Anyone with abdominal lymph node or peritoneal mets after resection?

Hi Billy,
My wife Lisa had a successful resection surgery for ICC in January of 2014. Prior to her surgery, she had a biopsy of an enlarged retroperitoneal lymph node that was confirmed to be metastatic. She had several lymph nodes in this area removed during surgery and only two of them were positive for metastatic disease. Lisa had adjuvant chemo-radiation due to a positive hepatic vein margin as well as the positive distant nodes. Lisa is currently battling metastatic spread to her lungs, but overall is doing well more than three years after her big surgery.

I have not heard of the combination of liver resection surgery and the HIPEC procedure at the same time. However, I am very intrigued by this combination and impressed that your surgeon is willing to take such an aggressive approach. The decision to have surgery now vs. two months is a difficult one and I am sorry that I cannot provide any guidance as each situation is unique.

We will keep Kathy in our thoughts and prayers and will be hoping for the best possible outcome.

-Matt

It is hard to find good information on treatments and each major center seems to do things a little differently. Here is how my treatment was organized. As part of my resection, my understanding is that the surgeon first did a laparoscopic “look-see” at the start of surgery. This was to look for any metastatic spread outside of the liver as well as to plan the procedure. I think this is the typical practice. If there had been evidence the cancer had spread, the surgery would have been halted. I recall being told prior to surgery that the surgeon thought there was a 50 percent chance the surgery could be successful, due to the size and location of the mass in my liver. When I woke up in the ICU, my first thought was to look at the incision to see if the full resection had occurred – luckily it had and with clean margins.

After surgery, I was advised to have adjuvant treatment due to a slim margin and the vascular invasion seen in the pathology report. As part of the adjuvant therapy, I had IMRT radiation (with capecitabine) focused on the tumor bed and the local lymph nodes close to the liver.

I have a chest-abdomen CT scan every three months which looks at, among other areas, the peritoneum and the lymph nodes in the abdomen, and so far thankfully there has been no evidence of spread after 15 months.

I hope this information is helpful, and wish you all the best as you look into treatment options.