Which surgery did you have first, liver or colon?

tko683

This stage 4 cancer is such a nightmare. My husband was diagnosed this June and it has been a whirlwind of medical appointments. You all know the story. Now we have met with 2 cancer surgeons each at a different major Cancer center in NC. Each surgeon has a totally different approach. The first one wants to do the liver surgery first with 2 resections since his lesions are on both sides of his liver. Then he wants him to do more chemo and then the chemo/rads and then the rectal surgery. The other surgeon wants to do the chemo rads now, with the rectal surgery to follow, and then either more chemo or liver surgery. He also says he would just resect one side of his liver and do ablation on the other side since it is only one lession towards the top. This is 2 totally different approaches and it really made sense to get the liver taken care of first since it was the most life threatening but now we have a new look and we are confused. Just wanting to hear from those who have had these surgeries, which one did you have first, and did they tell you why...thanks so much...and i hope everyone is doing well...Best wishes to you all.

maglets

different
oh I am so sorry but there are probably as many different routes as there are patients.

I had colon resection first but no evidence of liver mets yet....then chemo....then liver resection after the mets appeared....then chemo....then liver mets reappeared and another liver resection and then chemo

some surgeons wanted heavy chemo repeated before the first liver resection but my surgeon did the surgery then chemo

gosh that all sounds so confusing....

very best wishes to you both

maggie

pepebcn

maglets said:

different
oh I am so sorry but there are probably as many different routes as there are patients.

I had colon resection first but no evidence of liver mets yet....then chemo....then liver resection after the mets appeared....then chemo....then liver mets reappeared and another liver resection and then chemo

some surgeons wanted heavy chemo repeated before the first liver resection but my surgeon did the surgery then chemo

gosh that all sounds so confusing....

very best wishes to you both

maggie

Same time! but normally procedure use to be first the primary
( colon) and second metastasis ( liver ) .
Hugs my friend!

herdizziness

3 same time
They did all three the same day, first the liver surgeon (he wanted to do it first for cleaner "area")then colon then ureter. I had three different surgeons but since they are all at Stanford they just came in when it was their turn to operate. It was 9 1/2 hours I think, but glad they were all done at once.
Winter Marie

tko683

very confusing...
I understand that everyone is different but I just don't understand the logic behind the timing of the surgeries. I can't even imagine having both at the same time.....that must have been terrible. They told us that doing both surgeries at the same time was not an option. I guess I should also ask, which surgery is the hardest to recover from? Hugs to everyone!

mom_2_3

Same time
Both my liver and colon were resected during the same surgery. The philosophy of my surgeons differed a bit (the liver surgeon wanted both done at the same time and the colon surgeon felt we could do them at different times) but we ultimately went with the liver surgeon's opinion.

My liver surgeon felt that at the time of my scans, my liver was operable and he didn't want to risk any more time for a new met to develop or one of the existing ones to grow and thus make me inoperable. We knew I had responded well to my first 4 chemo treatments (Folfox) but he didn't want to risk that my good response might not continue. Additionally, as I would be off chemo for a period of 6 weeks (2 prior to surgery and 4 after) he didn't want to have two healing periods during which I had no chemo treatments. He also didn't want to risk healing complications from two surgeries. He was worried that if I had any issues with healing that it could impact a subsequent surgery.

So on 2/20/09 I had my liver resected, my gallbladder removed, an HAI pump implanted and my colon resected. The liver surgeon did the first three items in the first 5 1/2 hours and the colon surgeon came in after and did the colon resection in 4 hours. I was warned that it might be possible I would have a temp ileostomy after the surgery, and I was marked for one but when I woke up my colon surgeon said that he felt confident that the colon would heal with no complications. As mentioned in a response above, colon came after liver in order to have the field of operation be as sterile as possible.

My liver surgeon removed the left lobe of my liver (which had 3 mets on it) and then did two wedge resections (one on the right lobe and one in the middle). Approximately 40% of the liver was removed and it was back to its original volume and shape by my 8 week scan.
Ask the second surgeon why a wedge resection is not appropriate as compared to ablation. I do not know if outcomes are the same with both but it's a question I would have.

I am now 30 months NED. Next scan is November.

Amy

buckeye2

I think I would get a third
I think I would get a third opinion from one of the major players like MD Anderson, Mayo, etc. I think I read on the Mayo website where they do both procedures at the same time like some of the people here have had. It sounds like this is an area of controversy in the field. I wish your husband the best. Lisa

tko683

mom_2_3 said:

Same time
Both my liver and colon were resected during the same surgery. The philosophy of my surgeons differed a bit (the liver surgeon wanted both done at the same time and the colon surgeon felt we could do them at different times) but we ultimately went with the liver surgeon's opinion.

My liver surgeon felt that at the time of my scans, my liver was operable and he didn't want to risk any more time for a new met to develop or one of the existing ones to grow and thus make me inoperable. We knew I had responded well to my first 4 chemo treatments (Folfox) but he didn't want to risk that my good response might not continue. Additionally, as I would be off chemo for a period of 6 weeks (2 prior to surgery and 4 after) he didn't want to have two healing periods during which I had no chemo treatments. He also didn't want to risk healing complications from two surgeries. He was worried that if I had any issues with healing that it could impact a subsequent surgery.

So on 2/20/09 I had my liver resected, my gallbladder removed, an HAI pump implanted and my colon resected. The liver surgeon did the first three items in the first 5 1/2 hours and the colon surgeon came in after and did the colon resection in 4 hours. I was warned that it might be possible I would have a temp ileostomy after the surgery, and I was marked for one but when I woke up my colon surgeon said that he felt confident that the colon would heal with no complications. As mentioned in a response above, colon came after liver in order to have the field of operation be as sterile as possible.

My liver surgeon removed the left lobe of my liver (which had 3 mets on it) and then did two wedge resections (one on the right lobe and one in the middle). Approximately 40% of the liver was removed and it was back to its original volume and shape by my 8 week scan.
Ask the second surgeon why a wedge resection is not appropriate as compared to ablation. I do not know if outcomes are the same with both but it's a question I would have.

I am now 30 months NED. Next scan is November.

Amy

Great information
Thanks everyone. You all are an amazing source of information! I am so thankful to have you all. I do like the idea of one surgery, one big recovery instead of 2. I don't think we have that option as our insurance would consider anyone out of the state out of network and it has an unlimited out of pocket. I called MD Anderson and they said they don't accept our insurance. I am so frustrated and want the best care for my husband. I thought Duke would be able to provide it but it sounds like they are going to put him through 2 big surgeries when it can be done as one. He gets his 6th chemo next week so we have to decided what to do.....feeling overwhelmed.......thanks for the advice....best wishes to you all!
Congrats Amy on 30 months NED! I love to hear that! It is so encouraging....

mom_2_3

tko683 said:

Great information
Thanks everyone. You all are an amazing source of information! I am so thankful to have you all. I do like the idea of one surgery, one big recovery instead of 2. I don't think we have that option as our insurance would consider anyone out of the state out of network and it has an unlimited out of pocket. I called MD Anderson and they said they don't accept our insurance. I am so frustrated and want the best care for my husband. I thought Duke would be able to provide it but it sounds like they are going to put him through 2 big surgeries when it can be done as one. He gets his 6th chemo next week so we have to decided what to do.....feeling overwhelmed.......thanks for the advice....best wishes to you all!
Congrats Amy on 30 months NED! I love to hear that! It is so encouraging....

Insurance
I am sorry that not only are you dealing with your husband's health issues, but you are also dealing with insurance difficulties as well.

I don't know what state you are in but perhaps you could consider Memorial Sloan Kettering in NYC as an option. I know you have a limit for out of state/out of network coverage but with my own insurance policy, if I can show that no one in our network does a particular procedure, we can go out of network at in-network coverage. I have done that twice.

Perhaps you and your husband could consider an HAI pump as part of his surgery. I had one implanted and it can decrease the odds of recurrence in the liver. I know that not all places do this type of procedure so if you can show you need it then maybe insurance will cover it at MSK where they pioneered the procedure.

Even if you need to go out of network to go to MSK, please consider it. I am extrememly biased but I have found that my care at MSK is superb and I have been very happy with the facilities, coordination of my case, ease of navigating their system, and of course, their top-notch medical staff. I can't say enough good things about them. They have a commercial on the radio here locally for MSK and the tagline is, "The Best Cancer Care, Anywhere." Each time I hear that on the radio I am reminded how fortunate I am to be able to go there for my treatment.

If you want to PM me I can send you my email address so you can contact me that way. NYC has Hope Lodge which provides free lodging to patient and caregiver during treatment stays. Additionally, I have met a number of people that use a free service for flights (I think it's called Air Angels but have to research that again) where private jet owners make their planes available to those seeking treatment. I have one friend that flies back and forth from Cincy, OH to NYC on Procter & Gamble's corporate jet. They even gift him a full basket of their products each time.

Amy

janie1

buckeye2 said:

I think I would get a third
I think I would get a third opinion from one of the major players like MD Anderson, Mayo, etc. I think I read on the Mayo website where they do both procedures at the same time like some of the people here have had. It sounds like this is an area of controversy in the field. I wish your husband the best. Lisa

tko683
I know it's overwhelming, but one step at a time. My situation is probably a lot different, but I followed Amy's (above) recommendation, and got a second opinion at MSK. I live in the SE, also. If at all possible, if you can work it out, it would be good to know what they advise. They see a lot of out-of-staters, so they line up any appointments you need on the same day. It's pretty smooth. First, they will want records and scans sent, even lab slides which were easy to get. A week later, I was meeting with a doctor there. I assume that Duke is very good, but MSK sees so much of these same scenarios. On one of my trips to MSK, i met 2 different people who had started their treatment at Duke. It has been a huge committment, too soon to tell what the outcome will be, but I feel like I am in very good hands. I see where you had already contacted MD Anderson, so since you were already thinking about going a distance from NC, I thought I would tell you about my experience with MSK. Will be thinking of you both.

tko683

I should have been more clear, my husband needs rectal surgery not colon surgery.....not sure if it makes a difference with my question but thought I should clarify...thanks again...

janie1

tko683 said:

I should have been more clear, my husband needs rectal surgery not colon surgery.....not sure if it makes a difference with my question but thought I should clarify...thanks again...

--
I thought maybe it was rectal. Don't really have any answers, but only a suggestion to check with a facility where they do a lot of surgeries. Not sure what you could find out by phone. I doubt not much. Everyone seems to want records up front. Just something to think about.

Erinb

So many opinions. My husband
So many opinions. My husband had a liver resection and then the colon resected in the same operation. The doctors said they could do it all in one surgery and that's what we opted for. He had chemotherapy first, then a port embolism (sp). Both of his surgeries were done at UPMC. However the cancer was stuck to his portal vein and they weren't able to get it all, but did use ablation.
Hope you find an opinion you like.
Erin

PhillieG

Chemo First
I did chemo for 6 months before anything else. My situation was that the colon wasn't critical, the main problem was my liver. I had to try to shrink the tumors in there so I could be operated on. So after 6 months of FOLFOX (5 with Avastin since it was newly approved) I had everything done at once. Colon and liver resections, HAI pump installed, gallbladder removed, and some lymph nodes removed.

Like others have said, we're all different. We did what my Oncologist who I've stayed with since day 3 and I have no regrets. I know of people who did a different route and did not have the same results. That really proves nothing since no two of us are the same but I think it's important to take care of the most threatening thing first.
-p

abrub

mom_2_3 said:

Insurance
I am sorry that not only are you dealing with your husband's health issues, but you are also dealing with insurance difficulties as well.

I don't know what state you are in but perhaps you could consider Memorial Sloan Kettering in NYC as an option. I know you have a limit for out of state/out of network coverage but with my own insurance policy, if I can show that no one in our network does a particular procedure, we can go out of network at in-network coverage. I have done that twice.

Perhaps you and your husband could consider an HAI pump as part of his surgery. I had one implanted and it can decrease the odds of recurrence in the liver. I know that not all places do this type of procedure so if you can show you need it then maybe insurance will cover it at MSK where they pioneered the procedure.

Even if you need to go out of network to go to MSK, please consider it. I am extrememly biased but I have found that my care at MSK is superb and I have been very happy with the facilities, coordination of my case, ease of navigating their system, and of course, their top-notch medical staff. I can't say enough good things about them. They have a commercial on the radio here locally for MSK and the tagline is, "The Best Cancer Care, Anywhere." Each time I hear that on the radio I am reminded how fortunate I am to be able to go there for my treatment.

If you want to PM me I can send you my email address so you can contact me that way. NYC has Hope Lodge which provides free lodging to patient and caregiver during treatment stays. Additionally, I have met a number of people that use a free service for flights (I think it's called Air Angels but have to research that again) where private jet owners make their planes available to those seeking treatment. I have one friend that flies back and forth from Cincy, OH to NYC on Procter & Gamble's corporate jet. They even gift him a full basket of their products each time.

Amy

From another MSKer
Their colorectal group is fantastic, and the coordination between drs is great. Yes, they try to work all of your appointments into a day or so (depends on the days a given dr has clinic.)

I'm from out of town, and get my CT scan and f/u appointment the same day - makes life much easier. My surgeon there does a lot of rectal resections. He's colorectal, and I had appendix cancer, but he resected my colon and ileum in 3 places, and left me working perfectly normally. Stage 4, and I was just told 18 months till my next CT scan. (Had a CT last week.) I'm 4 1/2 years out from dx.

I love them, but bring good reading materials for your wait time!

PhillieG

abrub said:

From another MSKer
Their colorectal group is fantastic, and the coordination between drs is great. Yes, they try to work all of your appointments into a day or so (depends on the days a given dr has clinic.)

I'm from out of town, and get my CT scan and f/u appointment the same day - makes life much easier. My surgeon there does a lot of rectal resections. He's colorectal, and I had appendix cancer, but he resected my colon and ileum in 3 places, and left me working perfectly normally. Stage 4, and I was just told 18 months till my next CT scan. (Had a CT last week.) I'm 4 1/2 years out from dx.

I love them, but bring good reading materials for your wait time!

Ditto
7 1/2 years thanks to MSK and my team over there.

tko683

Surgeon's name at MSK
For those who are going to MSK, who was your surgeon?

abrub

tko683 said:

Surgeon's name at MSK
For those who are going to MSK, who was your surgeon?

Philip Paty, MD
Philip Paty is my surgeon. He's brilliant, kind and caring. I can't say enough good things about him.

tko683

HAI pump?
Thanks everyone for the wonderful advice! It sounds like many of you have gone to MSK and have done really well. That is so great to hear. Our surgeon at Duke actually trained at MSK. I still am trying to explore the possibility of checking it out just don't know if it is possible. We have a 14 year old still at home and can't exactly leave her and don't have family close by. So we will see. Our insurance coverage is not good for out of network and I am guessing the liver surgery will be over $100,000 maybe more. Can someone tell me more about the HAI pump? What is that for? Thanks as always for your wonderful support. Hugs to everyone!

tko683

abrub said:

Philip Paty, MD
Philip Paty is my surgeon. He's brilliant, kind and caring. I can't say enough good things about him.

Thanks
Adding his name to my list. Thanks!

PhillieG

tko683 said:

Surgeon's name at MSK
For those who are going to MSK, who was your surgeon?

Doctor at MSK
Dr Nancy Kemeny. The best!!!