Wednesday, June 29, 2011

Surgery report

Kel had his RPLND (RetroPeritoneal Lymph Node Dissection) this morning in Indianapolis. Surgery started around 9:30, surgeon estimated taking around 4 hrs but was done in 2. Not a bad thing, he just does so many of these that he is that good.

I need to get more specifics tomorrow, such as the overall size, how many lymph nodes were taken out, etc. But in general, the surgeon was happy with the removal. The kidney was saved, the vasculature wasn't touched, with one exception (in a minute), and the abdominal wall wasn't touched.

Kel's ureter (drains kidneys into the bladder) had the tumor adhering to it, so that was the toughest part to remove, and the stent was left in. That will come out in another month, but taking it out today after the adherence apparently would have been very dangerous. Also, one of the arteries to his left kidney was so ensconced in the tumor that it had to be removed. But that is ok, because it is not the only blood supply.

So, for now, all looks good. We have no idea if this was curative and won't for a long time. The important things to come soon:
-Pathology. We want to know that there is active cancer in there, which is a little unusual for this surgery: most people have this after chemo and after they have no biomarkers and want to see no cancer. We know that his markers have been on the increase since April, meaning his tumor is growing and we want to hear that it was in the parts removed. If not - then the 'active' cancer is still in there and needs to be dealt with, but this is highly unlikely.
-Biomarkers. Before surgery they were: AFP 390 and b-hCG 14, both increasing steadily. These shouldn't be down to 0 before he leaves the hospital, but we should see them down a bit, again indicating that all of the active cancer was in the lymph nodes removed.

For not knowing about a cure: Kel will continue to be watched by bloodwork and CT scans for increasing markers again and any new nodes. The chance of this surgery taking care of it all is probably somewhere around 50%. The lymphatic system is like the circulatory system in that it is a fluid system going throughout the body, so a few cells escaping can float around and take up residence elsewhere and go unnoticed for some time. So we watch.

If he reaches the one year mark from now with no increases, he can relax a lot more, according to the world's expert doc (Einhorn), so every 'markers' and results day will be stressful and dreaded. We will hope and pray and watch.

In the meantime (this is the not sux section for tonight), we celebrate. Well, Kel doesn't celebrate, he is mostly knocked out. He woke up having some bad muscle spasms, dry heaves and heavy nausea which did NOT help in terms of pain, and a bit of disorientation. He is pretty well medicated tonight and we have to get him up and moving around already tomorrow. Not a fun recovery, it will be a month before he can get back to physical activity, which he needs to do before he can even think of going back to full duty, but a recovery none-the-less.

Back to the not sux:
For the first time since the New Year, Kel will get a break - no chemo, no more surgery (ok, that is a lie - he has to have the stent removed in a month), no constant thinking of it all. Markers will (should) go down, he will be thrilled to see biochemical remission (no elevated markers), which he has yet to acheive, and life can resume a normal routine. We are so glad for a successful surgery, an easy removal and a hopeful surgeon. We even, after dinner, celebrated like 4 year olds swinging our cares away!

Full of love and hope tonight,

1 comment:

  1. Oh, and someone in the waiting room liked Sue (Kel's mom)'s 'Cancer Really Sux' shirt! :)