Advanced Peritoneal Metastases Treatment: Cytoreductive Surgery and HIPEC

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• Sugarbaker Procedure Overview
• Cytoreductive Surgery Technique
• Parietal Peritonectomy Process
• Visceral Resections Explained
• Electrosurgery and Blood Loss
• Medical Second Opinion
• Full Transcript

Sugarbaker Procedure Overview

The Sugarbaker Procedure is a comprehensive treatment for peritoneal metastatic cancer. Dr. Paul Sugarbaker, MD, pioneered this combination of cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). It is designed to treat cancers that have disseminated along the peritoneal cavity lining. This includes advanced colorectal cancer, ovarian cancer, gastric cancer, and appendiceal cancer. The procedure represents a last hope for cure in many stage 4 cancer patients.

Cytoreductive Surgery Technique

Cytoreductive surgery aims to remove all visible tumor deposits from the abdomen. Dr. Paul Sugarbaker, MD, emphasizes meticulous removal of cancer seedings as the key to success. The goal is to achieve a complete cytoreduction, leaving no macroscopic disease behind. This surgical effort creates a clean field for the subsequent heated chemotherapy bath. The procedure transforms an abdomen covered in cancer metastases back to normal anatomy.

Parietal Peritonectomy Process

Parietal peritonectomy is a foundational component of the Sugarbaker Procedure. Dr. Paul Sugarbaker, MD, describes it as a "skinning" of the inside abdominal wall. Surgeons remove only the portions of the parietal peritoneum involved by the malignant process. The parietal peritoneum is a static layer and a common site for cancer seeding. This technique, followed by chemotherapy wash, helps prevent cancer recurrence.

Visceral Resections Explained

Visceral resections involve removing organs or parts of organs affected by cancer. Dr. Paul Sugarbaker, MD, refers to structures like the omentum, spleen, and gallbladder as "abdominal spare parts." Patients typically do not miss these organs after recovery. Common resections include removal of the right colon for appendiceal cancer or the rectosigmoid colon for pelvic disease. The pelvis is a dependent area where cancer cells often accumulate by gravity.

Electrosurgery and Blood Loss

The Sugarbaker Procedure utilizes high-voltage electrosurgery instead of traditional sharp dissection. Dr. Paul Sugarbaker, MD, explains that a ball-tip electrocautery instrument vaporizes cancer cells. This technique creates a small margin of heat necrosis, allowing for a relatively bloodless dissection. Average blood loss is remarkably low at about two units, despite the extensive nature of the surgery. This precise technology is critical for managing the highly vascular peritoneal surface.

Medical Second Opinion

Obtaining a medical second opinion is a critical step for patients with peritoneal metastases. Dr. Anton Titov, MD, highlights that a second opinion can confirm a diagnosis and assess eligibility for curative treatment. It helps ensure that a precision medicine approach is selected for advanced ovarian, colon, or gastric cancer. Consulting with a specialist like Dr. Paul Sugarbaker, MD, can clarify whether the Sugarbaker Procedure is an appropriate option. This step is essential for navigating complex stage 4 cancer treatment decisions.

Full Transcript

Dr. Anton Titov, MD: Renowned Harvard-trained American cancer surgeon Dr. Paul Sugarbaker discusses the metastatic peritoneal cancer treatment method that bears his name: the Sugarbaker Procedure.

The Sugarbaker Procedure consists of cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC), also known as a "hot chemo bath" or heated chemotherapy. The Sugarbaker Procedure is often the last hope of cure for metastatic stage 4 cancers, such as colorectal cancer, ovarian cancer, and gastric cancer that have spread along the peritoneal cavity.

Peritoneal metastatic cancer treatment is explained by its inventor, Dr. Paul Sugarbaker, MD. Colon cancer, gastric cancer, and ovarian cancer spread in the abdomen and peritoneal cavity.

Peritoneal metastases in advanced stage 4 colon cancer are treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC), the hot chemo bath or heated chemotherapy. Meticulous removal of peritoneal cancer seedings is key to cancer treatment success.

Parietal peritonectomy and visceral resection of cancer-involved organs are performed. A medical second opinion clarifies a metastatic peritoneal diagnosis and confirms that cure is possible in metastatic peritoneal cancer.

A medical second opinion helps to select a precision medicine treatment for stage 4 ovarian cancer, stage 4 colon cancer, or metastatic stage 4 gastric cancer. It is important to get a medical second opinion on advanced cancer with peritoneal metastases.

The best peritoneal metastatic advanced cancer treatment is by surgical operation. This video interview is with Dr. Paul Sugarbaker, a leading expert in peritoneal metastatic cancer treatment, including cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC), the hot chemo bath or heated chemotherapy.

Peritoneal metastatic cancer treatment is explained by its inventor.

Dr. Anton Titov, MD: Dr. Sugarbaker, you and your colleagues pioneered and developed over many years the peritoneal cancer treatment procedure of cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). It is used to treat many abdominal cancers: colon cancer, rectal cancer, ovarian cancer, and more rare malignancies such as appendiceal cancer.

Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is used to treat those cancers that have spread along the peritoneal cavity. This procedure is now known around the world as the Sugarbaker procedure.

Dr. Sugarbaker, what is the Sugarbaker procedure?

Dr. Paul Sugarbaker, MD: The Sugarbaker Procedure is a combination of peritonectomy and resection of portions of the bowel. HIPEC is cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy. We call these "visceral resections".

The parietal peritoneum is the peritoneum on the outside of the intra-abdominal peritoneal space. Parietal peritoneum is static; it is not moving. The peritoneum on the viscera is moving all the time because of peristalsis.

This parietal peritoneum is the area that is most involved by the peritoneal metastatic cancer seeding. Usually, the first thing we must do is to remove the large volume of peritoneal metastatic cancer. We perform a parietal peritonectomy procedure.

Parietal peritonectomy is a kind of a skinning of the inside of the abdomen. We do not skin the whole inside of the abdomen; we just take out those portions of the peritoneum that are involved by the peritoneal cancer malignant process. What peritoneum is normal we leave behind.

We will wash the surface after peritonectomy with chemotherapy. This will not allow the cancer to grow.

In cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC), we will perform the peritonectomy procedures. Probably my greatest contribution to cytoreductive surgery is to describe peritonectomy. I formally described the five different peritonectomy procedures.

They are frequently used in cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). We will do the parietal peritonectomy. Then we will do visceral resections.

For example, we may need to remove the right colon because that is where the appendiceal cancer is located. We may need to remove the rectosigmoid colon because the pelvis is a dependent area. Those peritoneal cancer cells will fall down by gravity into the pelvis.

Sometimes the pelvis is an area of a large volume of peritoneal cancer disease. The only method you are going to get rid of peritoneal cancer is to remove the rectosigmoid colon.

The omentum, the spleen, the gallbladder, the surfaces of the liver—all those organ parts can all be removed. I call them abdominal spare parts. The patient won't miss them after they recover from the surgery.

The Sugarbaker Procedure is this combination of resections of the peritoneum. The Sugarbaker procedure uses high-voltage electric surgery to remove peritoneal cancer. Then we use more standard resection techniques.

We use staplers and resection of the mesentery to remove the bowel. By doing the Sugarbaker Procedure, we come up with an abdomen that before the procedure can be just covered with the peritoneal cancer metastases. After we finish cytoreductive surgery, you don't see anything except normal abdominal anatomic structures.

Dr. Anton Titov, MD: You do not use in cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) the typical surgical sharp dissection. You use blunt instruments with electrocautery. You vaporize the cancer cells.

Dr. Paul Sugarbaker, MD: Yes. You can imagine if you are dissecting all the parietal peritoneum. That parietal peritoneum has many blood vessels associated with it. If you use traditional sharp dissection, you are going to have oozing of blood everywhere you work.

The Sugarbaker Procedure is going to result in hemorrhage. The right technology is to use high voltage cutting electrosurgery. Electrosurgery basically gives you a small margin of heat necrosis.

Electrocautery during cytoreductive surgery gives you a free margin of dissection. Thereby you can do these cytoreductive surgery procedures to treat peritoneal cancer relatively bloodlessly.

Sometimes we do cytoreductive surgery, and the average blood loss is just two units of blood. Our blood loss is not five or six or ten units. This is what you might expect from such a lengthy and extensive surgical operation.

Low blood loss during cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is low because surgeons use this high-voltage electro-surgical technique.

Dr. Anton Titov, MD: They use a ball tip at the end of electrocautery. Surgeons do not use a spatula or blade tip.

Peritoneal metastatic cancer treatment is explained by its inventor, Dr. Paul Sugarbaker: cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC).