Appreciate your input – webinar

Marion,
I have a few questions that I would like to have covered regarding the surgical management of cholangiocarcinoma. One of the biggest questions and areas of controversy seems to relate to the eligibility for surgical resection. Some patients are eligible for curative resection immediately upon diagnosis, some patients become eligible after successful chemotherapy or radiation treatment, and unfortunately, many patients are not eligible for surgery at all. The criteria for surgery are far from clear cut. Some surgeons and institutions are more aggressive than others, and many patients who seek out multiple opinions get vastly different responses. In my wife Lisa’s case, we sought out six different opinions. Three of the top experts (including the Mayo Clinic) said no to surgery and three said maybe, meaning that surgery could be possible with a robust response to chemotherapy.

In the case of ICC, the primary requirement for surgery is to have at least 20% remaining healthy liver, with no involvement of major vessels (portal vein, hepatic artery, etc.). But from there the eligibility becomes very cloudy. Some surgeons will disqualify a patient with tumors in both lobes, or tumors of some seemingly arbitrary size. Some surgeons will disqualify patients with any extrahepatic spread. However, other surgeons will still perform surgery as long as the spread is limited to certain lymph nodes or other organs that can also be treated surgically or through other means.

I guess my main question would be: is it possible to come up with more easily understandable guidelines for surgical eligibility? I would also like to hear more about the concept of “tumor biology” and the role it plays into whether or not a patient is a candidate for a curative resection.

Thanks again for seeking our input. I look forward to listening in on Thursday.

HI Marion, I have a couple questions and I hope they deem appropriate and not too vague. After my surgery I kinda felt like I lost my support team after I had been receiving care for many months, and kind of felt on my own…”just go on and live my life.” Which sounds great but for me was so much harder to do after I had my resection and adjuvant chemo. I guess my questions are along the lines of if you do have surgery…
1) What should you expect to feel emotionally and physically after having an extended resection, rouex en Y, etc? (Not necessarily right after but maybe months, even years down the road) For me I felt like I was just kinda let go with not a lot of direction or expectations as to what I might feel and physically I have realized I might have a new “normal.” I was kind of expecting for everything to go back to how it was before I was diagnosed. I guess just more in depth of what one might expect and experience.
2) Does diet play a role after surgery, should I avoid or confide in certain foods?
3) The latest on success and recurrence rates?
4) Should any dietary supplements or vitamins encouraged or discouraged?
5) How often should bloodwork or lab tests be done?
6) Aside from drinking alcohol, other things we can do to try and preserve our livers the best possible way we can?
7) Are there any specific medications that someone shouldn’t be taking after such a big surgery?

I might come up with more. I do feel like these are kind of dumb and I have heard answers from some docs on most this stuff, but curious what Dr. Kato has to say.
Porter