MSK Doesn't Do HIPEC

March 19, 2026

Memorial Sloan Kettering doesn't do HIPEC. Not for colorectal peritoneal metastases. After PRODIGE 7 was published in 2021, the surgical oncology world had to reckon with an uncomfortable finding: adding oxaliplatin-based HIPEC to CRS showed no survival benefit over CRS alone and was associated with more complications. Many centers continued to offer HIPEC anyway, citing different drug protocols or patient selection criteria. MSK moved toward Cytoreductive Surgery (CRS) combined with EPIC —…

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Seek & Destroy

March 11, 2026

Today is chemo #5, and I'm writing this from the chemo chair — poison pumping into my body like soldiers on a seek-and-destroy mission. Cue Metallica's aforementioned song if you want to enter my headspace. Wow, I sound like a douchebag. My high school self would punch me in the face just for using the word "aforementioned" — let alone using it alongside Metallica. I'm sure Kaiser will do me the honor next time we meet. First word that popped into my head. I'm sticking with it. Before treatment…

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We Don't Accept That Plan

March 7, 2026

The total poison load in my chemo cocktail was reduced last week. The heavy head feeling was better, but the fatigue dragged on longer than ever. I made it to meetings Monday morning, then tapped out and took Monday and Tuesday off. On Wednesday, I was still running on fumes, but I pushed through. In my good week, head clear, I'm back in CEO mode on my cancer journey. I continued researching CRS+HIPEC surgeons, and through a Facebook group — HIPEC Support Group — I found Dr. Armando Sardi at…

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$400,000 Surgery for $10,600?

March 3, 2026

Can a U.S. expat living abroad use ACA insurance to cover a $400,000+ cancer surgery? I'm a 50+ year-old U.S. citizen living in Portugal with a cancer diagnosis that requires CRS+HIPEC surgery — one of the most complex abdominal procedures performed anywhere. At a major academic cancer center in the United States, the uninsured cost runs $200,000–$400,000+. The goal: legally obtain U.S. health insurance through the Affordable Care Act (ACA) Marketplace, cap out-of-pocket costs at $10,600, and…

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Finding the Right Surgeon

March 2, 2026

Where I Am Right NowStage IV colorectal adenocarcinoma. The short version: diagnosed, completed 12 cycles of FOLFOX, recurred in the liver nine months later, reclassified as Stage IV. Now on FOLFIRI — with a measurable response. My latest MRI came back better than expected. The cancer deposits — subcapsular implants on the liver surface and two pelvic implants — have all shrunk significantly. One liver implant went from 28×21mm down to 15×3mm. That is not a rounding error. The chemotherapy is…

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