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Posts Tagged ‘Retro-peritoneal lymph node dissection’

Oncology 14.1

February 7, 2012 27 comments

I have been a little lackluster of late with my updates. The main reason being that I have now been chemo free for over 2 months, and I have been playing the waiting game in anticipation for the upcoming surgery.

The surgery is indeed confirmed and going ahead on February the 14th. I have taken the time to speak to a number of very experienced surgeons at auckland hospital. Some of those will be involved in the surgery, some will not. The consensus seems to be that the surgery is an advisable option given my circumstance.

There is, however, no way of knowing what the outcome will be. Aside from the peri-operatively morbidity, which are the standard risks of infection, bleeding and damage to other structures, beyond that, whether the cancer comes back more aggressive, comes back in a few years time, or doesn’t come back at all is anyones guess. We are beyond the realms of evidence based medicine, beyond the ability of medicine to predict the outcome.

Its technically uncharted territory, and I may even get to publish a case report out of it (assuming I survive it).

One question that I repeatedly get asked over the past few weeks is how I feel about it. I’m not really sure what people are expecting when they ask that question, because how I feel is not something that is answered in a five words or less, which is usually the expectation or the context of the question.

If you do the maths, then going ahead with the surgery is a no brainer. When you take into the consideration the risk profile of the surgery (which is not insignificant), the possible outcomes of the surgery, and compare that to my current prognosis, then it makes complete sense to go ahead with it.

If you think about what it is like to have your belly cut from the xiphisternum to the pubic symphysis, have your intestines taken out and moved to one side whilst extensive dissection up the para-aortic lymph chain and left renal vein (with the very high chance of losing the left kidney) during a 4-6 hour procedure feels like… then you can imagine that I’m not particularly looking forward to the whole event.

I’m not excited, i’m not terrified, and i’m not apprehensive… I just have to do it. Its like sitting an exam, you never want to do it, but the work, the stress, and the learning is what you have to do in order to get the outcome you want.  I think the emotional flatness I feel towards this surgery is reflective of the roller coaster I have been on over the past 3 years. It is beginning to become routine for literal life or death events to have a hand to play in my life, and as such, I’m less responsive to them. I have a surprising amount of peace with the process, peace with the peri-operative morbidity and mortality risks, and peace with the unknown outcomes. If I didn’t have peace about this, I imagine that this would be a very stressful process.

Post-operatively, I will probably be in either the surgical HDU or DCC for a day or two afterwards, depending on what degree of support (i.e. inotropes or respiratory) I need after the anaesthesia, before returning to the ward. The expectation is that I will probably need about 14 days of recovery on the ward before going home, unless there are complications such as lymph leaks, or infections etc that may require me to stay longer. All things considered, there is about a 25% chance I will lose my left kidney, and a smaller chance that I will need my IVC and aorta grafted. All these will be intra-operative decisions that I wont find out about until after the surgery. They will also influence time in theatre, and time for recovery.

The long term plan is to get back to work in the 3rd quarter of this year, which is about 3 months off work. If i’m well enough to go back sooner, then I will do that.

Whilst I’m recovering, I shall endeavor to keep everyone up to date from the ward, as I imagine that between pushing morphine boluses, I shall have little left to do with my time.

In the mean time, I would appreciate prayers as I embark on the next chapter of this journey.

Until next time…

Oncology 14.0 PET Edition

January 13, 2012 13 comments

I have the semi-official results from my PET scan on Wednesday.

The results are reported by three different radiologists, so the final report is still pending, but the preliminary report is as follows.

There appears to be no further spread of my cancer than what we already know about from CT imaging. Basically, this is what we were hoping for. There was a real risk of having further metastasis that are too small to be seen by CT, if you were to follow the expectant course of adenocarcinoma, then you might expect to see these. I was thinking we would see further lymph node involvement at the very least, especially in the para-aortic chain where there is already disease. But, it would seem there are only the four nodes that we already knew about.

What this means is that I am being offered surgery. I described these surgery in a previous post, so won’t get into the finer details of it here, but retro-peritoneal lymph node dissection is pretty huge surgery, and not without its risks or complications. What surgery offers though, is the first prospect of turning my illness into something non-terminal for over two years. Its a bit to get my head around to be honest. Of course, surgery could equally accelerate the disease and having me find my end of life sooner rather than later, as with medicine in general, its a risk/benefit equation.

At this stage, surgery has been pencilled in for the 14th of February. I would expect to not be working for probably 3 months after that as I recover. The hospital stay is 10-14 days if there are no complications making me stay longer, but with a surgery this large, there is a reasonable chance that complications will occur. In the mean time, I may or may not re-start chemo, I have to wait till I meet with my oncologist to see what he thinks with regard to this.

If the final report adds or changes the picture, I shall update to let you all know. In the mean time, I will digest this new and rapidly changing course of events.

Into the unpredictable future I go…