the plan...


Dr. Botha's office received my recent scans and reports today and reviewed them in a matter of hours. (If you are familiar with the medical system, this is an amazing response time - usually it takes days to get answers. The folks at UNMC are on top of their game!) The (new) plan, per Dr. Botha is to perform a right hepatic lobectomy. This is similar to what was discussed with the staged resection, but instead, we would be skipping to the 2nd stage of the procedure. The goal is to get rid of these hybrid lesions ASAP, especially the largest tumor. So, we scrap the staged resection. Any remaining tumors (in the right lobe) would be treated by PRRT or other liver directed therapies. To perform this lobecotmy, they first have to do a "portal vein embolization". -Blood flow is cut to the left lobe in order to grow the right lobe. This is generally an out-patient procedure. After 6 weeks, if the liver grows as desired, they will proceed with removing the left lobe entirely. At this time, they would also remove the primary tumor in the pancreas.

In Short:
"Portal vein embolization is a technique used to help re-grow the liver prior to liver resection surgery. During the procedure a needle is placed percutaneously (through the skin) into the liver. Your physician will identify the blood vessel going to the side of the liver that has the largest portion of the tumor. This blood vessel is then embolized (cut off), thereby “tricking” the liver into making the other side of the liver grow. After several weeks, the side of the liver which has not been embolized should have grown to the point where there is now a sufficient amount of liver to do surgery."

For a better understanding of this procedure, click here to visit this link via John Hopkins. Watch the video which is short, but very clear.

Dr. Botha wants me to do the embolization as soon as next week (TBD). Therefore, I'd be headed back to Omaha. However, we need to get clearance first from Dr. Baum. Due to the PRRT treatment, I may have to wait another 7 weeks to make sure my blood levels (platelets, etc.) do not change. If this were to happen, it might make a procedure dangerous. I'm letting Dr. Baum and Dr. Botha figure out the best timing. I'll post as soon as I have a date confirmed.

The good news is that this surgery is done often. So, it has been well studied and often yields positive results.

Comments

  1. UnknownFebruary 24, 2010 at 4:12 AM

    Thanks for posting the link to the video which does a very good job of showing and explaining what the procedure is. Give me a shout when you get a chance - but if I don't hear from you because you're off to Omaha, no prob. Good luck.

    ReplyDelete
  2. AnonymousFebruary 24, 2010 at 5:10 AM

    Anthony, I'm amazed at your strength and perseverance over the past several months. Will continue to keep you in my thoughts over the next few weeks with your upcoming surgeries. Much love to you and Andrea. - Carrie D

    ReplyDelete

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