This is my report on stopped surgery. Still feel was great idea and took our best chance and turned out to be good diagnostic data. Very Hard emotionally of course. [ same posted on Johns Hopkins board and our carepages]
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Distal Pan aborted surgery report= Seeding found
Brother attempted Distal Pancreatectomy with Spleenectomy, Adreanal Gland out and Celiac Artery/Trunk removal.
PC tumor on body and tail. All scans ( dble spiral CT, PET) showed no
liver involvement, no lymph nodes pos. CA 19-9 trend way down from 1200
in Dec 2008 at dx to just 97 at time of operation. Post op CA 19-9 =
64. ( he had had 9 cycles Gem/Xeloda, very well tolerated, stable tumor
size)
Went in stomach with Laproscopic hole below navel. Also 4 inch hole for
HALS ( Hand Assisted Laprosopic Surgery= Hand Port== a vinyl donut
inflated in wall and fancy glove to insert hand to assist the scope, no
air , means not open surgery).
After an hour on table found "seeding" cancer pellets, size of rice
say 1 - 2 mm in size. About a couple dozen pieces , prob more smaller.
Sort of felt like 'sand paper' to touch at the peritoneal wall surface.
So this is calle Peritoneal Disease. Peritoneal spread. So we back to
Stage IV.
Thus aborted / cancelled the operation and sewed him up.
1 day in ICU, good recovery, 4 days in reg hospital with lots of
walking , not quite enough (MY OPINION) breathing in 'Incentiveometer
'breathing tube device.
Of course this is devastating news for all and very depressed. Same as intial dx last Nov.
Meet with surgeon= Dr. Robert( Rick) Selby of USC. He is fantastic
liver transplant vascular expert. One of the few guys/groups who can
remove the Celiac artery after checking for adequate blood flow thru
other veins , such as brother's extra one near the SMA ( Sem Mes
Artery..) = 5% of people have an extra vein/artery feeding liver and
other organs coming of Aorta. He has this, thus "good anatomy for
Celiac removal". The tumor was wrapped around the Celiac and hard to
"strip off" did not matter just take it out. If needed other vein/pipe
to feed area, can use the spleenic artery as replacement...taking out
spleen anyway.
Rick Selby at forefront of this operation. We were all confident it
would have been curative operation. Too Bad found the spread and
canceled.
He has assembled a great clinic and group there. He has trained many other surgeons around the country. Highly reccomended.
Later we saw Dr. Heinz Lenz at USC Norris Cancer Center. He is
Oncologist. Really part of Rick's group. Again Fantastic guy. LIstened
closely to all our questions. AND answered all. Excellent style ,
knowledge and person. So bottom line Brother must get more agressive
Chemo= reccomends Gemzar, Xeloda 2 weeks on , 1 week off. Also for
more aggressive suggests add Tarceva same schedule. I will post
questions on this Chemo elsewhere.
Idea is to hit hard chemo for more months ( 4-6?) and goal of trying surgery again.
Key problem is how to monitor both the main tumor and this invisible
Seeding. So will watch size, Watch marker. But bottom line will have to
guess when to slice open again for a look. Lenz suggested it would be
hard to view the seeding/ specs/ pellets with just camera????
Selby said can start Chemo basicallly now, 2 weeks post op. because
brother is healthy and recovered= which is when gastro digestion is
back online, passing reg solid food which he is doing.
thanks, Brogan in Seattle