Appendix Cancer Surgery
Surgical Treatment for Appendiceal Cancer
Appendix Cancer Surgeon Specialists
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Tissue Engineering of Small Intestine Offers New Hope
Tissue Engineering the Small Intestine
Researched by Spurrier RG, Grikscheit TC.
Source
Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California.
Abstract
Short bowel syndrome (SBS) results from the loss of a highly specialized organ, the small intestine. SBS and its current treatments are associated with high morbidity and mortality. Production of tissue-engineered small intestine (TESI) from the patient's own cells could restore normal intestinal function via autologous transplantation. Improved understanding of intestinal stem cells and their niche have been coupled with advances in tissue engineering techniques.
Originally described by Vacanti et al of Massachusetts General Hospital, TESI has been produced by in vivo implantation of organoid units. Organoid units are multicellular clusters of epithelium and mesenchyme that may be harvested from native intestine. These clusters are loaded onto a scaffold and implanted into the host omentum. The scaffold provides physical support that permits angiogenesis and vasculogenesis of the developing tissue. After a period of 4 weeks, histologic analyses confirm the similarity of TESI to native intestine. TESI contains a differentiated epithelium, mesenchyme, blood vessels, muscle, and nerve components.
To date, similar experiments have proved successful in rat, mouse, and pig models. Additional experiments have shown clinical improvement and rescue of SBS rats after implantation of TESI. In comparison with the group that underwent massive enterectomy alone, rats that had surgical anastomosis of TESI to their shortened intestine showed improvement in postoperative weight gain and serum B12 values.
Recently, organoid units have been harvested from human intestinal samples and successfully grown into TESI by using an immunodeficient mouse host. Current TESI production yields approximately 3 times the number of cells initially implanted, but improvements in the scaffold and blood supply are being developed in efforts to increase TESI size.
Exciting new techniques in stem cell biology and directed cellular differentiation may generate additional sources of autologous intestinal tissue for direct translation to human therapy.
Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.
Clin Gastroenterol Hepatol. 2013 Apr;11(4):354-8. doi: 10.1016/j.cgh.2013.01.028. Epub 2013 Feb 4.
Questions and Answers for Appendix Cancer Surgery
Appendix cancer survivors!
Is surgery necessary?
Why isn't an appendectomy "enough?"
How extensive is appendix cancer treatment surgery?
Appendix Cancer Surgery, HIPEC and Chemotherapy overview
Your surgical oncologist will explain and review all treatment options for appendix cancer. Your treatment plan will depend on your overall health, the type of tumor (pathology), the quantity (mass) size and location of the tumor, and whether the cancer has metastasized.
Treatment for appendix cancer generally includes CRS or cytoreductive surgery with or without systemic chemotherapy and HIPEC.
The purpose of debulking surgery is to remove as much tumor as possible. Debulking surgery often includes the removal of the omentum and the right colon. Additionally, for women, debulking will likely include a hysterectomy, if this was not perfomed previously. Adhesions become more troublesome with any additional debulking surgeries.
Cytoreductive surgery is a detailed, lengthy procedure often requiring ten or more hours.
Tumors are removed and destroyed using a variety of surgical techniques including argon beam coagulator, electro-evaporation, laser, and ultrasonic dissection.
CRS (cytoreductive surgery) consists of the removal of as much mucin and visible tumor as possible, from the abdominal cavity. CRS surgery, refers to the removal of all visible tumors present throughout the peritoneal cavity.
Cytoreductive Surgery includes thorough removal or destruction of all visible tumors throughout the surfaces of the peritoneum. Surgery may include the removal or resection of segments of small and large bowel, gall bladder, liver, omentum, ovaries, pancreas, spleen, stomach and uterus, and may require removing the lining of the peritoneum. Improved results are acheived when the surgeon is able to remove all visible tumor with minimal, or no deposits of residual disease (cancer.) The less residual disease, the better the opportunity for HIPEC to be effective.
Hemicolectomy is a surgical procedure involving the removal of a portion of the colon next to the appendix. This procedure may also include the removal of nearby blood vessels and lymph nodes at the same time.
Peritonectomy refers to stripping the parietal peritoneum and resecting structures at the sites that contain adenomucinosis. A combination of surgical techniques are utilized including organ resection, when necessary and tumor destruction via electro-evaporation and argon beam coagulation.
The peritoneum is the transparent serous membrane lining the cavity of the abdomen.
CRS surgery for Appendix Cancer and Pseudomyxoma Peritonei may include the following:
Removal of the omentum, spleen and gall bladder,
Right hemicolectomy, colectomy, removal of the rectum and sigmoid,
Stripping tumor from the surface of the liver,
Resection of the pancreas,
Gastrectomy (partial or total removal of the stomach)
Stripping the peritoneum from left and right hemidiaphragm;
Pelvic peritonectomy,
Ileostomy,colostomy or urostomy HIPEC may be included at the conclusion of the cytoreductive surgery for the treatment of pseudomyxoma peritonei and appendix cancer if substantial tumor debulking is accomplished through CRS.
HIPEC may be administered when complete removal of visible tumor (or debulking) is achieved through cytoreductive surgery; it involves perfusion of the peritoneal cavity with chemotherapy heated to approximately 40 degrees Celsius.
HIPEC is administered with the infusion of heated chemotherapy during the last 90 minutes of the CRS procedure. Through HIPEC the surgeon(s) intend to destroy any residual tumor cells that may not have been surgically removed during the actual CRS surgery process.
Although this procedure may initially sound drastic to the newly diagnosed patient, rarely is resection and/or removal of all of these organs is required.
Each patient's case is unique; most patients live productive and healthy lives following surgery!
Preparing for, and recuperating from, Appendix Cancer Surgery
Here are a series of articles written by Pal members Adele, Fred, Gabriella and Jim to help fellow patients, and their families, prepare for, and recuperate from, Appendix Cancer surgery!
How are patients selected for appendix cancer surgery?
by Pal Patient, Gabriella
This question is frequently asked by newly diagnosed patients and “veteran” patients experiencing a “recurrence of disease.”
Why are some patients accepted for CRS or CRS/HIPC while others are not?
Is there any truth to the rumors that surgeons “cherry pick” their patients?
Why isn’t every patient a candidate for surgery?
Surgeons refer to the process of evaluating a surgical candidate as “patient selection.”
Many factors are taken into consideration for patient selection.
The success of CRS and HIPEC may be dependent on the:
patient’s overall general health,
complete removal of all tumor tissue,
location of tumor site(s) and
type of tumor (histology and differentiation.)
The following is a very general explanation of how patients are selected as surgical candidates:
1. Preliminary disease criteria
Patients with metastasis to the peritoneum, aka Peritoneal Carcinomatosis.
Patients with disease contained within the abdomen (without metastasis outside the abdomen)
2. Preliminary general health criteria for patient selection
Good overall heath lacking any major co-morbid conditions*.
Age (some surgeons limit the ages of patients they will accept into surgery)
Mental health (coherence, ability to understand instructions, evidence of chemical dependencies, etc.)
Ability to pay for surgery (adequate health insurance coverage or ability to pay out-of-pocket for medical care)
3. Preliminary review of patient medical history
Medical history including surgical history, if applicable, co-morbid conditions* (ie diabetes, lung or heart disease) current medications (prescribed and OTC) allergies and family history
History of present illness including summary of symptoms
Operative reports of previous surgeries
Pathology reports
Record of previous chemotherapy and radiotherapy treatments, if applicable, including dates and protocols
4. Extent of disease
Evaluation of CT scans to determine PCI (Peritoneal Cancer Index.)
The PCI helps the surgeon to determine the extent, volume and locations of the disease.
Evaluation of tumor block samples from original surgery(ies) if applicable.
Laparoscopy optional
Biopsy optional
Evaluation of tumor markers and associated lab tests
Physical examination of the patient
Copyright © 2012 by PMP Pals’ Network/Gabriella Graham/All rights reserved.
This question is frequently asked by newly diagnosed patients and “veteran” patients experiencing a “recurrence of disease.”
Why are some patients accepted for CRS or CRS/HIPC while others are not?
Is there any truth to the rumors that surgeons “cherry pick” their patients?
Why isn’t every patient a candidate for surgery?
Surgeons refer to the process of evaluating a surgical candidate as “patient selection.”
Many factors are taken into consideration for patient selection.
The success of CRS and HIPEC may be dependent on the:
patient’s overall general health,
complete removal of all tumor tissue,
location of tumor site(s) and
type of tumor (histology and differentiation.)
The following is a very general explanation of how patients are selected as surgical candidates:
1. Preliminary disease criteria
Patients with metastasis to the peritoneum, aka Peritoneal Carcinomatosis.
Patients with disease contained within the abdomen (without metastasis outside the abdomen)
2. Preliminary general health criteria for patient selection
Good overall heath lacking any major co-morbid conditions*.
Age (some surgeons limit the ages of patients they will accept into surgery)
Mental health (coherence, ability to understand instructions, evidence of chemical dependencies, etc.)
Ability to pay for surgery (adequate health insurance coverage or ability to pay out-of-pocket for medical care)
3. Preliminary review of patient medical history
Medical history including surgical history, if applicable, co-morbid conditions* (ie diabetes, lung or heart disease) current medications (prescribed and OTC) allergies and family history
History of present illness including summary of symptoms
Operative reports of previous surgeries
Pathology reports
Record of previous chemotherapy and radiotherapy treatments, if applicable, including dates and protocols
4. Extent of disease
Evaluation of CT scans to determine PCI (Peritoneal Cancer Index.)
The PCI helps the surgeon to determine the extent, volume and locations of the disease.
Evaluation of tumor block samples from original surgery(ies) if applicable.
Laparoscopy optional
Biopsy optional
Evaluation of tumor markers and associated lab tests
Physical examination of the patient
Copyright © 2012 by PMP Pals’ Network/Gabriella Graham/All rights reserved.
Meet the "Charge Nurse" Prior to Surgery
How to Select a Surgeon, Part III: Meet the “Charge Nurse”
by Pal Patient Gabriella
While most patients take the time to interview their surgeon prior to scheduling CRS and HIPEC, few take the time to tour the floor of the hospital where recuperation will take place following surgery.
Typically, appendix cancer surgery patients spend 24 to 48 hours in ICU, immediately following surgery, before being released to the surgery recovery floor for the duration of their hospitalized recuperation.
The “charge nurse” is responsible for supervising the floor/unit where you will recuperate. S/he assigns nurses to specific patients, and monitors the unit to be staffed adequately to meet the needs of the patients. Charge nurses may also provide direct patient care when needed and may serve as liaisons between patients and the nursing staff. Charge nurses may be rotated throughout the week, therefore, the charge nurse may change from day to day. In some hospitals, charge nurses maintain that position for longer periods of time.
On the day you interview your surgeon, request to meet with the “charge nurse” of the floor where you will recuperate. Ask the charge nurse to give you a tour of the ward. You and your family caregiver will want to see an example of the room where you will recuperate, as well as any amenities the floor or hospital may have to offer, e.g. a lounge for patients and caregivers, cafeteria, access to Wi-Fi, etc.
Prior to meeting with the charge nurse, prepare your list of questions for him/her, just as you prepare your questions for the surgeon. Among the questions to consider asking are the following:
What is the "nurse to patient" ratio on this floor? (How many patients are assigned to each nurse?)
Will the majority of your hands on nursing care be provided by RNs, LVNs, or licensed aides?
How many HIPEC patients are cared for on this floor each week? (How experienced is the nursing staff in taking care of HIPEC patients?)
These are just a few of the important questions patients must consider when selecting a surgeon/specialist. It's important to pay attention to these details regarding the hospital itself because after you are released from the ICU, you will spend the remainder of your hospitalized recuperation on the floor (unit or ward) supervised by the charge nurse.
As a proactive cancer patient and consumer, interview all potential healthcare providers whenever possible. Your health and your future are deserving of your time and attention to investigating your healthcare treatment plan thoroughly, prior to scheduling your surgery.
These are just a few of the important considerations that one must examine prior to selecting a surgeon/specialist. A more detailed and comprehensive list of questions is included in the PMP Pals’ Network Handbook: Preparing for Surgery. This handbook is provided to all new members of the PMP Pals’ Network.
Articles posted in PMP Pals and on www.pmppals.org are written from the perspectives of patients and their families and are not intended to substitute for licensed, professional legal or medical advice. Each patient is unique and should seek specific counsel from their own licensed healthcare professional. Copyright © 2012 by the PMP Pals’ Network. All rights reserved.
The Importance of Walking After Surgery (CRS and HIPEC)
Jim has been cancer free for 5 years!
The Importance of Walking After Surgery (CRS and HIPEC)
By PMP Pal, Jim M, cancer free for five years!
After surgery, get up as soon as your healthcare team recommends and as often as they allow. Generally, your nurses will help you to stand up and walk a few steps the first day after surgery, including while you are still in ICU. You will feel unsteady on your feet, therefore, a nurse will assist you.
During the days following surgery set a goal to walk a little farther every day. Begin with two steps, four steps, out the door of your room, half way down the hospital corridor, and so forth. Gradually you will walk the length of the corridor once/twice/three times! Your IV pole will be your “walking partner!”
Getting out of bed and walking may make a difference in your recovery time. Eventually you will be strong enough to stroll down the corridor without a nursing assistant or family member to accompany you!
Why is the NG Tube Used for After Surgery?
What is the NG Tube?
by Pal Patient, Gabriella
Kerry from the USA asks the PMP Pals’ Network:
“I am scheduled for CRS and HIPEC. My surgeon says I will wake up from surgery with an NG tube. What can I expect to experience with the NG tube?”
GG responds:
“The Nasogastric tube, or “NG tube” is plastic tubing inserted through the nose, down the throat and into the stomach. In the case of CRS and HIPEC patients, it is inserted while the patient is “asleep” under anesthesia.
In the case of CRS and HIPEC patients the NG tube is used for aspiration to suck out the patient’s stomach contents, including secretions and swallowed air from the stomach. The NG tube is attached to a drainage bag or bottle alongside the patient’s bed, for the collection of drainage contents. When used for aspiration the patient is not allowed to eat or drink anything by mouth, including popsicles, broth or gelatin. In order to prevent vomiting, it’s important for the patient to refrain from eating or drinking anything while the NG tube is in place.
For CRS and HIPEC patients, the NG tube is typically left in place for several days to a few weeks, depending on how much time is need for peristalsis to resume. The nose and throat may become irritated the longer the NG tube has been left in place. For this reason, and due to oral dryness, some patients prefer to limit speaking at length (limit the length of their conversations.)
To combat oral dryness, refer to our article “Dental Care for Cancer Patients” offering solutions to combatting the oral discomfort that may accompany use of the NG tube. Although the patient is neither eating nor drinking while the NG tube is inserted, it’s very important to maintain dental hygiene during this period in order to prevent future dental decay.
During the time the NG tube is in place, the patient’s abdomen will be checked several times a day for signs (sounds) of peristalsis. Peristalsis typically slows or ceases during the initial days following CRS and HIPEC, especially when narcotics are being administered for pain relief.
When signs (sounds) of peristalsis return, the NG tube is typically removed within a day or so. As tempting it may be for the patient to remove the NG tube prematurely, a conservative approach to removing the NG tube is suggested, as should the NG tube need to be reinserted, it will most likely be done so without the use of general anesthesia. Most patients prefer to avoid re insertion, if at all possible.
After the NG tube has been removed, clear fluids are gradually introduced to the patient’s diet. Once again, it is suggested that patient’s progress conservatively in re introducing clear, followed by soft, and eventually solid foods back into the diet, in order to avoid vomiting.
Each patient should consult with his/her personal surgeon for detailed information about the use of the NG tube for the patient’s specific case.”
Articles posted in PMP Pals and on www.pmppals.org are written from the perspectives of patients and their families and are not intended to substitute for licensed, professional legal or medical advice. Each patient is unique and should seek specific counsel from their own licensed healthcare professional. Copyright © 2012 by Gabriella Graham. All rights reserved.
by Pal Patient, Gabriella
Kerry from the USA asks the PMP Pals’ Network:
“I am scheduled for CRS and HIPEC. My surgeon says I will wake up from surgery with an NG tube. What can I expect to experience with the NG tube?”
GG responds:
“The Nasogastric tube, or “NG tube” is plastic tubing inserted through the nose, down the throat and into the stomach. In the case of CRS and HIPEC patients, it is inserted while the patient is “asleep” under anesthesia.
In the case of CRS and HIPEC patients the NG tube is used for aspiration to suck out the patient’s stomach contents, including secretions and swallowed air from the stomach. The NG tube is attached to a drainage bag or bottle alongside the patient’s bed, for the collection of drainage contents. When used for aspiration the patient is not allowed to eat or drink anything by mouth, including popsicles, broth or gelatin. In order to prevent vomiting, it’s important for the patient to refrain from eating or drinking anything while the NG tube is in place.
For CRS and HIPEC patients, the NG tube is typically left in place for several days to a few weeks, depending on how much time is need for peristalsis to resume. The nose and throat may become irritated the longer the NG tube has been left in place. For this reason, and due to oral dryness, some patients prefer to limit speaking at length (limit the length of their conversations.)
To combat oral dryness, refer to our article “Dental Care for Cancer Patients” offering solutions to combatting the oral discomfort that may accompany use of the NG tube. Although the patient is neither eating nor drinking while the NG tube is inserted, it’s very important to maintain dental hygiene during this period in order to prevent future dental decay.
During the time the NG tube is in place, the patient’s abdomen will be checked several times a day for signs (sounds) of peristalsis. Peristalsis typically slows or ceases during the initial days following CRS and HIPEC, especially when narcotics are being administered for pain relief.
When signs (sounds) of peristalsis return, the NG tube is typically removed within a day or so. As tempting it may be for the patient to remove the NG tube prematurely, a conservative approach to removing the NG tube is suggested, as should the NG tube need to be reinserted, it will most likely be done so without the use of general anesthesia. Most patients prefer to avoid re insertion, if at all possible.
After the NG tube has been removed, clear fluids are gradually introduced to the patient’s diet. Once again, it is suggested that patient’s progress conservatively in re introducing clear, followed by soft, and eventually solid foods back into the diet, in order to avoid vomiting.
Each patient should consult with his/her personal surgeon for detailed information about the use of the NG tube for the patient’s specific case.”
Articles posted in PMP Pals and on www.pmppals.org are written from the perspectives of patients and their families and are not intended to substitute for licensed, professional legal or medical advice. Each patient is unique and should seek specific counsel from their own licensed healthcare professional. Copyright © 2012 by Gabriella Graham. All rights reserved.
How to Set Limits for Hospital Visitors
Setting Limits for Hospital Visitors
by Pal Patient, Gabriella, USA
As much as we appreciate cards, calls and visits from friends and family, during or following medical care, some appendix cancer patients and their families feel overwhelmed when hospital and home visits are “overextended.”
This week I received an inquiry from a caregiving “Pal” who expressed the following concerns:
“My husband is recuperating from CRS and HIPEC, and returned home, from the hospital, last week. A visiting nurse comes by to change his bandage each morning.
My husband needs to take a long nap every afternoon. Several neighbors, relatives and co-workers have stopped by to visit unannounced. I feel uncomfortable asking them to call first or to limit their visits. My husband almost feels obligated to answer all calls and accept “drop in” visitors. He is clearly fatigued yet feels we must “entertain” friends and family.
I am running short on patience and wonder how other spouses manage balancing caregiving while setting limits for visitors.”
In response, I share the following suggestions for enjoying visits from friends and family while setting boundaries to respect your personal “space.”
Hospital and home visits:
Set limits for your own, or for your spouse’s visiting hours in the hospital and at home. Limit the number of visitors you, or your spouse will receive and during which days and hours. Tell friends and family “John is awake for visitors on Sunday, Tuesday and Thursday from 1 to 2 PM. He requires the remainder of the day for rest and medical care.”
Advise the nurses at the call desk of your preference for visiting hours. Visitors don’t always check in at the call desk, therefore, you will also need to post a handwritten sign on the door to your room, advising everyone of your personal visiting hours.
Don’t assume that “other cancer patients” who may visit you, will be perceptive of your energy limitations; they will not be.
Many well meaning and caring friends and relatives have NO concept of how tired post op CRS and HIPEC patients are, what they have experienced in the hospital, the amount of uninterrupted time that patients need to bathe, change dressings, attend to “bathroom needs” (which are generally more frequent during the weeks immediately following surgery) the time required to eat and consume nutritious foods, or to administer TPN and change bandages without having the
Gifts for patients:
Likewise, visitors may be unaware of appropriate gifts for recuperating appendix cancer patients.
Many gastrointestinal cancer patients experience nausea, especially following HIPEC or other chemotherapy treatment(s.) Therefore, when selecting floral arrangements, visitors should select non fragrant flowers, i.e. tulips or cyclamens, or non flowering plants.
Thoughtful gifts include music selections, light hearted films and DVDs, crossword puzzles, magazines and books.
Whether patients are recuperating in the hospital, or have returned home, they, and their family caregiver, will appreciate gifts of an hour or two of housekeeping services, laundry/dry cleaning, grocery shopping, transportation to medical appointments, extended childcare, gift cards, prepared meals, comfy lounging apparel, care and shelter of pets, etc.
Visitors should limit wearing, or giving, gifts of fragrances, scented lotions, and perfumes. Patients may easily become nauseated from aromatic food or beverages, including coffee, therefore, visitors should limit their own refreshments to the hospital cafeteria or coffee shop.
Telephone calls:
Post an outgoing message on your cell or home voicemail advising friends of your “telephone hours.” Tell friends and family that you welcome their incoming calls during specific hours of the day and for brief durations of time. Here is a suggestion for your voicemail message:
“Thank you for calling. Please call back between 2 and 4 PM. During my recuperation I am limiting calls to ten minutes per caller.”
Create a “visiting policy” that works for you:
Patients and their family caregivers can sit down together and discuss their own needs for setting limits for visitors. Friends and family will never know your personal preferences unless you tell them your wishes!
Copyright © 2012 by PMP Pals’ Network/Gabriella Graham/All rights reserved
by Pal Patient, Gabriella, USA
As much as we appreciate cards, calls and visits from friends and family, during or following medical care, some appendix cancer patients and their families feel overwhelmed when hospital and home visits are “overextended.”
This week I received an inquiry from a caregiving “Pal” who expressed the following concerns:
“My husband is recuperating from CRS and HIPEC, and returned home, from the hospital, last week. A visiting nurse comes by to change his bandage each morning.
My husband needs to take a long nap every afternoon. Several neighbors, relatives and co-workers have stopped by to visit unannounced. I feel uncomfortable asking them to call first or to limit their visits. My husband almost feels obligated to answer all calls and accept “drop in” visitors. He is clearly fatigued yet feels we must “entertain” friends and family.
I am running short on patience and wonder how other spouses manage balancing caregiving while setting limits for visitors.”
In response, I share the following suggestions for enjoying visits from friends and family while setting boundaries to respect your personal “space.”
Hospital and home visits:
Set limits for your own, or for your spouse’s visiting hours in the hospital and at home. Limit the number of visitors you, or your spouse will receive and during which days and hours. Tell friends and family “John is awake for visitors on Sunday, Tuesday and Thursday from 1 to 2 PM. He requires the remainder of the day for rest and medical care.”
Advise the nurses at the call desk of your preference for visiting hours. Visitors don’t always check in at the call desk, therefore, you will also need to post a handwritten sign on the door to your room, advising everyone of your personal visiting hours.
Don’t assume that “other cancer patients” who may visit you, will be perceptive of your energy limitations; they will not be.
Many well meaning and caring friends and relatives have NO concept of how tired post op CRS and HIPEC patients are, what they have experienced in the hospital, the amount of uninterrupted time that patients need to bathe, change dressings, attend to “bathroom needs” (which are generally more frequent during the weeks immediately following surgery) the time required to eat and consume nutritious foods, or to administer TPN and change bandages without having the
Gifts for patients:
Likewise, visitors may be unaware of appropriate gifts for recuperating appendix cancer patients.
Many gastrointestinal cancer patients experience nausea, especially following HIPEC or other chemotherapy treatment(s.) Therefore, when selecting floral arrangements, visitors should select non fragrant flowers, i.e. tulips or cyclamens, or non flowering plants.
Thoughtful gifts include music selections, light hearted films and DVDs, crossword puzzles, magazines and books.
Whether patients are recuperating in the hospital, or have returned home, they, and their family caregiver, will appreciate gifts of an hour or two of housekeeping services, laundry/dry cleaning, grocery shopping, transportation to medical appointments, extended childcare, gift cards, prepared meals, comfy lounging apparel, care and shelter of pets, etc.
Visitors should limit wearing, or giving, gifts of fragrances, scented lotions, and perfumes. Patients may easily become nauseated from aromatic food or beverages, including coffee, therefore, visitors should limit their own refreshments to the hospital cafeteria or coffee shop.
Telephone calls:
Post an outgoing message on your cell or home voicemail advising friends of your “telephone hours.” Tell friends and family that you welcome their incoming calls during specific hours of the day and for brief durations of time. Here is a suggestion for your voicemail message:
“Thank you for calling. Please call back between 2 and 4 PM. During my recuperation I am limiting calls to ten minutes per caller.”
Create a “visiting policy” that works for you:
Patients and their family caregivers can sit down together and discuss their own needs for setting limits for visitors. Friends and family will never know your personal preferences unless you tell them your wishes!
Copyright © 2012 by PMP Pals’ Network/Gabriella Graham/All rights reserved
How Long Does it Really Take to Recover from Surgery?
Pal member, Fred
Fred Suggests a Frank Discussion About Post Op Recovery!
By “Pal” member, Fred S, from the USA
“A frequent concern that arises among patients who are planning to, or have had CRS and HIPEC, is the length of time required to recover. A corollary to recovery time is what “recovery” actually means. Before addressing these issues, I should emphasize that each patient’s experience will differ depending on a host of factors (e.g., age, general health, extent of tumors, type of cancer, invasiveness of surgery, etc.). There is no simple rule of thumb to determine an expected recovery time.
What is recovery? How do patients and surgeons define “recovery?”
This question is one that never occurred to me in my initial discussions with my surgeon; as a result there was a misunderstanding. He did not mince words regarding the seriousness of my condition and the necessary surgery. However, he indicated that I should be back to “normal” in a few months. The problem was his idea of “normal” and mine were different. I viewed “normal” as my state of health prior to developing the disease. His notion was apparently being able to return to work and everyday activities free of the disease.
In brief, my post operation weight dropped from about 150 to 109 before recovering to 118, which is my new “normal” (permanent weight loss is a common result of the surgery) and the necessary removal of various organs and sections of organs has had a major impact on my digestive system, which in turn has affected my quality of life in certain ways. As I’ve often joked, I’ve developed a close personal relationship with my bathroom and have become much more aware of the locations of public facilities. Thus, in one sense I’ve never “recovered” from the surgery; I have not returned to my prior state of health.
However, I did return to work, returned to my nature photography, and took up competitive table tennis after a 30 year hiatus. I am physically able to do most things I did pre surgery, including working out at a fitness center several times a week, but am acutely aware of the limits due to the digestive issues.
Time frame for recovery
My particular surgery was about 10 hours. I spent almost a month in the hospital before being released, then another few days a week later due to dehydration.
At home, I began walking around the neighborhood gradually lengthening the time and distance as I felt stronger I was able to return to my desk job on a part time basis 3 months after surgery and on a full time basis a couple of months later.
I began doing my nature photography carrying very limited equipment about 4 months after surgery and a full backpack about a year after surgery.
Recovery, the “new normal”, and Senior Olympics!
I retired 14 months after the surgery and began playing table tennis at a local club soon after, winning two bronze medals and a silver medal in the local senior Olympics and a bronze medal for my talent level at the 2011 U.S. nationals this past December.
Looking back, I’d say full recovery for me, which I’d define as reaching my new “normal,” took about 9-12 months. As noted above, and as a former economist, I again emphasize that I represent just one data point. Recovery time will vary considerably across individuals.”
Articles posted in “PMP Pals” and on www.pmppals.org are written from the perspective of patients and their family caregivers and are not intended to substitute for licensed professional legal or medical care. Each patient is unique and should seek the counsel of a licensed professional for their own specific case. Copyright © 2012 by Gabriella Graham/PMP Pals’ Network/All rights reserved. Visit us on the web at www.pmppals.org
Tips for Returning to Work After Appendix Cancer Surgery
By PMP Pal member, and patient, Adele
Our Pal Patient, Elizabeth, has recuperated from CRS with HIPEC and is returning to her job soon.
Today she asked her fellow Pals for helpful suggestions for returning to the office
Pal Mentor, Adele, came forward to offer the following suggestions:
“Be realistic about what you can accomplish during the day.
Ask your supervisor for flexibility in your work schedule while you transition back into your working life.
Bring hand sanitizer and Lysol to work with you and use them.
Avoid anyone who has a cold or a cough!
Bring nutritious, high protein, small meals and snacks so that you can eat a little throughout the day.
For women, consider carrying a smaller, lighter handbag!
Dress comfortably. When selecting shoes, choose safety and comfort over style.
Be careful about lifting anything heavy.
Your surgeon will advise you of weight limitations. Ask for assistance in opening heavy doors
Be realistic about what you can accomplish during the day.
If you find yourself becoming tired over what were previously routine tasks, like walking from the parking lot or from one building to another, pace yourself, remember that your body is still healing, and allow yourself extra time for routine tasks, if needed.
Ask your supervisor for flexibility in your work schedule while you transition back into your working life.
Your colleagues and coworkers will be happy to see you back on the job and will likely want to assist you in any way they can…let them!”
Articles posted in PMP Pals and on www.pmppals.org are written from the perspective of patients and family caregivers and are not intended to substitute for licensed, professional legal or medical advice. Each patient’s case is unique; therefore consult with a licensed professional regarding your specific needs. Copyright © 2013 by PMP Pals’ Network. All rights reserved. Todos derechos reservados.
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We have HOPE for YOU!
What to Expect the Night Before Surgery
Questions to Ask Before Surgery
Questions for Your Doctor
Suggestions for Selecting a Surgeon
Symptoms and Treatment of Blood Clots, DVTs
Dr Richard C Frank
What are DVTs?
How do you recognize the symptoms of blood clots?
Why is it necessary to seek immediate care?
How are DVTs treated?
Cancer and Blood Clots: What Patients Need to Know
Source:Richard C Frank, MD
How do you recognize the symptoms of blood clots?
Why is it necessary to seek immediate care?
How are DVTs treated?
Cancer and Blood Clots: What Patients Need to Know
Source:Richard C Frank, MD
Getting to the Truth About Cancer Pain!
Infection Prevention
Systemic Chemotherapy for Appendix Cancer
Has your physician prescribed chemo for appendix cancer treatment?
Read about a variety of systemic chemotherapies
Does Your Hospital Make You Happy?
Appendix Cancer Surgery at the NCI, Mexico City, 2012
Photo provided by Dr Lopez Basave
Dr Jesus Esquivel and colleagues perform life saving surgery at the National Cancer Institute, Mexico City, 2012
Dr Paul Sugarbaker Explains Surgical Abbreviations
Dr Paul Sugarbaker Provides List of Abbreviations for Surgery and HIPEC
Dr Paul H Sugarbaker
Thank you to Dr Paul Sugarbaker for providing the PMP Pals' Network with this listing of abbreviations commonly used for the treatment of Appendiceal Cancer.
For additional information see our Appendix Cancer Glossary.
1. CS – Chemosurgery (most general abbreviation includes CRS, HIPEC, EPIC and ABC)
2. HIPEC – Hyperthermic intraperitoneal chemotherapy
3. HIPEC + 5FU – Hyperthermic intraperitoneal chemotherapy plus intravenous 5-fluorouracil
4. HIPEC + IFO – Hyperthermic intraperitoneal chemotherapy plus intravenous ifosfamide
5. EPIC – Early postoperative intraperitoneal chemotherapy usually 5-FU or paclitaxel
6. ABC – Adjuvant bidirectional chemotherapy
7. CRS – Cytoreductive surgery
8. CCRS – Complete cytoreductive surgery
9. PM – Peritoneal metastases (should replace PC)
10. PC – Peritoneal carcinomatosis
11. POC – Perioperative chemotherapy
12. LM – Liver metastases
13. LNM – Lymph node metastases
14. LR – Local-regional
15. IP port – Intraperitoneal port used for ABC
16. Tenckhoff catheter – Temporary catheter used to deliver EPIC
Another Boost for Minimally Invasive Abdominal Surgery
Another Boost for Minimally Invasive Surgery
By Michael Smith, North American Correspondent, MedPage Today
Published: April 16, 2012
"For most types of abdominal surgery, an open procedure appears to increase the risk of later small bowel obstruction, compared with laparoscopy, researchers reported.
In a population-based study, the incidence of small bowel obstruction, owing to adhesions, ranged from 0.4% to 13.9% depending on the procedure, according to Eva Angenete, MD, PhD, of Sahlgrenska University Hospital/Ostra in Gothenburg, Sweden, and colleagues.
But with the exception of bariatric surgery, the risk of small bowel obstruction was higher with open surgery than laparoscopy, Angenete and colleagues reported in the April issue of Archives of Surgery."
For details:
1. Read the full article as published in MedPage Today2. Read the original report, posted directly below...
Effect of Laparoscopy on the Risk of Small-Bowel Obstruction
Effect of Laparoscopy on the Risk of Small-Bowel Obstruction
A Population-Based Register Study
Source Eva Angenete, MD, PhD; Anders Jacobsson, MSc; Martin Gellerstedt, PhD; Eva Haglind, MD, PhD /Arch Surg. 2012;147(4):359-365. doi:10.1001/archsurg.2012.31
Objective To investigate the incidence and risk factors for small-bowel obstruction (SBO) after certain surgical procedures.
Design A population-based retrospective register study.
Setting Small-bowel obstruction causes considerable patient suffering. Risk factors for SBO have been identified, but the effect of surgical technique (open vs laparoscopic) on the incidence of SBO has not been fully elucidated.
Patients The Inpatient Register held by the Swedish National Board of Health and Welfare was used. The hospital discharge diagnoses and registered performed surgical procedures identified data for cholecystectomy, hysterectomy, salpingo-oophorectomy, bowel resection, anterior resection, abdominoperineal resection
Conclusions Open surgery seems to increase thn, rectopexy, appendectomy, and bariatric surgery performed from January 1, 2002, through December 31, 2004. Data on demographic characteristics, comorbidity, previous abdominal surgery, and death were collected.
Main Outcome Measures Episodes of hospital stay and surgery for SBO within 5 years after the index surgery.
Results A total of 108 141 patients were included. The incidence of SBO ranged from 0.4% to 13.9%. Multivariate analysis revealed age, previous surgery, comorbidity, and surgical technique to be risk factors for SBO. Laparoscopy exceeded other risk factors in reduction of the risk of SBO for most of the surgical procedures.
Conclusions Open surgery seems to increase the risk of SBO at least 4 times compared with laparoscopy for most of the abdominal surgical procedures studied. Other factors such as age, previous abdominal surgery, and comorbidity are also of importance.
Laparoscopy: minimally invasive surgery
Laparoscopy surgery includes the use of a thin, narrow, tube shaped instrument inserted into the abdominal wall. Laparoscopy may be used as a diagnostic tool, and has become a surgical option for specific patients, providing a less invasive (and less expensive) alternative to more extensive surgery.
Recuperation from laparoscopy requires less hospitalization due to a faster recovery period, with less trauma and post op pain.
The following articles and abstracts pertaining toappendiceal cancer, mesothelioma, pseudomyxoma peritonei, gastric, liver, ovarian and pancreatic cancer are posted for your reference.
Laparoscopy for Oncological Surgery (this article provides a detailed explanation for patients)
Source: MDAnderson, Houston TX
Laparoscopic Mucin Removal of Pseudomyxoma Peritonei
Source: Dept of OB GYN, Kinko Univ, Osaka Japan, 2009
Minimally Invasive Laparoscopic Surgery
Source: Mercy Medical Center
Minimally Invasive Laparoscopic Surgery, Liver, Pancreas
Source: UCSD, Dr Andrew Lowy, 2009
Laparoscopic CRS and HIPEC Treatment for Peritoneal Mesothelioma
Source: Dr Jesus Esquivel, 2009
Laparoscopic Surgery for the Treatment of Peritoneal Surface Malignancies including Pseudomyxoma Peritonei
Source: Memorial Sloan Kettering, NY
Laparoscopic Surgery for the Treatment of Liver Cancer, Pancreas Cancer
Source: University of Southern California
Laparoscopic Staging for Gastric Cancer
Source: Dr Paul Mansfield, MDACC, Annals of Surgical Oncology, 2001
Laparoscopic Colon Resection
Source: UPMC Koch Cancer Treatment Center
Laparoscopic Surgery for Liver Cancer
Source: Dr David L Bartlett UPMC Koch Cancer Center
Laparoscopic Surgery for Whipple Procedure, Pancreatic
Source: USC Norris Cancer Center
Laparoscopic Surgery, Gastric and Esophageal Cancers
Source: Dr Charles Filipi, Creighton University
Laparoscopic restoration of the colon continuity after Hartmann procedure
Source: Pub Med 2009
Laparoscopic Management of Ovarian Cyst
Source: Springerlink:2008
Laparoscopic Management of Pseudomyxoma Peritonei
Source: Cleveland Clinic 1999
Recuperation from laparoscopy requires less hospitalization due to a faster recovery period, with less trauma and post op pain.
The following articles and abstracts pertaining toappendiceal cancer, mesothelioma, pseudomyxoma peritonei, gastric, liver, ovarian and pancreatic cancer are posted for your reference.
Laparoscopy for Oncological Surgery (this article provides a detailed explanation for patients)
Source: MDAnderson, Houston TX
Laparoscopic Mucin Removal of Pseudomyxoma Peritonei
Source: Dept of OB GYN, Kinko Univ, Osaka Japan, 2009
Minimally Invasive Laparoscopic Surgery
Source: Mercy Medical Center
Minimally Invasive Laparoscopic Surgery, Liver, Pancreas
Source: UCSD, Dr Andrew Lowy, 2009
Laparoscopic CRS and HIPEC Treatment for Peritoneal Mesothelioma
Source: Dr Jesus Esquivel, 2009
Laparoscopic Surgery for the Treatment of Peritoneal Surface Malignancies including Pseudomyxoma Peritonei
Source: Memorial Sloan Kettering, NY
Laparoscopic Surgery for the Treatment of Liver Cancer, Pancreas Cancer
Source: University of Southern California
Laparoscopic Staging for Gastric Cancer
Source: Dr Paul Mansfield, MDACC, Annals of Surgical Oncology, 2001
Laparoscopic Colon Resection
Source: UPMC Koch Cancer Treatment Center
Laparoscopic Surgery for Liver Cancer
Source: Dr David L Bartlett UPMC Koch Cancer Center
Laparoscopic Surgery for Whipple Procedure, Pancreatic
Source: USC Norris Cancer Center
Laparoscopic Surgery, Gastric and Esophageal Cancers
Source: Dr Charles Filipi, Creighton University
Laparoscopic restoration of the colon continuity after Hartmann procedure
Source: Pub Med 2009
Laparoscopic Management of Ovarian Cyst
Source: Springerlink:2008
Laparoscopic Management of Pseudomyxoma Peritonei
Source: Cleveland Clinic 1999
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