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Are liver mets resectable? Article says it depends on who you ask.

SandiaBuddy's picture
SandiaBuddy
Posts: 878
Joined: Apr 2017

I have seen this issue come up on the board.  Hopefully this article is helpful to those facing it.

http://canjsurg.ca/wp-content/uploads/2018/07/61-4-251.pdf

Assessment of resectability varied significantly between specialties, and resectability was often underestimated by nonhepatobiliary surgeons. Hepatobiliary referral was not considered in a substantial proportion of cases erroneously deemed unresectable. These disparities result largely from an imprecise understanding of modern surgical indications for resection of [colorectal liver metastases].

Another related article: http://hbsn.amegroups.com/article/view/17764/20401

Most CRS (60%) reported they could not accurately predict hepatic resectability, with only 27% familiarity with evidence-based guidelines. . .  There was general agreement between CRS and general surgeons on numerous topics, but additional education is required with regard to HPB surgical capabilities and to provide truly individualized patient-centered care.

Trubrit's picture
Trubrit
Posts: 4828
Joined: Jan 2013

Many members on the forum have had liver resections, some have had multiple liver resections, and are alive and well to tell their story.  So, I would say yes, but heck, what do I know. 

I was supposed to have a liver resection, but my liver surgeon said I was a great candidate for ablation, and that is the road I took, almost FIVE years ago - OK, four years three months, so I exaggetate - 

I will be interested to read other responses.  And no, I didn't follow your link. 

Tru

impactzone's picture
impactzone
Posts: 531
Joined: Aug 2006

Had one done 11 years ago for stage 4 and it never showed up back in liver. I would suggest going to places where they do liver transplants. Those surgeons love a challenge.

I had mine done at Stanford.

Best

Chip

kyolcu
Posts: 112
Joined: Jun 2017

My oncologist at MD Anderson said there will be no chance for liver transplant because my primary is colon. So, I wonder your primary was also colon or liver. If your primary is colon too, I may see liver surgeon as well.

thanks

kadir

abita's picture
abita
Posts: 608
Joined: Dec 2017

I had one. Had 3 large lesions removed

Twinzma
Posts: 210
Joined: Jan 2018

If I could give you a great big hug right now I would! Good Lord does this article renew my hopes for my husband. I hope we find the right surgeon for him and the right oncologist too. Sandi I so hope you realize what a Godsend you are. You do so much research are a weatlth of information and a real inspiration! Thank you!!!!!!

miamax
Posts: 1
Joined: Aug 2018

Hello all, I am new here...although diagnosed with stage IV endometrial cancer June 2016 after suffering DVT and ascites I received a radical hysterectomy followed by a regime of Taxol/Carbo every 3 weeks for 6 treatments.  Since then have had NED with regular visits to gyno/onco every 3 months and scans every 6. CA-125 pre surgery was over 4000, after surgery 400, after chemo has stayed in the range of 10-20. My doctor has always been very forthcoming about my prognosis and seemed surprised I have beaten the odds thus far, however after finding a small liver lesion on CT in May followed by biopsy which confirmed it was consistent with endo cancer and then a scare of a positive IFOBT test which was found to be ok after colonoscopy in July...my doctor's only recommendation with new recurrence was straight back to chemo, even after I asked if there were any other options. I was told surgery was not as she believed it was now "systemic and would just pop up somewhere else," so being stubborn I asked for second opinion and 2nd doctor believes he can help with liver resection and already have surgeon on board after PET scan was completed this past Friday (8/17) found no new evidence of disease. My assigned doctor is now "torn" as she has spoken with colleagues and is leaving decision for next steps up to be whether it be resection, chemo or combination of the two. Second opinion isn't sure if I will need additional chemo and now 3rd says I would do 3 treatments chemo, surgery and then 3 more.  Long story (sorry) very confusing...so now my doctor seems on board although she honestly told me if she were in my shoes or I was a family member she would not recommend the surgery as she would hate to see me go thru invasive procedure just to have additional reoccurence shorty after....but, (it gets better) now 2nd doctor is saying slim/possibly small chance of surgery now being a "curative" vs palliative option..while all along they have been saying palliative only....I am 54, divorced, no children...so my mind says...if there is any iota of a chance shouldnt I do the surgery? but after reading about complications and after care about resection I am now fearful. Surgeon is also about 100 miles from my home so this creates another layer of concern for after care/complications although I am a Kaiser patient and can receive emergency services closeby if needed. long story...short NOT! has anyone else experienced similar situation and any opinion, guidance, success stories on endo mets to liver would be much appreciated although I think mine may be an odd presentation.  The lesion in the liver is small <2cm and no others have been found as of this writing.  HELP!!! surgery sound scary, but I hated the chemo regime also........your thoughts? thanks and love, M. 

Trubrit's picture
Trubrit
Posts: 4828
Joined: Jan 2013

Relativly non-invasive, I had mine out-patient, but most people stay overnight. My surgeon said that if another met pops up, he will just ablate, and on and on. So far, no other mets have popped up (four years and counting). 

Look into it. Its a relativly new procedure. Find a good liver surgeon, who is up on his game. 

Welcome to the forum, and I look forward to getting to know you here, as you continue to post. 

Tru

abita's picture
abita
Posts: 608
Joined: Dec 2017

I had no idea that it wasn't an open one up deal. I am not a candidate for surgery due to location, but reading about ablation makes it seem good idea.  Mine are still small, they are too spread out to be  resected. I guess the downside would be it doesn't also kill any other hidden cells. I wonder if it damages the liver. I looked at the possible side effects, which seem scary, but it sounds like maybe would have same possible with surgery. I almost think no matter what the results are it is better than not knowing and trying to guess what treatment I will get.

Trubrit's picture
Trubrit
Posts: 4828
Joined: Jan 2013

The only side effect I have experienced, is the scar tissue. It gets irritated easily, but is not painful. More like a niggling pain, and not really a pain, I call it a twinge.  I was not warned about this, and I thought it was another tumour in the liver, which caused quite a scare. 

I pretty much know now, what irritates it, and try to limit them. Some, like vacuuming or sweeping, I can't avoid, and just know that its going to twinge a bit afterwards. 

As far as incisions, I had three VERY small incisions because I also had my appendix removed at the same time. One incision for the camera, one for the paddle or whatever the ablation thing is called, and one to remove the appendix. Healed up like a dream. 

So, a good outcome for me, so far. 

Tru

tanstaafl's picture
tanstaafl
Posts: 1292
Joined: Oct 2010

We found we could improve both the chemo and the surgery choices.   In our case, we decided on a mild chemo forever AND an aggressive surgery on lynph nodes.  This is one form of a multimodal treatment, to use their buzz phrase for several kinds of treatment to solve "hopeless" problems.

tanstaafl's picture
tanstaafl
Posts: 1292
Joined: Oct 2010

This situation is common across the board on surgeries from early stage 4s not getting their primary out to salvageable patients with 1-2 met sites, even lymph nodes.  In many ways medicine is still in the dark age information wise.  They live in little superstitious fiefdoms with surprisingly backwards rules.  We got told no several times, but persisted,  improved our answers, and improved our dr candidate choices.

Several major medical deficiencies that really could have been caastrophic or stopped us:

1.  Lack of early immune treatments - cimetidine and the whole nine yards in nutraceuticals.  

2.  Lack of coordinated planning.   How many times do people get rushed into an elective surgery without the least preparation?  It nearly happened to my wife, but she called me first and we used several productive weeks instead.

3. Lack of continuity on chemo.  Patients are not allowed chemo 2-6 weeks before, and after, surgery depending on adjuvants (Avastin=6 weeks),  5FU alone 2-3 weeks.  We went to 12 and 24 hours  with ours, where everybody acknowledged "hopelessly" metastatic prospects. 

4. Lack of targeting and mild adjuncts.  Both prospectively and in real time oncologists are clueless about a lots of possibilities with mild off label adjuncts.  They are just rote learners listening to various pharma "though leaders" and detail(wo)men.  Aspirin, cimetidine, PSK  can be targeted off of markers,  many things can be done by chemo sensitivity testing, even high quality theranostics (empirical personal trials with great bloodwork).

5.  Lack of advanced nutrition options for wound healing and chemo side effects. 

beaumontdave's picture
beaumontdave
Posts: 993
Joined: Aug 2013

Well I had two separate resections, three spaced mets, then one three years later. They cut me wide, a foot x over a foot incision, but I healed with no complications, excluding the jumbo hernia they fixed last Dec. I'll be 4 years out from the last resection in Sep. The last met was hard to get at, up by the diaphram, but I'm glad I choose the surgery. The scary part for me was having the onc.-surgeon ask me how I wanted to go, chemo, radiation, or surgery. How the hell am I the expert, or was he saying it didn't matter much which way I went. Aside his crappy manner, the choice seemed right to me, from here. He ran the heptology dept. at Kaiser's LA hospital, Dr. Difronzo, but if you go there, look for kindness and patience from his second, a sweet lady doctor whose name I can't recall at the moment...........................................Dave

mountainhiker
Posts: 54
Joined: Aug 2018

Here is a link to a paper written by my surgeon and oncologist.

https://link.springer.com/article/10.1245/s10434-015-4456-9

mountainhiker

Joan M's picture
Joan M
Posts: 374
Joined: Oct 2016

Thank you for posting the link to the article.  It gives hope to me even though I've been told surgery to remove my liver tumors was never an option.  I had an ablation and also the SIRT, but new tumors have grown back on one side.  Maybe the new ones can be resected and increase my lifespan, I'd like to see a liver surgeon.  As the article said, the oncologists and GI surgeons really can't make the decision if the liver is operable or not. 

Joan 

   

mountainhiker
Posts: 54
Joined: Aug 2018

Hey Joan,

I'm somewhat familiar with your journey and if anyone deserves a break it's you.  I pray for you often.

This is just my opinion, but I believe there are many oncologists who just want to collect a paycheck and only offer treatments they consider standard of care.  Not many are willing to be aggressive and creative when attacking this disease.  Cancer is serious business, especially when a person is stage iv, and patients deserve the most aggressive/qualified team available...and after telling three oncologists their treatment plan was unacceptable I'm confident I finally found the right doctors.  I'm also a realist and understand that although I am cancer free today, that could change at any time.

God bless.

mountainhiker

 

Joan M's picture
Joan M
Posts: 374
Joined: Oct 2016

My oncologist at Mayo wanted a liver surgeon to meet with me in March before my April 2018 colon surgery.  He thought the new liver tumors should be removed at the same time.  The colon surgeon and other doctors disagreed because of tumors in my lungs and my stage 4 status.

I've gone to MD Anderson to get on clinical trials, but maybe should go to the hospital that are offering more aggressive treatments like surgery for liver and lung tumors. I'm going broke with the travel and medical costs.

Praying for what direction to take in this journey and also for the financial resources to travel for better care than is available locally.  The doctors here just want me to take the Folfiri until it stops working and then move on to the next chemo regime until that stops, etc.  That sounds like giving up to me.  I'm just not ready for that yet.  I realize the day may come that I am out of options.  Just not yet.    

Mikenh's picture
Mikenh
Posts: 777
Joined: Oct 2017

I'd suggest Mass General Hospital if its an option for liver resection. I've heard from two Stage 4 patients that did well there.

pcmeiners
Posts: 4
Joined: Aug 2018

Had a liver resection (colorectal liver metastases)  followed by FOLFOX chemo in the last 6 months, appears clear. A large issue is the location of the lesion, mine was located in an upper part of a lobe.

I live in a borough of NYC, due to how the medical profession practices it took me 3 months until I had my first cancer treatment, since then I have learned alot. In my neck of the woods, it take 2 to 3week for every doctor you see, 1-2 weeks for the consultation ( for the fee), again same for the regular appointment. Issue is you see a lot of individual doctors before recieving treatment...that is unlikely in a top teaching hospital.

Best advice I recieved so far, from my GP, is to find a teaching hospital specializing/top rated in treatment of your specific cancer (or any other major illness you have). My mistake was not going to a top rated hospital in the first place. Anyone not using a top rated hospital is risking their lives.

US News rates hospital thoughout the U.S.

https://health.usnews.com/best-hospitals/rankings

I ended up using Mt Sinai (top rated colorectal cancer) in Manhattan for surgery and tomography scans. Excellant staff, incredibly fast appointments (3 days).

 

Good Luck everyone

 

 

Trubrit's picture
Trubrit
Posts: 4828
Joined: Jan 2013

Anyone not using a top rated hospital is risking their lives.

I live in rural Nevada. I am monetarily poor. I travel a 320 mile round trip to see my Oncologist and radiation oncologist. My treatment with both, and with the hospital I had both of my surgeries, has been excellent. I am alive to tell the tale.  

All of our lives are at risk. For some of us, going to a top rated hospital is out of the question. Going to a Cancer centre is out of the question, but we can still recieve quality care from good Oncologists. 

I am happy for those who are able to pick and choose, but don't make it sound like its the end of the line for those who can't. 

Tru

myAZmountain
Posts: 256
Joined: Apr 2018

I live in rural AZ and am wondering which hosptial you travel to? I have appt at Mayo Phoenix in 2 weeks for second opinion--just curious wher you have chosen to go. Thx and bless you!

abita's picture
abita
Posts: 608
Joined: Dec 2017

I go to Mt Sinai west. Completely by accident, it was the closest went urgent care told me to go to ER immediately. 

pcmeiners
Posts: 4
Joined: Aug 2018

"Anyone not using a top rated hospital is risking their lives."

Agree, the ststement was a bit dramatic. Just going by my experience where I live. 3 month to get treatment, doctors more interested in consultation fees (causing delay) then health issues, doctor performing a biopsy with an xray not ultra sound , long derlays in appointments, staff losing mediccal records (all different doctors). Also note it is not critical to have radiation/chemo at a top cancer center, but it gives you an edge to be be diagnoised and a treatment regiment setup by one ( quickly) to be performed near your home. Going to a top rated/teaching hospital gives you a 5% better outcome, and less chances of  experiences like mine.

 

 

beaumontdave's picture
beaumontdave
Posts: 993
Joined: Aug 2013

I agree that the best hospitals are the ideal way to go for top level treatment, but getting things done fast is important too. In my case, wanting it done quickly meant a referral to a local surgeon in a nearby town and a ten day wait. Had I decided to go to UCLA or City of Hope, out here in Cali, what would my wait times have been for a single 5cm mass in my sigmoid section? After the colectomy and chemo I got Kaiser through the state's high-risk program, and they won't top any lists on cutting-edge treatment, but they do hustle you into the tests, scans, and surgeries quickly, and with the fine line I was walking at recurrance, I was happy to be in a place that got it done. Since surgery has been the means of my being NED now, I'm comfortable with Kaiser, if it should come back spread, and surgery wasn't an option, I would head to MD Anderson or the equivalent facility post haste.........................................Dave

LSU2001
Posts: 23
Joined: Dec 2017

Hey everyone,

I have Stage IV rectal cancer and all my mets were in my liver.  I had over 20 lesions/tumors total  8 large and the rest small to medium, and on both lobes.  I was initially told that I was inoperable and I would need pallative chemo-radiation on my primary tumor and then chemo (Folfox with avastin).  i did the radiation and despite the pain of the treatments and the long term effects, I had a complete clinical response to the radiation therapy.  I visited several liver surgeons in my area, and even went to Oschner Cancer Center in New Orleans to see a liver specialist.  All said the same thing, I would never be able to have a liver resection, there were just too many spots.  Fast forward about 6 months, after getting pissed off at the way I was treated at Oschner I asked my oncologist for a referral to MD Anderson in Houston.  I went in about a month later and had all types of scans, tests, etc.  the oncologist I saw, said the same thing everyone else was saying, Inoperable and that I had maybe two years with treatment.  The thing that impressed me most about the MDA doc was that he said, he could see no way to operate but that he would refer my case to their Hepato-billiary dept. 

About two weeks later the onc called me out of the blue and told me that the liver surgeon wanted to meet with me because he thought he could operate.  Wooooo Hoooo finally!! 

In any case the surgeon put me through even more tests and scans and then told me that he felt very confident that he could operate successfully, but I would have to have two resections about 6 weeks apart.   So a month or so later, I went to MDA to have my left lobe remove the spots their first.  I had good results from that and healed quickly. I only missed about 4 weeks of work.  Then about 3 weeks after my resection, I had to have a portal vein embolization done to force my left lobe to grow bigger than I should be.  Because almost 6 weeks to the day of my first resection I had my second to remove the entire right lobe.  This was a much harder recovery because of all the recent surgies etc.  anyway, on my first follow up appt. with the liver surgeon, He walked into the room and the first words out of his mouth were, "Now we can talk about longevity"  while I did have a recurrence in my liver since surgury and I had my 36th chemo treatment last wednesday, I feel the resections were very successful and saved my life at the time>

I firmly believe that had I taken the advice of numerous doctors and surgeons I would be dead now.  By pushing the issue and insisting that I wanted to continue to search for someone who was willing to at least try to resect my liver, I was able to find just that surgeon.  

So I guess what I am saying is Never Give UP and the best advocate for you is you!!

TIm

abita's picture
abita
Posts: 608
Joined: Dec 2017

Only 2 years without surgery? That is depressing. I thought it would be much longer if get chemo to shrink what is there. That being said, I have been trying to have hope. But that 2 years number is so depressing. My doctor didn't tell me how long I have now that I have a recurrence. And I am not going to ask now.

tanstaafl's picture
tanstaafl
Posts: 1292
Joined: Oct 2010

So one area of improvement that remains is the post surgical treatment to prevent recurrence.  Here I would nominate some extended form of ADAPT therapy (oral 5FU drug + celecoxib), extended by any number of off label adjuncts, mostly supplments with chemo and immune enhancing propeties and other benefits. 

LSU2001
Posts: 23
Joined: Dec 2017

I was 48 when I was daignosed in 2016. And yes, 2 years give or take but my cancer was so far advanced with so many mets in the liver that I initally had a very poor prognosis.  I really don't think the tumors were going to respond to treatment, but they did somewhat.  They shrank some but not a lot.  I was very lucky that my liver tumors were in places that they could be resected by a confident and skilled surgeon.  

abita's picture
abita
Posts: 608
Joined: Dec 2017

I had 3 original large tumors in my liver that were removed by a very skilled surgeon. Even did the mop up chemo. We thought I was "cured". My first post chemo scan showed a recurrence. My tumors did shrink with the 4 rounds of chemo I had before my surgery but I became allergic to that drug. Going to start back on it again anyway because we know it works. Mine are not resectable because of location even though they are small. I am starting the treatment plan, but am getting a second opinion. I refuse to believe that this is my prognosis 

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