Personal experience with Retroperitoneoscopic pancreatectomy with Dr.Walz in Germany, Ivan, Aug.2016
Re: Personal experience with Retroperitoneoscopic pancreatectomy with Dr.Walz in Germany, Ivan, Aug.2016
Olga, I want to thank you and Ivan for posting this info on pancreatic surgery. We thought Sam was going to have his lesion resected laparoscopically as a minimally invasive procedure per oncologist. However, the surgeon said it could be done laparoscopic but would need to remove spleen too. His lesion is in the tail of the pan but I'm concerned that this treatment is very risky with complications. I'm concerned with dealing with post op issues as we live 4 hours from this hospital but I read where you guys had a similar situation with logistics. Again, thanks for sharing Ivan's story.
Re: Personal experience with Retroperitoneoscopic pancreatectomy with Dr.Walz in Germany, Ivan, Aug.2016
I want to answer the previous comment from jcs2007 and to provide an update on Ivan's pancreatic/spleen status post laparascopic resection in Germany by Dr.Walz.
Ivan just recently had two follow up scans - abdominal MRI and CT with the contrast (both in May 2017).
We have a good news - no tumor recurrence or new metastasis is found on the resection site, pancreas and spleen survived this procedure and are doing fine, but we also have a it of the sad news - one of the vessels connecting the spleen to the blood supplies - the vein that returns the blood into the circulation - did not survive the post-op processes and became thrombotic and consecutively (probably gradually) shut up. The spleen managed to create an alternative veins route so now Ivan has few emergency grown veins in his abdomen running in the places they are not expected to be - around the stomach, along the colon. The radiologist deserves our admiration this time as he went much further than they usually do and described this condition in details alerting us in this rare condition so I started to read and found, that after the distal pancreatectomies with the vessels and spleen preservation about 24 % of the patients eventually loose the splenic vein. To resect the tail of pancreas, the surgeon need to dissect the vein and the artery that run along the elongated body of pancreas toward the spleen at the end of pancreas. They became scarred and often develop thrombosis, sometimes it is a catastrophic event when the emergency abdominal bleeding occurs, probably Ivan also had some as they report of some adjacent area getting smaller from scan to scan, but actually this event passed rather unnoticed by Ivan - probably it was a gradual process of shutting the vein down so the new ones grew. They call them varices and we can expect diff.kind of problems - they grew to fast, sometimes their walls are to thin and they can break down if located close to the stomach/intestines/colon surface so there is some possibility of the bleeding which can be severe. The literature is pretty limited on the subject as the distal pancreatectomies with the vessels/spleen preservation is a relatively rare thing and this condition is more known from the cirrhotic patient cohort, but they have all types of the co-existing conditions and are not healthy people overall. Some doctors think that this group of people with the complications after this surgery is in somehow better prognostic group with rare cases of bleeding - they have better vascular health overall. Stats find only single cases of bleeding in that group, but the number of the patients surveyed is low and I would say not statistically significant.
The bottom line is - Ivan kept the pancreas and spleen but lost this vein and got few strange ones that need to be investigated from the point of trying to find out if any of these may be at risk of bleeding. We have the appt. with the gastroenterologist scheduled for the end of July. Our oncologist could hardly understand what the radiologist and us are talking about, so I am reading on the subject re. what I need to find out - the exact location, diameter and if they are submucosal.
I am not disappointed in Dr.Walz re. loss of vein. The 25% stats of people eventually loosing it are taken from the group of people who had this surgery overall, most of them had it done for benign conditions not cancer or metastasis. He had to virtually lift the vein from the metastasis and scrap the vein and even repair its wall. It had provided the chance for the spleen to survive and to grow the new vein system. I am very glad that he kept the spleen. Sometimes when the vein fails there is a necrosis in the spleen and a big inflammation so they have to remove it, as a post-surgery complication damage control. Feeling sad that we lost the vein but glad we kept the spleen and pancreas.
To comment re. previous post by jcs2007 re. surgeons idea to remove tail of pancreas with the spleen attached to it. It is really hard to perform this type of surgery from the front laparascopically and to keep the spleen as all of it is located in the very back close to the spine sandwiched between the stomach and kidneys and adrenal gland. It is very important and beneficial to keep the spleen as it generates the immune system response cells. People can live without it esp. gown up but for the young ones every attempt has to be done to keep it. The reason we traveled to Dr.Walz was his approach from the back so he got more chance to keep the spleen. There are the surgeons from the US that were educated by him, try find the one that intent to keep the spleen or go to Dr.Walz if possible. Pancreatectomies with the spleen preservation are done now more often, but it needs to be done by the surgeon experienced in this particular area.
Ivan just recently had two follow up scans - abdominal MRI and CT with the contrast (both in May 2017).
We have a good news - no tumor recurrence or new metastasis is found on the resection site, pancreas and spleen survived this procedure and are doing fine, but we also have a it of the sad news - one of the vessels connecting the spleen to the blood supplies - the vein that returns the blood into the circulation - did not survive the post-op processes and became thrombotic and consecutively (probably gradually) shut up. The spleen managed to create an alternative veins route so now Ivan has few emergency grown veins in his abdomen running in the places they are not expected to be - around the stomach, along the colon. The radiologist deserves our admiration this time as he went much further than they usually do and described this condition in details alerting us in this rare condition so I started to read and found, that after the distal pancreatectomies with the vessels and spleen preservation about 24 % of the patients eventually loose the splenic vein. To resect the tail of pancreas, the surgeon need to dissect the vein and the artery that run along the elongated body of pancreas toward the spleen at the end of pancreas. They became scarred and often develop thrombosis, sometimes it is a catastrophic event when the emergency abdominal bleeding occurs, probably Ivan also had some as they report of some adjacent area getting smaller from scan to scan, but actually this event passed rather unnoticed by Ivan - probably it was a gradual process of shutting the vein down so the new ones grew. They call them varices and we can expect diff.kind of problems - they grew to fast, sometimes their walls are to thin and they can break down if located close to the stomach/intestines/colon surface so there is some possibility of the bleeding which can be severe. The literature is pretty limited on the subject as the distal pancreatectomies with the vessels/spleen preservation is a relatively rare thing and this condition is more known from the cirrhotic patient cohort, but they have all types of the co-existing conditions and are not healthy people overall. Some doctors think that this group of people with the complications after this surgery is in somehow better prognostic group with rare cases of bleeding - they have better vascular health overall. Stats find only single cases of bleeding in that group, but the number of the patients surveyed is low and I would say not statistically significant.
The bottom line is - Ivan kept the pancreas and spleen but lost this vein and got few strange ones that need to be investigated from the point of trying to find out if any of these may be at risk of bleeding. We have the appt. with the gastroenterologist scheduled for the end of July. Our oncologist could hardly understand what the radiologist and us are talking about, so I am reading on the subject re. what I need to find out - the exact location, diameter and if they are submucosal.
I am not disappointed in Dr.Walz re. loss of vein. The 25% stats of people eventually loosing it are taken from the group of people who had this surgery overall, most of them had it done for benign conditions not cancer or metastasis. He had to virtually lift the vein from the metastasis and scrap the vein and even repair its wall. It had provided the chance for the spleen to survive and to grow the new vein system. I am very glad that he kept the spleen. Sometimes when the vein fails there is a necrosis in the spleen and a big inflammation so they have to remove it, as a post-surgery complication damage control. Feeling sad that we lost the vein but glad we kept the spleen and pancreas.
To comment re. previous post by jcs2007 re. surgeons idea to remove tail of pancreas with the spleen attached to it. It is really hard to perform this type of surgery from the front laparascopically and to keep the spleen as all of it is located in the very back close to the spine sandwiched between the stomach and kidneys and adrenal gland. It is very important and beneficial to keep the spleen as it generates the immune system response cells. People can live without it esp. gown up but for the young ones every attempt has to be done to keep it. The reason we traveled to Dr.Walz was his approach from the back so he got more chance to keep the spleen. There are the surgeons from the US that were educated by him, try find the one that intent to keep the spleen or go to Dr.Walz if possible. Pancreatectomies with the spleen preservation are done now more often, but it needs to be done by the surgeon experienced in this particular area.
Olga
Re: Personal experience with Retroperitoneoscopic pancreatectomy with Dr.Walz in Germany, Ivan, Aug.2016
Olga, thanks for this very in depth response. I'm sorry that Ivan lost that vein but happy he doesn't have to remove the spleen.I will look into who may do that type of pancreatectomy in the USA since traveling to Germany would not be an option. However, I was wondering how quickly we need to act on this. Unfortunately, I cannot consult Dr. Wilkey until next Tuesday. Thanks again and I want to encourage everyone who is monitoring an area to not forget to do routine ct the abdomen and MRI of the brain since we learned the hard way.