I enjoyed reading the recent blog written by Dr Eric Liu entitled The Complications of Surgery. In his article, Dr Liu, himself a surgeon, explains that surgery comes with risks and patients should be made aware and able to discuss these risks with their doctors.
This got me thinking about my own experience which goes back to the autumn (fall) of 2010 when I first met my surgeon. At that time, there were a few articles about whether surgery or biochemistry was the best treatment for certain types, grades and stages of Neuroendocrine Tumours (NETs). Another difficult issue for NETs can be the decision to cut or not to cut – as outlined in this article.
NETs are not that much different to other Cancers in this respect – there is always a balance between maximizing QoL and extending life. I was very lucky that I lived on the south central coast of England because the local Neuroendocrine Cancer expertise was (and still is) one of the best in the country. After initial diagnosis, I was followed up with more specialist tests and then offered multimodal treatment including surgery. The risks of surgery were always fully explained to me – in any case I had to sign the consent forms where they were listed! Not sure why but I couldn’t help laughing (probably nervously!) when I noted that ‘death’ was one of the risks. It didn’t put me off and I told him to “get on with it“.
What also caused me to smirk was my surgical labelling as a “young, slim and fit man”. I was then 55 years old, slightly heavier than I thought I should be and although I had been fit for most of my life, I wasn’t that fit at the time of diagnosis. However, my surgeon was clearly doing his own risk assessment and I seemed to tick all the boxes to be able to withstand what was to be a fairly rigorous 9 hours on his table. However, it was clear to me that age, weight/BMI and level of fitness are risk factors for surgery.
I don’t want to get too deep into the moral and ethical dilemmas faced by surgeons but Dr Liu’s very honest blog and my own patient experience, highlights the need, not only for a two-way conversation between surgeon and patient, but also the need for informed consent.
I clearly survived but to be honest, it was a tough period. During my first major operation, some risks were realised resulting in a much longer stay in hospital and some effects are still present today. Many of the risks involved the dissection of desmopasia (fibrosis from NETs) around the aortic area (read more here). The planned 10 day stay was extended to 19 due to a suspected infection (elevated white blood cell count) and a post operative seroma (a pool of ‘liquid’) which was causing some pain. The white blood cell count eventually settled down but for the post operative seroma, I was subjected to a CT guided needle aspiration which was great fun to watch. Fortunately for this short notice and risky procedure, I was in the hands of one of the best Interventional Radiologists in the country. Some six weeks after discharge, a follow-up scan spotted Pulmonary Emboli (blood clots) on one of my lungs and I’ve been on blood thinning treatment ever since. I returned to the same surgeon’s table 4 months later for a liver resection using laparoscopic techniques (keyhole). Again the risks were explained but it was a breeze and I was home after 6 days.
Yes, surgery comes with risks – sometimes they are realised, sometimes they are not. Action planning to counter the common risks if realised is no doubt sensible (and I suspect already part of surgical procedures and training). However, as Dr Liu says, there can be unforeseen circumstances in the course of the operation and recovery.
Almost 8 years on from diagnosis, I’m certain the two major surgeries have played a big part in keeping me alive and as well as can be expected. For me surgery remains the The Gift that keeps on Giving. If you have time, I also published a blog Surgery for NETs – Chop Chop! which contains links to surgeons talking about surgery for Neuroendocrine Cancer. There are also links to some surgical videos – I personally found them fascinating.
Thanks for reading