Preparing for surgery: A detailed talk with Dr Cavallucci
As I prepare for surgery, I’ve been reflecting on how far I’ve come in this journey. My face-to-face consultation with Dr David Cavallucci brought a mix of emotions - a sense of relief in having a clear plan, but also the reality of what lies ahead. We discussed the current state of my tumour, which is in a grey area in terms of size. Although it is low grade, my age means that over the next few years, the chances of it growing, spreading, and causing issues becomes significant. This is why we are considering surgery now.
Initially, we hoped for a less invasive procedure, but after consulting with other specialists, the Whipple procedure is the best option. This surgery is complex, and there are two main considerations: whether it can be done using keyhole surgery and managing the high risk of leakage due to the normal state of my pancreas apart from the tumour. If keyhole surgery becomes too risky, they will switch to an open procedure to ensure my safety.
The surgery involves removing the tumour along with all of my gallbladder, part of the stomach, small intestine, pancreas, and bile duct. The surgery requires my stomach to be reattached to my small intestine, the pancreas and liver. This join is critical and can be risky, but it’s necessary to ensure the best outcome. If everything goes well, I could be out of the hospital in about 10 days, but complications could extend this to three weeks or more.
During the surgery, Dr. Cavallucci will keep my family informed. After the operation, I will spend some time in the ICU, and the duration will depend on my recovery and bed availability in the surgical ward. The first few days post-op are crucial, and the team will closely monitor for any signs of complications such as bleeding or leakage.
Weight and Nutrition: Post-surgery, most people lose 10-15% of their body weight. While some weight might be regained, it’s common not to return to the pre-surgery weight. Supporting the pancreas with digestive enzymes might be necessary if there are issues with the digestive juices, but the likelihood of needing insulin or sugar management is low.
Surgery Details: The surgery involves removing the tumor along with part of the stomach, small intestine, pancreas, and bile duct. The challenging part is reattaching the pancreas to the small intestine and liver. This join is critical and can be risky. If the keyhole surgery is not feasible, an open procedure will be performed to ensure safety.
Post-Op Monitoring: After surgery, I will spend some time in the ICU. The duration depends on my recovery and bed availability in the surgical ward. The first few days post-op are crucial, and the team will closely monitor for any signs of complications such as bleeding or leakage.
Long-Term Outlook: The prognosis and life expectancy to be determined after surgery.
In the long run, I should be able to eat normally, including enjoying a glass of wine or beer once I’ve recovered. The surgery might result in smaller meal portions, similar to weight loss surgeries, but I should be able to enjoy a wide variety of foods.
Hospital Stay Essentials: For my hospital stay, I’ll need to bring pajamas, soap, and other personal items. The admissions pack will provide all the details. To combat boredom, I’ll bring an iPad or laptop, though I won’t be using them much in the first few days.
Aftercare at Home: By the time I go home, I shouldn’t need much apart from some dietician support. If there’s any need for wound or drain care, it will be organized before discharge. I hope to be back on my feet and returning to normalcy without needing any home modifications.
Diet and Nutrition: In the hospital, a dietician will visit me several times and provide a plan for when I go home. They will follow up with phone calls to ensure everything is going well.
Returning to Work: Returning to work is variable and depends on my recovery. Most people take a minimum of 6 weeks, but it can stretch closer to 3 months. It’s important to not rush and allow myself time to recover both physically and mentally. A graduated return to work is also an option if I feel up to it.
Pathology Results: The pathology results from the surgery will take about 2-3 days. These results will help determine the next steps in my treatment and surveillance.
Pain Management: The plan is to reduce pain medication before I go home. Initially, I’ll have intensive pain relief, then transition to tablets, and eventually, minimal pain relief. Most people experience some aches and pains after the first two weeks, but it’s manageable without strong painkillers.
Risk of Recurrence: The likelihood of the cancer returning depends on the pathology results. If the tumor is low grade and primary pancreatic, the risk is low. Surveillance will be crucial in the first 5-10 years, with regular scans to monitor for any changes.
Genetic Testing: Given my lack of family history with similar tumors, genetic testing might not be necessary, but it’s an option to consider.
Pre-Surgery Preparations: I’ll need a CT scan a week or two before the surgery to reassess and ensure nothing has changed. The surgery is scheduled for either February 16th or 23rd, with robotic assistance.
Surgery Details: The surgery will involve removing the tumor along with the gallbladder, part of the stomach, small intestine, pancreas, and bile duct. The challenging part is reattaching the pancreas to the small intestine and liver. This join is critical and can be risky. If the keyhole surgery is not feasible, an open procedure will be performed to ensure safety.
Post-Op Monitoring: After surgery, I will spend some time in the ICU. The duration depends on my recovery and bed availability in the surgical ward. The first few days post-op are crucial, and the team will closely monitor for any signs of complications such as bleeding or leakage.