RPLND surgery date coming up 8/17

[rosewoodblues]

Hi all,

I have been pretty quiet for a while just getting things in order and actually had a week to take a vacation before the surgery. I am set now for a RT template RPLND @ Emory w/ Dr. Carney. Anxieties? I sure have them as I am a bit of a whimp when it comes to pain and surgery. I've had my share (non cancer related) and am not looking forward to this however, it gives me the best chance for survival and so off I go! I was wondering what others have experienced during the first week to 2 weeks out of the hospital? I am not counting the 5-7 days in patient and am looking to get a feel for the type of care that I might be needing once I am released. I am asking the hospital as well but would like a survivors view point.

On the diagnosis front there was an addition to my pathology report that told of minimal amounts of choriocarcinoma as well. No percentages to report but enough that I will still be on monthly blood tests to monitor after the surgery. Now I know that there is truly no such thing as normal with This type of disease however, has someone else had a mix similar to myself?
90% Teratoma
10% Embrional carcinoma
(minimal amount) choriocarcinoma
2% yolk sac

I seem to have hit the cancer jackpot here and covered a lot of the bases

thanks to you all for your conitnued support!

peace and love,
ken;

[Davie]

Ken,

I covered a fair few bases myself with teratoma, embryonal, seminoma and chrorio (like you, very little). My original pathology also had yolk sac, but they couldn't find that on the second opinion. I'm sure if they'd have looked hard enough, they'd have found a bit of the kitchen sink.

The TCRC website says that chorio whilst rare in its purer form, is present in focal amounts in about 1 in 12 patients diagnosed with TC.

I'd be interested to know why you chose primary RPLND over primary chemotherapy given your chorio element.

Wishing you all the best for your upcoming surgery......Davie

[rosewoodblues]

Davie,

Hi! With the Teratoma at 90% RPLND was / is the first line of defense as Teratoma does not respond to chemo. At least that is the information that I recieved. Embrional / Chorio does respond to it and based on what is found (if anything) when they go in I could be in for some chemo afterwards. Actually The pathology first (faxed over) pathology report didn't show any chorio and I shceduled this before that piece of information came through.

daily I waffle around canceling it or not and just surveying however in the end going forward with the surgery helps my percentages of remaining cancer free for the long term. I would rather go through with the surgery than do CT scans every 2 months. The not knowning is the worse thing for me.

so did you do chemo / RPLND? survey or what in your case?

[Davie]

Ken,

If you are in the UK like me, you have no choice - you are never offered primary RPLND. If you require treatment, it is always chemotherapy.

Given I had raised markers after IO, chemo was the only path for me (even if I'd have lived in the US)

I guess the concern for you is the possibility of the chorio in the bloodstream, hence the RPLND may not be curative by itself. But, if teratoma is in the lymph nodes an RPLND at some point may well be necessary anyway.

I can fully understand your dilemma and daily waffle you describe.

Davie

[Mom]

Good luck tomorrow. We will be thinking about you. Post as soon as you can to give us a status. From what I read on the forum, you are in good hands with Dr. Carney. My husband had his RPLND 26 years ago by another urologist who is at Emory now. Hang in there, you'll be able to tough it out. Dianne

[dadmo]

Ken:
My training ride tonight will be dedicated to you.

[danebert]

The RPLND sounds worse than it really is. At least that was the case for me.
Some people have said the orchiectomy was worse. After surgery you will be pretty doped up. That first day was good for me! The pain isn't near as bad as you would think. It aches more than anything. The only real pain will be when you first get up to move, but after that the recovery is quick. One bit of advice, Walk Walk Walk. It helps heal, gets the blood flowing, and wakes the bowels up. The more you walk the quicker you will get out of the hospital. Also, make sure to make friends with the nurse who will pull out the catheter. Ouch! That was the worst part of the whole ordeal for me . After a week , you will feel pretty good and after the staples come out you should feel almost back to normal.
!Good Luck!

[Karen]

Ken,
Best wishes for a smooth surgery tomorrow and quick, uneventful recovery. Post when you're up to it. We're pulling for you!

[rosewoodblues]

Thank you all so much for the words of encouragement and dedications! Every bit of information gives me hope and I look forward to posting after the surgery....

thank you all again! And I will bribe the nurse who pulls the catheter well!

peace and love to all,
ken;

[dadmo]

Ken:
I did a yahoo search for you phone number, I just wanted to let you know that your forum family would be thinking of you. I just wish the number I called was the right one . I can tell you that the Ken I spoke to was very happy to hear he wasn't the one needing surgery tomorrow. Anyway good luck.

[Scott]

Some people have said the orchiectomy was worse.

That was not my experience. I was back at work after my orchiectomy after missing just three days. My RPLND surgery and complications that followed kept me out of work for the better part of three months.

[danebert]

Don’t forget the "complications" part. Your treatment and related complications were far fro standard protocol. Your complication, Ascites is quite and frequently associated with the Lap procedure. Complication rates, in the hands of an experienced surgeon doing a pre chemo OPEN RPLND should be near 5%. Hospital stay for me after post chemo RPLND was 3 days, quick by most standards but according to Dr. Foster of IU most RPLND patient are out in 2-3 days. Posted below is an abstract of the article I was suppose to give to Scott 6 months ago. I’m not known for my diligence.
Its a small study but still alarming.



Department of Surgery, Division of Urology, University of Maryland Medical System, Baltimore, Maryland, USA.

OBJECTIVES: To assess the operative feasibility, clinical outcomes, and complications of laparoscopic retroperitoneal lymphadenectomy (RPLND) after chemotherapy. METHODS: A retrospective review of clinical records from 7 patients who underwent laparoscopic RPLND after chemotherapy was performed. Five patients presented with nonseminomatous germ cell tumor after orchiectomy. One patient was diagnosed with pure seminoma and one with epididymal small cell cancer. All 7 patients received multiagent chemotherapy for clinical Stage IIA or higher disease, followed by laparoscopic RPLND for findings of a residual retroperitoneal mass on computed tomography or a prechemotherapy mass size greater than 3.0 cm. The mean tumor diameter was 3.07 cm before chemotherapy and 1.91 cm after chemotherapy. A modified laparoscopic left (n = 3), right (n = 3), and bilateral (n = 1) template was used. None of the patients had received radiotherapy before surgery. RESULTS: Postchemotherapy laparoscopic RPLND was successfully completed in 5 (71.4%) of 7 patients. Two patients required a conversion to open surgery. The overall complication rate was 57.1% (4 of 7), with a major complication incidence of 42.8% (3 of 7). No mortalities were recorded. Of the 5 patients who presented with nonseminomatous germ cell tumor after orchiectomy, 3 were found to have retroperitoneal lymph nodes consistent with mature teratoma, 1 had necrotic tissue, and 1 had residual viable tumor. CONCLUSIONS: Laparoscopic RPLND is a feasible operation in patients after systemic chemotherapy. This technique remains challenging at this time and should be reserved for patients with limited residual disease and should only be performed at institutions with considerable laparoscopic expertise.

[Scott]

Chylous ascites is a possible complication with either open or laparoscopic surgery. As you noted, the odds are low, but it does happen. I was one of the "lucky" ones.

You're right, of course, that it was the complications that made for the long recovery. I would have stayed home from work for just two weeks without them.

[dadmo]

Your complications may also have been less if a strict fat free diet was prescribed both before and after the LRPLND.

[Kev332]

Good luck today Rosewoodblues! I hope it all goes well and that you have a speedy recovery. Take it one day at a time.

-Kevin