For patients with advanced abdominal cancers, a late diagnosis can mean fewer treatment options. The Sugarbaker procedure aims to rid the body of cancerous tumor cells through a combination of surgery and chemotherapy. This unique procedure can help patients with rare conditions, like peritoneal mesothelioma, a type of cancer that forms in the lining of the abdomen.
WebMD Connect to Care spoke with Paul Sugarbaker, MD, FACS, FRCS, director of the Center for Surgical Oncology at Washington Cancer Institute, to discuss the treatment method he pioneered.
WebMD Connect to Care: What is the Sugarbaker procedure?
Dr. Paul Sugarbaker, MD, FACS, FRCS: This is a single surgical procedure to remove tumors in the abdomen, followed by a wash of a chemotherapy solution in order to eliminate the disease. That’s 10 hours for the surgery, the HIPEC [i.e., hyperthermic intraperitoneal chemotherapy, or chemotherapy infusion], and then reconstruction to put pieces of the bowel back.
The diseases that have peritoneal metastases [i.e., cancer spread to tissues of your abdominal wall from other organs] are the ones appropriate for the Sugarbaker procedure. Prior to this procedure, peritoneal metastases were always fatal. Now, we have an approach to gastrointestinal and gynecological malignancies [e.g., stomach cancer or ovarian cancer], including mesothelioma, with tremendous improvement.
WebMD C2C: Can you describe the surgery performed on patients?
Dr. Sugarbaker:Peritoneal mesothelioma is a unique disease. It’s a disease that involves all of the peritoneal surfaces. We actually strip away the peritoneum [i.e., the tissue lining the wall of your abdomen] in the abdomen that’s involved with cancer. Then, you may take out a piece of the stomach, bowel or colon. You wash with chemotherapy and put everything back together.
WebMD C2C: What was the major breakthrough for cancer patients using the Sugarbaker procedure?
Dr. Sugarbaker: First, the success in the treatment of peritoneal metastases, including peritoneal mesothelioma, was the concept of peritonectomy, the surgical removal of the lining of the abdomen. That is the No. 1 surgical innovation. Second, chemotherapy is part of the surgical procedure, and it’s a vigorous chemotherapy washing of the peritoneal surfaces.
WebMD C2C: Can you tell us more about chemotherapy for mesothelioma treatment?
Dr. Sugarbaker: Yes, chemotherapy is used both in the operating room and for six months postoperatively [i.e., after surgery]. Our chemotherapies are recommended to go directly into that peritoneal space, and not into a vein. The chemotherapy is there to prevent the tumor from growing back.
WebMD C2C: How does the Sugarbaker procedure help patients live longer with mesothelioma?
Dr. Sugarbaker: It used to be that surgery for mesothelioma was all palliative [i.e., providing relief from symptoms]. The way we do it now, we select our patients carefully. Our most recent data shows over 70% of patients are 10-year survivors. It’s a huge improvement. It’s important here that we specify these outcomes for peritoneal and not pleural mesothelioma [mesothelioma that affects the lungs], which is a much more virulent [i.e., toxic] type of mesothelioma.
WebMD C2C: How are patients identified as candidates for the Sugarbaker procedure?
Dr. Sugarbaker: The two symptoms that peritoneal patients have are a distended abdomen [i.e., swollen belly] or they have pain, which are nonspecific symptoms, so there is a considerable delay in diagnosis. On average, the delay is about six months. There are now some clearly defined CT scans for peritoneal mesothelioma to make a diagnosis.
WebMD C2C: What does a mesothelioma patient’s life look like after the procedure?
Dr. Sugarbaker: The follow-up for the first three years involves a CT scan every six months, then annually for 10 years. It’s quite demanding. Being a cancer patient is a continuous worry for patients. But quality of life is good, and patients get back to a normal existence.
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