Renowned Harvard-trained American cancer surgeon Dr. Paul Sugarbaker discusses metastatic peritoneal cancer treatment method that bears his name. The Sugarbaker Procedure. Sugarbaker Procedure consists of cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC), also known as “hot chemo bath” or heated chemotherapy. Sugarbaker Procedure is often last hope of cure for metastatic stage 4 cancers. It is colorectal cancer, ovarian cancer, gastric cancer. Cancers spread along the peritoneal cavity. Peritoneal metastatic cancer treatment explained by its inventor. Dr. Anton Titov, MD. Colon cancer, gastric cancer, ovarian cancer spread in the abdomen and peritoneal cavity. Dr. Paul Sugarbaker, MD. Peritoneal metastases in advanced stage 4 colon cancer treatment by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC), hot chemo bath, heated chemotherapy. Meticulous removal of peritoneal cancer seedings is key to cancer treatment success. Dr. Paul Sugarbaker, MD. Parietal peritonectomy. Visceral resection of cancer-involved organs. Medical second opinion clarifies metastatic peritoneal diagnosis. Dr. Anton Titov, MD. Medical second opinion confirms that cure is possible in metastatic peritoneal cancer. Medical second opinion helps to select a precision medicine treatment for stage 4 ovarian cancer or stage 4 colon cancer or metastatic stage 4 gastric cancer. Get medical second opinion on advanced cancer with peritoneal metastases. Best peritoneal metastatic advanced cancer treatment by surgical operation. Video interview with Dr. Paul Sugarbaker. Leading expert in peritoneal metastatic cancer treatment (cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC), hot chemo bath, heated chemotherapy. Peritoneal metastatic cancer treatment 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). Dr. Paul Sugarbaker, MD. It is used to treat many abdominal cancers: colon cancer, rectal cancer, ovarian cancer, and more rare malignancies such as appendiceal cancer. Dr. Anton Titov, MD. 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. Renowned Gastrointestinal Cancer Surgeon. 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. Dr. Paul Sugarbaker, MD. This parietal peritoneum is the area this 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 inside of the abdomen. We do not skin the whole inside of the abdomen. We 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 the chemotherapy. Dr. Paul Sugarbaker, MD. 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. Dr. Paul Sugarbaker, MD. 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 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. Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. 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. Patient won't miss them after they recover from the surgery. Sugarbaker Procedure is this combination of resections of the peritoneum. Sugarbaker procedure uses the high-voltage electric surgery to remove peritoneal cancer. Dr. Paul Sugarbaker, MD. Then we use more standard resection techniques. We use staplers and resection of the mesentery to remove the bowel. By doing 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. Dr. Anton Titov, MD. You use blunt instruments with electrocautery. You vaporize the cancer cells. Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. 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. Dr. Paul Sugarbaker, MD. Electrosurgery basically gives you a small margin of heat necrosis. Electrocautery during cytoreductive surgery gives you free margin of dissection. Thereby you can do these cytoreductive surgery procedures to treat peritoneal cancer relatively bloodlessly. Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. Sometimes we do cytoreductive surgery. Then 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 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 spatula or blade tip. Peritoneal metastatic cancer treatment explained by its inventor, Dr. Paul Sugarbaker. Cytoreductive surgery Hyperthermic Intraperitoneal Chemotherapy HIPEC.