, it's really better to have on a bit of extra than to be underweight. So, just something to consider if that's an issue for you. Ask your doctor, also, about how they're going to close up your wound, just so there are no surprises for you. It sounds like, from what I've heard, most people get their incision stapled shut. For whatever reason, I didn't have any staples or sutures on the outside. Steri-strips held mine closed and they worked well. They didn't even start to come loose when they were supposed to, so I started working on them after awhile. I've got a pretty decent scar compared to some pictures I've seen (but I'm not posting any pics of mine!) Some get an L shaped cut, some an upside down T, and I've got a diagonal curve.

The day or two afterwards, I thought I'd never even be able to lift my head or body up off the bed. But, of course, I did and it got better and better each day. So, when you feel the couple of days following your surgery like your guts have been ripped out (because they will have been!), just know that it really does get better and better fairly soon after that! Although pain went with recovery for a while, I was up and walking (very slowly) down my street within a couple of days after arriving home from the hospital.

You'll do fine and I'm glad you're to the point where you can have this surgery!
Keep us informed as to when your surgery gets scheduled.
Best wishes to you,
Lisa

Fight for my love

Hi Mike,best luck and best
Hi Mike,best luck and best wishes to you and your surgery.Take care.Please keep us updating.

Sundanceh

lisa42 said:

you can do this!
Hi Mike,

I had my liver surgery in May '08. I had about 45% of my liver removed- the entire left lobe and a wedge resection of the right. I really probably didn't do a lot ahead of time to prepare for it except for what you're doing now- asking around and finding out what other people experienced with it. Being underweight wasn't an issue for me (I'm not huge, but I would like to lose about 15 lbs) but, if being underweight from treatment is an issue for you, you might want to work on putting on weight now in preparation for being in the hospital. My surgeon told me I would probably lose up to 20 lbs from the whole things. I never did though- I actually gained about 10 lbs in the hospital- LOL- probably from fluid retention at the time, but the weight stayed on! The ironies of life- I can't even lose weight from surgery or while on chemo! I guess, though, it's really better to have on a bit of extra than to be underweight. So, just something to consider if that's an issue for you. Ask your doctor, also, about how they're going to close up your wound, just so there are no surprises for you. It sounds like, from what I've heard, most people get their incision stapled shut. For whatever reason, I didn't have any staples or sutures on the outside. Steri-strips held mine closed and they worked well. They didn't even start to come loose when they were supposed to, so I started working on them after awhile. I've got a pretty decent scar compared to some pictures I've seen (but I'm not posting any pics of mine!) Some get an L shaped cut, some an upside down T, and I've got a diagonal curve.

The day or two afterwards, I thought I'd never even be able to lift my head or body up off the bed. But, of course, I did and it got better and better each day. So, when you feel the couple of days following your surgery like your guts have been ripped out (because they will have been!), just know that it really does get better and better fairly soon after that! Although pain went with recovery for a while, I was up and walking (very slowly) down my street within a couple of days after arriving home from the hospital.

You'll do fine and I'm glad you're to the point where you can have this surgery!
Keep us informed as to when your surgery gets scheduled.
Best wishes to you,
Lisa

Best of Luck Mike
I got the "L."

Just a quick story - I was originally scheduled for liver resection. I had read that only a very few lucky ones even qualify to have a liver resection, so congrats to you for that.

They were going to take 80% of my liver - still can't believe I just jumped up on the gurney and said ok to that.

Anyway, the old and tried rule, is they NEVER KNOW what they will find until they open you up. CT, PET, MRI, Bloodwork, nothing can tell them for certain until they are inside.
Well when they got inside me, they discovered that I had what is called a Fatty Liver - I very quickly became un-qualified on the spot.

They switched over to RFA - Radio Frequency Ablation, and burned a tumor the size of an ORANGE out of my liver - Ouch.

Something else to keep in mind, you will be "unconscious" in the OR when they open you up, so if there are any surprises, they will stop the surgery and come out to talk with your wife and she will have to OK the decision that they might need to go to. Like in my case, my wife had to approve the RFA, so it would be good to talk with her and have her ready if she needs to step in as your medical advocate on your healthcare. I base this on personal experience.

I've got alot of scar tissue build up in there, because they had me down for the liver resection and did the "L" procedure as Lisa eluded to. That combined with the RFA knocked me for a loop - post up chemo followed etc.etc.

But if they can do a liver resect, that is still considered the "gold standard." However, studies indicate that RFA has an equal or even better chance of a success rate as the resection. So that was good news for me, since I was no longer a resection candidate.

My point is which ever way it goes, you've got a good chance. We had mine on hold for about 8 months but scans are showing it has moved on down the road to the pleura of my lung, and I am facing a Thoractomy procedure, but I won't bore you with those details.

Best of luck on your surgery - I'm pulling for you...we've never talked, but it's nice to meet you...I've read your posts.

Take it EZ
-Craig

mom_2_3

Liver resection
Mike,

I'm glad that you got good news regarding your scans and moving forward with liver surgery.

I had my liver resection (colon resection, HAI implantation as well) on 2/9/9. It was performed by a spectacular surgeon at MSK (www.mskcc.org/prg/prg/bios/708.cfm). I had 40% of my liver removed (the entire left lobe and a wedge resection of the right lobe). Last CT scans have shown that my liver is completely re-generated and basically back to what it was looking like before my surgery (without the mets...).

I did no special preparation prior to surgery. After surgery I had a catheter and a PCA line for pain management. I had no other stents or drains. My surgery was on a Friday morning and on Saturday the catheter was removed. I was up and walking on Saturday morning. I won't lie and say I had no pain...it was there but it was manageable and I made it a point to move as much as I could to get my body back into gear. I ended staying in the hospital until the following Saturday. The pain decreased over the entire time but I still went home with a Percoset prescription that I used for about another 2 weeks. It was difficult to keep my body straight during that time and I hunched over a bit. Your incision may be different but mine went from the breastbone to about 4-5 inches below my belly button. I had over 40 staples and they were removed 10 days after surgery. They replaced the staples with steri-strips and those fell off over the course of the 2 weeks after they were put on.

I would advise bringing a small hard pillow to put over your incision for when you cough as that can be painful. Bring chewing gum to get your bowels moving (every one that came into the room always asked the question... ).

It is now more than 5 months since surgery and I feel fantastic. The first 8 weeks I was very fatigued and I napped quite a bit. I wasn't able to lift anything over 10 pounds for 6 weeks so I had help in our home to assist with the children. After I got through those first 8 weeks my energy has returned and I am no longer tired. I think your body puts most of its energy into liver re-generation during that time so be prepared for feeling a general run-down feeling. Take naps as often as you can and don't try and push your body. I was very careful to follow my doctors instructions as to lifting and exertion as I wanted to make sure I didn't end up with any infections, hernias, ripped suture, etc. It was really hard for me not to lift things but I had a mother-in-law, husband and sister yell at me if I even so much as looked at something I wanted to pick up or even lifting my hands high above my head. It was easier to just comply...

Did your oncologist indicate that your surgery would be done at MSK? I would recommend my surgeon in an instant. He was compassionate, extremely intelligent, optimistic and very cute (ok, that probably doesn't matter to you). At the time of surgery I also had an HAI pump implanted. I know I mentioned it to you before but you may want to seriously consider it. I was told that chance of recurrence in the liver was 50% but with the pump that dropped down to 30%. As my cancer really seemed to like my liver (I had 5 bilobar mets) I wanted to decrease recurrence chances. The HAI pump directs the chemo directly into the liver and provides a concentrated way to get the cancer-killing chemicals there without impacting the rest of your body. I did a recent post about it you may want to review. I think you should discuss this with your doctor. Do not be put off by your local oncologist indicating it shows no benefit. It absolutely does have benefit but many doctors don't want to implant them because they are difficult to put in if the DR has no experience (but MSK does 200-300 a year) and they require close monitoring of your liver enzymes (which many oncologists don't want to take the time to do). You may hear that it's an "old" technology but there are a number of long-term survivors here and at colonclub.com that had it many many years ago and are still NED.

If you have any questions, PM me or post here. Perhaps I will see you at MSK for your consult. I will look for someone that looks like your pic. I will be at MSK (outpatient facility) this coming Monday (July 3) and then July 17.

Best of luck to you and your family Mike. If your wife has any questions about what she could expect she could contact my husband via email.

Amy

tootsie1

Glad for you
Hey, Mike.

Whew! I was so anxious to read the results of your MRI. I'm so glad you can do the resection. I've been praying for you all along, but I'll ramp it up with the pending surgery.

*hugs*
Gail

Nana b

tootsie1 said:

Glad for you
Hey, Mike.

Whew! I was so anxious to read the results of your MRI. I'm so glad you can do the resection. I've been praying for you all along, but I'll ramp it up with the pending surgery.

*hugs*
Gail

liver resection in April, 8
liver resection in April, 8 weeks out of work. The moraphine is a must, take it....
It was a lot harder to get to the point that I was walking straight, and not in pain. I was out of the hospital in 5 days, my days and nights were all messed up when I got home and just slept when I could, and watched movies the other times. Being a constant mover the disability was tough for me. At this point I feel realy good, but there is some lighting up on the liver lobe that reginerated, not to scare you...but they don't know if it's a tumour, could be an abscess, heck it could be gas! :-)

menright

lisa42 said:

you can do this!
Hi Mike,

I had my liver surgery in May '08. I had about 45% of my liver removed- the entire left lobe and a wedge resection of the right. I really probably didn't do a lot ahead of time to prepare for it except for what you're doing now- asking around and finding out what other people experienced with it. Being underweight wasn't an issue for me (I'm not huge, but I would like to lose about 15 lbs) but, if being underweight from treatment is an issue for you, you might want to work on putting on weight now in preparation for being in the hospital. My surgeon told me I would probably lose up to 20 lbs from the whole things. I never did though- I actually gained about 10 lbs in the hospital- LOL- probably from fluid retention at the time, but the weight stayed on! The ironies of life- I can't even lose weight from surgery or while on chemo! I guess, though, it's really better to have on a bit of extra than to be underweight. So, just something to consider if that's an issue for you. Ask your doctor, also, about how they're going to close up your wound, just so there are no surprises for you. It sounds like, from what I've heard, most people get their incision stapled shut. For whatever reason, I didn't have any staples or sutures on the outside. Steri-strips held mine closed and they worked well. They didn't even start to come loose when they were supposed to, so I started working on them after awhile. I've got a pretty decent scar compared to some pictures I've seen (but I'm not posting any pics of mine!) Some get an L shaped cut, some an upside down T, and I've got a diagonal curve.

The day or two afterwards, I thought I'd never even be able to lift my head or body up off the bed. But, of course, I did and it got better and better each day. So, when you feel the couple of days following your surgery like your guts have been ripped out (because they will have been!), just know that it really does get better and better fairly soon after that! Although pain went with recovery for a while, I was up and walking (very slowly) down my street within a couple of days after arriving home from the hospital.

You'll do fine and I'm glad you're to the point where you can have this surgery!
Keep us informed as to when your surgery gets scheduled.
Best wishes to you,
Lisa

Liver surgery
Lisa:

Thanks for sharing your story and your words of encouragement. I look forward to getting this done.

Mike

menright

mom_2_3 said:

Liver resection
Mike,

I'm glad that you got good news regarding your scans and moving forward with liver surgery.

I had my liver resection (colon resection, HAI implantation as well) on 2/9/9. It was performed by a spectacular surgeon at MSK (www.mskcc.org/prg/prg/bios/708.cfm). I had 40% of my liver removed (the entire left lobe and a wedge resection of the right lobe). Last CT scans have shown that my liver is completely re-generated and basically back to what it was looking like before my surgery (without the mets...).

I did no special preparation prior to surgery. After surgery I had a catheter and a PCA line for pain management. I had no other stents or drains. My surgery was on a Friday morning and on Saturday the catheter was removed. I was up and walking on Saturday morning. I won't lie and say I had no pain...it was there but it was manageable and I made it a point to move as much as I could to get my body back into gear. I ended staying in the hospital until the following Saturday. The pain decreased over the entire time but I still went home with a Percoset prescription that I used for about another 2 weeks. It was difficult to keep my body straight during that time and I hunched over a bit. Your incision may be different but mine went from the breastbone to about 4-5 inches below my belly button. I had over 40 staples and they were removed 10 days after surgery. They replaced the staples with steri-strips and those fell off over the course of the 2 weeks after they were put on.

I would advise bringing a small hard pillow to put over your incision for when you cough as that can be painful. Bring chewing gum to get your bowels moving (every one that came into the room always asked the question... ).

It is now more than 5 months since surgery and I feel fantastic. The first 8 weeks I was very fatigued and I napped quite a bit. I wasn't able to lift anything over 10 pounds for 6 weeks so I had help in our home to assist with the children. After I got through those first 8 weeks my energy has returned and I am no longer tired. I think your body puts most of its energy into liver re-generation during that time so be prepared for feeling a general run-down feeling. Take naps as often as you can and don't try and push your body. I was very careful to follow my doctors instructions as to lifting and exertion as I wanted to make sure I didn't end up with any infections, hernias, ripped suture, etc. It was really hard for me not to lift things but I had a mother-in-law, husband and sister yell at me if I even so much as looked at something I wanted to pick up or even lifting my hands high above my head. It was easier to just comply...

Did your oncologist indicate that your surgery would be done at MSK? I would recommend my surgeon in an instant. He was compassionate, extremely intelligent, optimistic and very cute (ok, that probably doesn't matter to you). At the time of surgery I also had an HAI pump implanted. I know I mentioned it to you before but you may want to seriously consider it. I was told that chance of recurrence in the liver was 50% but with the pump that dropped down to 30%. As my cancer really seemed to like my liver (I had 5 bilobar mets) I wanted to decrease recurrence chances. The HAI pump directs the chemo directly into the liver and provides a concentrated way to get the cancer-killing chemicals there without impacting the rest of your body. I did a recent post about it you may want to review. I think you should discuss this with your doctor. Do not be put off by your local oncologist indicating it shows no benefit. It absolutely does have benefit but many doctors don't want to implant them because they are difficult to put in if the DR has no experience (but MSK does 200-300 a year) and they require close monitoring of your liver enzymes (which many oncologists don't want to take the time to do). You may hear that it's an "old" technology but there are a number of long-term survivors here and at colonclub.com that had it many many years ago and are still NED.

If you have any questions, PM me or post here. Perhaps I will see you at MSK for your consult. I will look for someone that looks like your pic. I will be at MSK (outpatient facility) this coming Monday (July 3) and then July 17.

Best of luck to you and your family Mike. If your wife has any questions about what she could expect she could contact my husband via email.

Amy

MSK liver surgery
Amy:

Thanks for sharing your story. I plan to discuss the possibility and benefits of having my surgery at MSK. It would not be convenient, but I want the best care. I am still waiting for a doctor recommendation and then I will schedule the visit for the second opinion. I'll let you know when and which doctor.

Your comments on the HAI pump are interesting. I will definitely include this in my conversation. My current oncologist was indeed against the idea when I first mentioned it and now you have me questioning his motive. It is good to ask questions. How long will the pump remain?

Thanks again for all the good information. Wish me luck.

Mike

mom_2_3

menright said:

MSK liver surgery
Amy:

Thanks for sharing your story. I plan to discuss the possibility and benefits of having my surgery at MSK. It would not be convenient, but I want the best care. I am still waiting for a doctor recommendation and then I will schedule the visit for the second opinion. I'll let you know when and which doctor.

Your comments on the HAI pump are interesting. I will definitely include this in my conversation. My current oncologist was indeed against the idea when I first mentioned it and now you have me questioning his motive. It is good to ask questions. How long will the pump remain?

Thanks again for all the good information. Wish me luck.

Mike

Pump Therapy
Mike,

My oncologist just presented at ASCO (May) and they are showing studies that show great success with HAI therapy in getting people to resectability. I know that is not your case as you are ready for surgery but current studies at MSK (of which I am now part of) are looking at the pump as adjuvant therapy to prevent recurrence and they are also showing great promise. It just seems logical to me that if the pump can take someone that is inoperable and decrease liver tumor volume amazingly that it should also have benefit to the liver after surgery in killing any remaiming microscopic cells. There isn't a lot of risk to the pump. You're going to be in there for liver surgery anyway so a skilled surgeon can install the pump as well. It looks like a hockey puck and is implanted in your abdomen similar to a power port in the shoulder area.

It is critical, however, that someone used to placing the pump does the procedure. If you have it done you will have an injection via the HAI pump into your liver (like a CT scan) to make sure the liver is being perfused appropriately. When I get my liver chemo (every 5 weeks and it stays in for 2 weeks) I have absolutely no side effects. Access to the pump is similar to the Power Port, just a different location. It isn't painful but you can use EMLA cream on the site to numb it. How long will it remain? Well, Phil has had his for 5 years (I think) although it isn't currently being used. Someone people will have them removed after treatment (adjuvant is 6 sessions - about 30 weeks) but others will keep them in. There is no downside to keeping it in, you just need to fill it every couple of months with glycerol. If you do remove it, it cannot be put back in. God willing, I will have mine removed in 3-4 years.

I know oncologists don't give the pump too much credit, espcially in the era of Avastin. As my surgeon explained to me, every single DR at MSK (if in the same situation) would absolutely have the pump placed for pre-surgical or adjuvant therapy. Additionally he felt that the skill and volume required to place them correctly isn't widespread (hence the need to go to a place like MSK). You wouldn't want a local surgeon performing this procedure. Finally, oncologists have certain goals (financial and otherwise). I am not bashing anyone's oncologist but it does take a certain amount of additional time and effort to monitor an individual on this therapy. And, it takes a great amount of experience to know how to manage dosages based upon liver enzymes that fluctuate during therapy. My oncologist is the queen of this therapy and so it comes very quickly to her how to adjust chemo. Another oncologist may need additional time to do this and that time translates into less patients he/she can see and more time spent on you with the same co-pay/insurance payment. Again, I wouldn't assign a financial motive on every oncologist but the more patients they see, the better (for them).

One thing to consider is implanting the HAI pump and having my oncologist monitor you in conjunction with your local onco. She does this all the time. Her information is http://www.mskcc.org/prg/prg/bios/123.cfm. I would suggest that you get second opinion at MSK and try and include her in your information-gathering process. It is best to call her office number and speak to her staff as opposed to the referral line. If you want the number, PM me. If she takes you as a patient you would have to travel to NYC every 5 weeks for the pump therapy and hopefully your local office could be trained to do the saline push into the HAI pump on your systemic chemo sessions. She also likes CT scans done at MSK so you would have to travel for those as well but you could do those at other outpatient facilities (like Basking Ridge, NJ and Long Island) which may be more convenient for you then getting into NYC.

All the best Mike!!

Amy