Surgical Oncology: Day 6

I came into the hospital today and did pre-rounds from 6a-830a, and I am working tonight 6p-6a (on call). So I packed my toothbrush and things, expecting to be in from 6a-6a...Much to my surprise, my chief resident told me I could go home at 8:30! Suddenly I had something like a day off (well only 9.5 hours, but that's a lot of time away from the hospital after a full, already 70 hour, week!). So Mike & I went car shopping (more like car browsing), then we came home and I took a short nap and studied while Mike watched the Liverpool game and then went to play a footy game with some of his mates. I could really use more days like this!haha :)

The Whipple Procedure which I spoke about previously was the first case I scrubbed in on in this rotation. It is done to treat pancreatic cancer. The 12+ hour surgery entails removing the antrum of the stomach, the 1st/2nd parts of the duodenum + proximal jejunum & associated lymph nodes, removing the head of the pancreas (or more if the cancer is in the body or approaching the tail - if you remove the whole thing you must also remove the spleen, as its blood supply runs thru the pancreatic tail), removing the common bile duct and the gallbladder. So it is a fairly extensive surgery. It is also a fairly rare surgery; its indications for use include localized/non-metastasized pancreatic cancer, and rarely for palliative care for pancreatic cancer patients. The reason it is so rare is not because pancreatic cancer is rare, but because pancreatic cancer often grows unnoticed until it is too far along to treat. This helps explain why pancreatic cancer, although it is only the tenth most common cancer, it is ranked as the fourth leading cause of cancer deaths. In lucky patients, there are noticeable signs/symptoms if the cancer is at the pancreatic head, which obstructs the common bile duct, and leads to "painless jaundice" - a yellow color to the skin and sclera without any pain around the liver. In such patients, we may be able catch the cancer before it has had a chance to spread, and we opt to perform a whipple procedure to try and cure the patient. I know of one lucky man that survived pancreatic cancer for many years thanks to a successful Whipple (a patient at the nursing home where I used to work). After removing the antrum of the stomach, a portion of the duodenum and jejunum, and part of the pancreas, we found a hard nodule behind the portal vein as well as behind the superior mesenteric vein, which we presumed to be cancerous and completely unresectable. So about 7 hours into the procedure, we realized that this procedure will more than likely prove to be unsuccessful, and the patient's prognosis is very poor...If those nodules were in fact mets from the pancreatic cancer, the average patient can expect a 3-6 month survival. When we realized that the procedure was not to be a success, I really didn't want to be in the OR anymore. It felt like such a failure...but I can try to be optimistic and think that the nodules might have been scar tissue from radiation, not a met, in which case she will have been cured from the disease. Only time will tell...


On a brighter note, I thought I would share some photos of our Saturday River Time from last week! We went with 4 of our friends, and had another really great time out on the water. I just love summer time!!! :)

Me on the Water

 Mike loves to fish

...and he caught some seaweed...twice! ;)

 

I suppose its time to get back to the hospital - I have lives to save, you know!!! (or more like foley catheters to put in, IVs to place, and H&Ps to perform...). Hope everyone is having a great weekend :) :) :)