For those with liver mets, no spread elsewhere:

NJC said:

Dave (Dr. Bartlett) is an
Dave (Dr. Bartlett) is an extremely talented surgeon, and one of the top in his field. In fact, he was responsible for the development of the "new" HIPEC procedure while at the University of Pittsburgh. He is often referred to from Sloan, MD Anderson, etc., and has practiced at each, respectively.

He is my wife's surgeon and is very much the reason she is still here, as well as his multi-disciplinary team.

She's gone from "should have been dead by now" to NED after presenting with 15-20 difuse, mucinous liver mets shortly after the birth of our son 18m ago.

Independent of my wife's future outcome, he has certainly made a significant difference in her outcome, thus far.

-Joe

pete43lost_at_sea said:

steve, great article thanks
I posted about these limitations a year ago, just a warning from pubmed and i got into hot water over it. nethertheless, the message is clear here, if you have a low bmi ie you are not fat, your chances of avoiding CASH are improved. so why not be healthy. just think about the big M for mcdonalds being equal to M for mortality. thats what stops me walking inside each and every time i go past. these studies are just confirmation that my extreme approach to health is whats required to get the body ready for surgery. and i hope its not needed , but if it is so be it.

it still all comes down to the liver,the liver, the liver. Anyone interested could do worse than read sandra cabots book the liver and bowel bible as a starting point.

hugs,
pete


Limitations of Chemotherapy
FIGURE 1

Comparison of Survival of a Group of Patients With Colorectal Metastases to the Liver and a Second Group With Carcinomatosis
The role of chemotherapy is to enhance the outcomes of surgery and/or permit potentially curative resection to be performed. Unfortunately, chemotherapy has potential disadvantages, which relate to direct toxic effects on the liver, leading to an increased risk of potential postoperative complications. There is now a large body of evidence showing that systemic chemotherapy can result in nonalcoholic fatty liver disease and sinusoidal injury. The chemotherapy-associated liver disease ranges from steatosis to steatohepatitis (CASH).[62] Steatosis resulting from chemotherapy and/or any other etiology has been shown to lead to a higher rate of complications following hepatic resection. However, the development of CASH appears to hold greater significance.[63] Of note, CASH appears to be more closely associated with the use of irinotecan-based chemotherapy and to occur more commonly in patients with higher body mass index.[64] The development of CASH has been associated with a higher postoperative mortality rate related primarily to postoperative liver failure. In one series, the 90-day mortality rate in patients with steatohepatitis was 14.7% vs 1.6% for those who did not have steatohepatitis.[65] In contrast to treatment with irinotecan, oxaliplatin-based chemotherapy has been typically associated with liver sinusoidal injury.[62,65,66] In more severe cases, perisinusoidal fibrosis, sinusoidal obstruction, and portal hypertension have been observed. In contrast to CASH, the development of sinusoidal dilation has not been associated with an increased risk of perioperative morbidity and mortality.[67,68]