No Resection Because of Multiple Liver Mets
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Holly – I just finished reading all your posts. I am not a doctor, but it appears to me that the reason you are going to have surgery on the 31st of this month is not because of any shrinkage of your multiple liver tumors, but because you were industrious enought to find a surgeon, Dr. Tomoaki Kato, who said “yes” to replace a surgeon, or several of them, who said “no.” I noticed that after three cycles of GemCis, your tumor markers came down but there was no mention of shrinkage. Also, you wrote “All said that once there is intrahepatic metastasis, there is disease throughout, even that which cannot be seen on scans,” however Dr. Kato found a section of your liver which can be left in place after the resection. Evidently he was not worried that this section could contain cancer cells which could not be seen on scans.
According to the surgeon who resected my wife’s liver, at least 20% of the liver must be left to insure it growing back. I believe that Dr. Kato would have resected your liver even if you hadn’t had chemo. In fact, I think he would have preferred that.
We were lucky because my wife’s first surgeon said “yes.” Then, at my daughter’s urging we got a second opinion from another surgeon and he and his board said “absolutely no,” fearing that they would have to cut out more than 80% of the liver and it wouldn’t grow back. They suggested a procedure to grow the healthy lobe and start chemo treatments to shrink the tumor. My wife’s first surgeon was totally against this saying they would have to do the treatments for at least a month and then he would have to wait a month after the chemo was stopped before he could operate. We ended up getting a third opinion from the first surgeon’s mentor, who agreed with him, and the operation proceeded within a week, ending with an R0 resection.
I have since entered all of your data in my database. If I had done this before I started this topic, I would have used Dr. Kato as another example of a surgeon who works around this multiple liver met excuse for not operating.
Good luck on your surgery.
Bruce
The “many little ones throughout the liver” may have been the deciding factor, but because of her statement, “once there is intrahepatic metastasis, there is disease throughout,” I think they would have come to the same conclusion with just the 7 cm main tumor and two smaller ones, which is similar to what you had.
Holly22a, did your surgeons address what they would have done if the “many little ones” were not present?
Hi,
I think the difference in holly22a’s case is that the patient has “many little ones throughout the liver”.
God bless.Well, I have not yet had the resection surgery but it is scheduled for next week. I was told no by many because of one 7 cm main tumor and two smaller ones and many little ones throughout the liver, but with a robust response to chemo the surgery is a go and we will clean up afterwards, say my oncologist and surgeon. All said the response to chemo was key, that everything had to shrink or disappear. All said that once there is intrahepatic metastasis, there is disease throughout, even that which cannot be seen on scans.
So far I’ve found 8 patients in the foundation’s database who could not have an initial resection because of multiple liver mets. However, Percy (PCL1029) had this diagnosis (main tumor in left lobe and 2 spots on right lobe) and yet Dr. John Brems, Loyola, Chicago, still performed the operation, resecting the left lobe and RFA on the 2 spots remaining on the right lobe.
Bruce Baird
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