I'm finally rested after two busy days of consults and preop visits for my upcoming node dissection on 1/18. Whew! What a whirlwind, both physically and emotionally.
Overall, the team is ready to go and there are specialists in place for anything foreseeable that might come up, which should allow for a good resection with no hesitation to remove or blast things as needed. This is all barring any extensive disease not seen on the scans when they do the initial scope.
I met with:
(1) Urology, who will be putting in stents to help visualize and protect my ureter during the operation. It will help them see it to avoid damaging it, and will also enable them to move it out of the way if they want to radiate and area. This surgeon (Dr. Pisters.... 😆), will be on standby to repair or remove part of the ureter if needed. And won't be shy about doing it!
(2) Rad onc (radiation oncology), who will be available to blast any areas that the surgeons suspect might have local microscopic mets or any area they can't safely remove that still has a piece of tumor on it. The said it will add up to one hour of operating time but is so focused they can target and area as small as a pencil eraser while moving other organs out of the way!
(3) A vascular surgeon (Huynh), who will be on standby if the tumor is more involved with my artery/major veins than the imaging suggests. One big fear going into these appointments was the ultrasound to check for vascular involvement. Overall, I have very healthy veins and, while the tumor has a "good" supply of blood from some of the smaller vessels, they plan to remove those with the tumor and said that the rest of the vasculature in the area should be able to take over the task, no problem. Should the tumor be move involved than it appears, she will be available to come in and remove and repair it.
(4) a Gynological surgeon (Westin) who will be one of the two primary surgeons removing the node tumor and any other suspicious areas. She will be deciding whether or not to go ahead with a surgery after the initial laparoscopic imaging.
And (5), the melanoma surgeon and very active researcher (Wargo) who will be using part of the tumor for TIL treatment for me down the road (assuming the immune cells replicate) and part for several of her many ongoing research projects. She will also be taking a stool sample that will be put into a mouse to recreate my "biome" as part of a study comparing gut bacteria to immunotherapy response (a new and promising frontier in immune therapy research).
This team is 4/5 female (power to the she!) and was assembled with a LOT of pushing and fighting on the part of my medical oncologist and also myself. It is not how things are typically done but they are all happy to be a part of it!
We are all so hopeful that the scope doesn't reveal widespread pelvic mets not seen on scans - that is the biggest foreseeable hurdle, in my opinion. If they DID, they would try to take some for TIL (laparoscopically) and then radiate the area. BUT, we are hoping the nivolumab has kept doing it's job and that I can heal up and resume this treatment soon after. The surgeons are pulling for holding off for 2-3 weeks on the immunotherapy post surgery but Patel is pushing for one week out (since I'm skipping me pre-surgery dose on the 16th). It sounds like it will depend on how I'm healing. I don't know yet when my next imaging and restaging will be, we will discuss that after we see what happens in the surgery.