The resection surgery
We met with surgeons from both Columbia and MSK. I picked the one from MSK.
Dr. Lee described the surgery, using my pre-chemo MRI images to help explain. In removing the tumor, he would take up to 3cm of healthy nerve on both ends of the tumor (this means that a total of 13cm of the tibial nerve would be removed). He would remove a bit of 1 or 2 hamstring muscles. He would be able to leave the peroneal nerve, even though it is adjacent to the tumor. Because of the location of the tumor with respect to the blood vessels, the envelope of the vessels would be taken out with the tumor. This wouldn't leave a large enough margin, so I would need radiation (6 weeks ?) to sterilize the area. The new incision would encircle the entire biopsy incision (the biopsy incision and a margin would be removed to make sure that there are no cancer cells left in the local area); this would involve 2 inches x 7 inches of skin.
If Dr. Lee performs my surgery, he will have 2 residents assisting him. The surgery would last approximately 4 hours. I will have a drain for 3-5 days. I would probably have to stay in the hospital for 7-10 days.
Recovery: I will have some leg swelling (which might last up to a year), but should be walking in 3-4 days. (The swelling can be helped by elevating the foot and doing foot pumping exercises.) I would probably be on crutches for 2-4 weeks, and using a cane for a few weeks after.
Radiation would start 10 days to 2 weeks after surgery. Chemo could resume 2-3 weeks after surgery.
Dr. Lee discussed how it might be possible to save the tibial nerve if it is flattened on the tumor, and not involved in the tumor. (It is my understanding from the neurosurgeon who did the biopsy that the tumor is in the tibial nerve.)
Dr. Lee is not supportive of a nerve graft being done at the time of the resection. When it is done, it would be done with a piece of the sural nerve (which is located in the calf). The radiation might affect the ability of the nerve graft to take. He stated that I should be able to walk fine with an ankle brace; he called the brace an AFO.
He suggested that I meet with Dr. Peter Schiff (a radiation oncologist) before the resection.
He wanted a PET scan performed; it might be able to tell if the tumor is mostly dead before the surgery. (Dr. Keohan disagrees; she has seen obviously growing tumors come back PET negative.)
We met with Dr. Brennan on July 12. The description that he gave of the surgery was the same as Dr. Lee with a few exceptions, e.g., I would probably have to stay in the hospital for 5-7 days. Due to his experience removing soft-tissue sarcomas, we choose him to perform the surgery.
I spoke with Dr. Keohan, my oncologist, on July 3. I learned the following:
I spoke with Dr. McKhann, the neurosurgeon who did my biopsy, on July 3. I learned:
Some radiation pointers:
Some relevant papers:
Copyright © 2003 The Shriver Family: Last modified: 01/06/04.