Liver resection...need advice please

[jessica]

Hi All~
As my Thanksgiving holiday in paradise (home in Hawaii w/my family) comes to a close, I find myself beginning to get anxious...what with all that lies ahead once I get back to Atlanta...
The day before I left for Hawaii, I had a PET scan that showed that the spot in my liver is acting up again. I've only been off chemo for 8 weeks, after ~6mos of treatment, and here we are again!
I start back on Taxol/Herceptin on Thursday, have a detailed liver CT on Monday & meet w/the surgeon on Wednesday to talk about resection.After a year of watching, my docs feel pretty confident that this really is the only spot, and are offering surgery as a treatment option. That is Good News. I think we're planning the surgery ~Christmas time.
My question to all of you w/experience is, how did you choose your surgeon? I chose my breast surgeon b/c she specialized in breast surgeries, and that was all she does & had been doing for the past 15 years. I'm hoping to find someone comparable to do the resection too. I don't know if I feel comfortable with just any Surgical Onc. I want the person that does liver resections all day long & nothing else! To make matters even more complex, this stinky stubborn spot lies so close to the inferior vena cava, that in order to get clean margins, the surgeon said he'll have to cut out a portion of the IVC out & reconstruct it!
All of this is making my head spin again...I'd appreciate any input or wisdom or sharing of your experiences....
In the mean time, I'm going to try to enjoy my last day here...suspend reality for just a little longer...
Keeping the Faith~
JML

[al from Canada]

Jessica,

Have you considered alternatives to this procedure? The thought of a ICV reconstruction makes my head spin as well! Just to confuse you some more, (just kidding):

1. Selective Internal Radiation Therapy;

2. Radio frequency abalation

3. Cryotherapy (cold)

4. Heat therapy

5. Alcohol therapy (direct injection into tumor)

6. Heptic arterial infusion (direct infusion into tumor at up to 100X the systemic dosage

Some of these techniques could be used to downsize the tumor pre-resection.

From my readings, resection has by far the best results however it may be prudent to consult with other surgical oncologists before hacking away at the ICV.

Here is another thought; why not put this desicion on hold for 2 weeks until the SABCS is over as it may provide other options and updated stats.

Good luck,
Al

[kristen]

Dear Jessica,

If you lived here in KC, there is a woman who did just that. Got the best and waited all day because other surgeries took longer or whatever. Bedside manner wasn't what you would call the greatest. But he was the best! It went off without a hitch.

You should ask around. Ask your breast surgeon who she/he would recommend. The lady mentioned above had a hard time getting this guy to do her surgery, because he wanted to do liver transplants and stuff. But she was persistant and he did it. She/he is out there. Your just going to have to do a little detective work. Good luck with it all. I am so sorry you have to go through all this.

Hawaii, what a nice morale booster to get you ready for what lies ahead. Be well.

[LauraP]

Hi Jessica (and Kristen!)

I am the woman that Kristen referred to above. I had a 1cm spot on my liver that was there from the beginning. I was originally Stage II when diagnosed at the beginning of this year. Pre-chemo scans showed that I had a couple of spots on my liver that they thought were hemangiomas, which are just things you are born with and benign. We decided to push through my first two sets of chemo and then do scans to determine if they were still there, thinking that the chemo would stave off any further growth if they were cancerous.

To make a long story short, one of the spots was a hemangioma and the other ended up being cancer. I had a post-chemo PET/CT to help determine this. We looked at all of the options, but decided to have the resection so that we could have the biopsied tissue and determine if it was similar to my primary tumor site on the breast (ER-, PR-, Her2+++). Anyway, the resection was scary, but very easy in terms of recovery. It was especially easy in comparison to my bilateral mastectomy and TRAM flap reconstruction surgery.

The worst part for me was dealing with a surgeon who did not know a lot about breast cancer. He was very negative, but in the end, was the best liver surgeon. Patients were flying in town to see him. He was really good. I am doing carboplatin and taxotere as additional insurance against recurrence. I did EC and Taxol+Herceptin before.

I would encourage you to find the best liver surgeon in the area. If your onc has recommended someone that you feel comfortable with, then that is great. I have learned with these organ surgeries that it is better to have someone who cuts well, than someone who has a great personality. You want the liver surgeon who does transplants and things like that so that your resection is a slam dunk...a no-brainer. That is how my guy was. I really think he was bored with my surgery as it was not glamorous. I had to wait all day fasting as he kept pushing my surgery back for the more needy cases, but I just put up with it because he was the best.

Also, they did an interoperational sonogram to determine that the rest of the liver looked great. I don't know if this is part of your procedure, but make sure that your surgeon can do this. This is really the best way for them to determine that there are no other lesions on the liver. It sounds like your scans are giving you good information so this will just give you even better verification that you are on the mend.

I know it is hard as it has been a challenge for me, but try to remember that there are no other spots on the liver. Believe that when this is removed that your cancer is gone. I talked to my onc regarding my liver function and they said my liver function has been great. It sounds the same for you. I would encourage you to believe that your liver does not even know it has cancer.

Please feel free to e-mail me at lplunkett@kc.rr.com if you want any more information. My liver surgeon is here in Kansas City, but I would give you any information you would like...or would just talk to you about the surgery.

Best wishes,

Laura

[jessica]

Thanks for all the wonderful input! I was feeling really overwhelmed, started reaching for the bottle of Xanax, but then decided to post here FIRST. Many of these ideas have been swirling around in my head, but I just wasn't sure. Now I feel more confident, armed with some good questions for my Onc on Thurs.
Al~Thanks for your suggestions...I do know the Surgical Onc will say, as he has said before,'none of the embolizing techniques are curative & it's time for us to take care of this spot once and for all'. I admire his optimism, but am a little weary of how anxious he is to fire up his scalpel! Interestingly, he said the RFA was never going to be completely successful for my circumstances, which is quite a bit different than what the Interventional Radiologist implied.I questioned why then, did I have RFA if complete response was not a possibility?He did a little of "hmmm....ahh...hmm..." I suspect b/c he didn't want to dispute a colleague's opinion..."Honor among thieves" is what I like to call it. I would really like to find a way to prevent so much cutting, especially on the IVC.From what I've read, we need a 1" negative margin around the lesion.I just don't know if any of those techniques will successfully achieve that. The RFA I had back in Jan left a peripheral edge, closest to the IVC, viable but successfully cooked the center of the lesion. It was recommended that I do 2 weeks chemo, RFA, 2 weeks chemo, but instead I had 4 weeks chemo, RFA, watch & wait...I wonder if I would have had more success if we had followed the recommded way...Regardless, I'm going to ask my onc to bring the IR in on our consults to get his opinion as well...And wait for the SABC as you suggested!
Kristen~what a brilliant idea to ask my breast surgeon! I respect her implicitly & really like her as a person & know I can trust her to guide me towards someone she respects & trusts too.
Laura~thanks for all the insight...there's nothing like talking to someone who's "walked the walk". I'll certainly be in touch w/you directly. Thanks for that.

Looks like Hawaii's morning drizzle has burned off & the sun's coming out...

Prayers, Faith & Courage!

[Unregistered]

Dear Jessica:

My wife has just had her second liver surgery. The surgeon we used was one of the top men in the USA in this field. His name is Dr. David Geller and he works a UPMC in the liver transplant unit in Pittsburgh, Pa. He studied under Dr. John Fung, the former director of the liver transplant unit. This is the place where Dr. Starzl first did liver transplants in the US.

We are personal friends of Dr. Fung and almost three years ago my wife, Lisa, had RFA on several tumors in her liver that were responding nicely to herceptin. The RFA could not be done percutaneously because one of my wife's tumors was located very close to a major artery in her liver. During this process one of her tumors was excised while two others were RFA'd.

Lisa's liver was clean until a tumor was spoted in early October, 2005 in a spot that had been previously RFA'd. Upon further investigation the surgeon discovered that two other spots had a suspicious look to them and he re-ablated them. She has recovered from the surgery nicely and is doing well. She is now NED (the hard way) and her Onc has her on Xeloda and Herceptin to hopefully prevent recurrance.

If I was looking for a liver surgeon, I would go nowhere else that UPMC and Dr. Geller. Or Cleveland Clinic and Dr. Fung.

Good Lucka and God Bless.

Lisa and Brian

[Barbara]

Laura:

I am happy you are doing well. I imagine you have many worrys that are hard to put aside. I hope that your current treatment is the magic bullet for your liver mets. Before the diagnosis of your liver mets were any of your cancer markers elevated? I know in some people they are not accurate particularly during active chemo.

Barb

[IRENE FROM TAMPA]

Hi Jessica -

I just read your post re your considering liver resection.

I had my liver resected ( 1/2 of liver removed) last July. I had had a tumor in the liver for around 3 years without it moving anywhere else so they thought I would be a good candidate for the surgery. My first chose was RFA to the tumor which we performed the year prior but it returned so I decided I wanted to go for the "Gold Standard" which is resection. My liver has since grown back beautifully and so far clean. I must say that I did have a recurrence this year but not in the liver.

In selecting my surgeon, I interviewed (3) surgeon's in my area at different hospital. My third was my pick. He heads the Gastrointestinal dept. in my hospital and I immediately loved his bed-side manner. His caring manner and willingness to give me lots of his time explaining everything made me feel very comfortable and not scared. Not to mention that his surgery record and experience in this area was very much complimented by all.

Good luck in your chose and your surgery. If I can be of any help answering any questions you might have regarding the surgery, pls feel free to contact me.

[StephN]

... to find the surgeon who feels right to you. A good THORACIC specialist can work on any organs and is competent in understanding how our bodies work.
I used a Thoracic Surgeon who is head of the whole surgery dept for my breast work and nodes. I have a great looking outcome with little scarring (did not need reconstruction). I would trust him to do something like a resection to my liver.
All the Thoracic specialists see many cancer patients and this may be up to 70% of their work.
As for RFA, my med onc told me that he would rather see a resection any time for the best results.

Looks like you have a lot of good ideas going forward in your quest. Seems like you are not too convinced that the consulting surgeon you are talking with is THE one.