Liver resection criteria?

mom_2_3 said:

Peter
I am so sorry to hear of your wife's diagnosis.

In answer to your question, my opinion based on everything I have read is that different surgeons/facilities have different criterion for liver resections. I have read posts from people here and on other boards commenting that the consulted surgeon wouldn't do surgery because of extrahepatic disease, bilobar disease, multiple liver mets, location of particular mets and volume of liver mets compared to total volume of the liver.

I have found many of those posts interesting as when I was diagnosed I had 5 liver mets across both lobes of my liver. So according to some of those surgeons, I would not have been operable. I sought treatment, however, at a facility that I have found to be exceptional in its care and its assertiveness in treating Stage IV colon cancer.

In particular, my own doctor is pre-eminent in the colon cancer field and she has a video here describing a treatment protocol of which she has been a pioneer. Video here. (Thanks Phil for that link. I'm going to use it whenever I can!)

The particular therapy that this doctor pioneered is called HAI or Hepatic Arterial Infusion pump therapy whereby a hockey-sized pump is implanted into the abdomen and routed directly into the hepatic artery. This allows for the profusion of chemo directly to the liver with no side effects to the rest of the body. This treatment protocol is used in both pre-surgical as well as adjuvant settings. If you sit through the attached link you will see that the treatment can be very effective in helping a patient achieve operability as well as helping to prevent future recurrence (as I chose to do).

I have met countless patients in my oncologist's office who have had this treatment successfully (achieving long-term remission). I have met people who have described their livers as "swiss cheese" and "completely covered" with liver mets, only to have gone on to remission and hopefully permanent cure. One gentleman I know is having his 2 1/2 year scan next month. Doctors in his hometown of Cincy, OH told him to forget about ever having surgery on his liver and to get his affairs in order. He chose to ignore their advice and instead had an HAI pump implanted February 2009. He became operable in August 2009 when he had his liver resection and has been in remission since.

Another man I met had a liver met right on an artery which prevented resection. He had HAI therapy for 6 months during which time the met shrunk enough to allow for a resection.

I met another person who had lung involvement simulataneous with liver mets but he was able to have the liver resection done first and next month will have 2 lung mets removed.

So for all the reasons I have heard someone was not resectable, I have met or experienced personally those that have had surgery despite those reasons.

When you speak with your wife's oncologist remember that he is an oncologist, not a surgeon and while he may be familiar with the standard protocols at that particular facility, he is not the last word on the matter. Many hospitals employ a board comprised of oncologist, surgeons and IR who discuss each case and can help determine direction for treatment. If I were you I would make sure I obtained an opinion from a hepatabiliary surgeon (not general surgeon) that practices at an NCI hospital. If you don't like the opinion you receive, look for another.

I will leave you with one last patient story who is treated where I am treated. This young woman had her colon resection (despite extensive liver involvement and had the pump implanted). In the 2 years subsequent to that surgery she has had 2 liver resections (they did each side, one at a time) and then 3 RFAs on the liver. She is currently in remission. My gut feeling is that this woman would not have received the same aggressiveness with respect to her care at another facility. The doctors have never given up on this woman.

In summary, ask your wife's doctor about HAI, RFA, portal vein embolization (where they cut the hepatic vein to make one side of the liver grow). I'm sure there are other protocols but there are the ones I think I would be most interested in.

If you have any questions, please feel free to PM me here and I can give you my email address. I reside in NJ.

Amy