Update: Surgery

Hi everyone,

I was finally able to meet with the surgeon at Emory. He is a wonderful man named Charles Staley.

Staley was extremely impressed with my response to chemotherapy. On the other hand, he admitted to me that my recurrence is extremely rare. Most colon cancer recurrences occur in the liver or lungs, whereas mine is the in the mesentary and peritoneum (i.e., in my guts and the surrounding "bag" that lines the intestines, stomach, liver, and surrounding areas).

Staley is the "best" surgical oncologist in Atlanta. Yet, he told me that the surgery recommended for rare recurrences like mine is one that he has never done. So he is referring me to the surgeons at MD Anderson in Houston, TX.

The surgery will occur after my chemotherapy is over + one month to recover from the avastin (which causes bleeding, so they wait for surgery after avastin treatment), so mid to late April, early May. The surgery is gruesome. It involves doing small resections of the mesentary and peritoneum. The problem here is that the mesentary and peritoneum contain networks of blood vesseles, arteries, and so on, all of which are connected to very specific locations in the gut. So in addition to resecting areas of me that were infected with cancer, they then have to "follow" the blood vessles these areas fed with blood and nutrition, and then resect those areas too, since once they resect the blood vessles in the mesentary, they have to also take out the areas that will surely "die" once those blood vessels are dead and gone. So, for example, if they resect an area of my mesentary that supplies blood to a 1 foot section of my small intestine, they have to also go on and resect that area of my small intestine. So there is no way going into this surgery to tell what you'll come out with. I could come out with areas of my small intestine, stomach, bladder, or liver (among other things) gone.

In addition to resecting areas of the mesentary and organs they supply blood to, this surgery involves perfusing the mesentary and peritoneum with "hot" chemotherapy. They insert a needle into one area of the mesentary and peritoneum with a solution of heated chemotherapy drugs (heating the chemo makes it more able to permeate small, microscopic areas) to kill any microscopic cancers that may still exists therein. They then insert a drain in my abdomen and sew me back up. the drain is removed a few days later, once the chemotherapy has left the system.

Sounds awful, I know, and I am worried, as are my parents. They call this surgery the MOAS (Mother of All Surgeries). It's also called the "sugarbaker," after the DC surgical oncologist who pioneered it, but which also sounds like a pastry. Is it a surgery, or a cookie? It's rough. But, on the bright side, it will increase my chance of remaining disease free (of having no other recurrences after 5 years) by about 50%. So even though the surgery sounds awful, I have hope about the fact that the surgeons at MD Anderson are some of the best surgical oncologists in the world, and that once this is over, it will FINALLY be over for good.

Wanted to just let you all know what's going on. If I die, I hope it's not in Texas!! Especially the home of Enron. If something goes wrong, just be sure that I am not buried anywhere near Ken Lay.

Love, Chet