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

SandiaBuddy
SandiaBuddy Member Posts: 1,256 Member
edited September 2018 in Colorectal Cancer #1

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.

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Comments

  • Trubrit
    Trubrit Member Posts: 5,625 Member

    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
    impactzone Member Posts: 539 Member
    Had one done 11 years ago for

    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

  • abita
    abita Member Posts: 1,109 Member
    I had one. Had 3 large

    I had one. Had 3 large lesions removed

  • Twinzma
    Twinzma Member Posts: 236 Member
    If I

    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
    miamax Member Posts: 1
    edited August 2018 #6
    liver resection vs. straight chemo

    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
    Trubrit Member Posts: 5,625 Member
    miamax said:

    liver resection vs. straight chemo

    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. 

    Have you looked at Ablation?

    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
    abita Member Posts: 1,109 Member
    Trubrit said:

    Have you looked at Ablation?

    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

    I had no idea that it wasn't

    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
    Trubrit Member Posts: 5,625 Member
    abita said:

    I had no idea that it wasn't

    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.

    Side effects

    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

  • beaumontdave
    beaumontdave Member Posts: 1,206 Member
    Well I had two separate

    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
    mountainhiker Member Posts: 54
    edited August 2018 #11
    To resect or not to resect

    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

  • tanstaafl
    tanstaafl Member Posts: 1,299 Member
    its pretty f'g arbitrary

    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. 

  • tanstaafl
    tanstaafl Member Posts: 1,299 Member
    miamax said:

    liver resection vs. straight chemo

    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. 

    jumping hurdles

    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.

  • Joan M
    Joan M Member Posts: 409
    Mountain hiker,

    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 

       

  • Mikenh
    Mikenh Member Posts: 777
    I'd suggest Mass General

    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.

  • mountainhiker
    mountainhiker Member Posts: 54
    edited August 2018 #16
    Joan M said:

    Mountain hiker,

    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 

       

    Status Quo

    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

     

  • kyolcu
    kyolcu Member Posts: 111

    Had one done 11 years ago for

    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

    Liver transplant

    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

  • Joan M
    Joan M Member Posts: 409

    Status Quo

    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

     

    Thank you for your thoughts and prayers!

    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.    

  • pcmeiners
    pcmeiners Member Posts: 4
    edited August 2018 #19
    My doctor's advice

    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
    Trubrit Member Posts: 5,625 Member
    pcmeiners said:

    My doctor's advice

    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

     

     

    I disagree

    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

  • abita
    abita Member Posts: 1,109 Member
    pcmeiners said:

    My doctor's advice

    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

     

     

    I go to Mt Sinai west.

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