Leading expert in cytoreductive surgery and HIPEC, Dr. Paul Sugarbaker, MD, explains the rigorous training required to master the Sugarbaker Procedure. He details that a surgeon must observe and participate in over 100 cases before performing the complex operation independently. Dr. Paul Sugarbaker, MD, emphasizes the critical need for a long-term mentorship at a high-volume center. He also names several leading international hospitals for peritoneal cancer treatment. The interview highlights that the surgeon's experience is a key prognostic factor for patient survival.
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Mastering Cytoreductive Surgery and HIPEC: The Surgeon's Learning Curve
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- Sugarbaker Procedure Complexity
- Learning Curve Requirements
- Importance of Mentorship
- Global Centers of Excellence
- Surgeon Impact on Survival
- Full Transcript
Sugarbaker Procedure Complexity
The Sugarbaker Procedure for peritoneal cancer is a lengthy and technically demanding operation. Dr. Paul Sugarbaker, MD, the inventor of cytoreductive surgery and HIPEC, explains that the complexity extends to the entire surgical team. This procedure combines cytoreductive surgery to remove all visible tumors with hyperthermic intraperitoneal chemotherapy (HIPEC) to treat microscopic disease.
It is a primary treatment for peritoneal metastases from colon cancer, ovarian cancer, and gastric cancer. The intricate nature of the surgery requires a highly specialized skill set to achieve optimal outcomes for patients.
Learning Curve Requirements
Mastering cytoreductive surgery and HIPEC requires observing and participating in a minimum of 100 cases. Dr. Paul Sugarbaker, MD, cites studies that define this extensive learning curve for safe and effective treatment. The surgeon-in-training does not need to perform every aspect of each procedure initially.
However, active participation in over a hundred cases is essential before operating independently. This extensive hands-on experience is crucial for developing the proficiency needed to manage the complexities of peritoneal surface malignancy.
The Critical Importance of Mentorship
A long-term mentorship is the cornerstone of learning the Sugarbaker Procedure effectively. Dr. Paul Sugarbaker, MD, stresses that a brief visit to a center is insufficient to gain expertise. Surgeons must find a highly experienced mentor and work with them for a couple of years.
This extended collaboration allows a surgeon to develop advanced skills in removing metastatic cancer from the peritoneum. Dr. Anton Titov, MD, facilitates this discussion, highlighting the journey from novice to expert in peritoneal oncology.
Global Centers of Excellence for HIPEC
Several high-volume centers worldwide have decades of experience in treating thousands of peritoneal cancer cases. Dr. Paul Sugarbaker, MD, names specific leading institutions across Europe. In England, the major centers are in Basingstoke and at The Christie Hospital in Manchester.
In Germany, leading centers are located in Regensburg and Berlin. The Netherlands and Sweden each have five well-established programs. France also has excellent centers for training and treatment, notably in Paris, Lyon, and Marseille.
Surgeon as a Prognostic Factor in Survival
The choice of surgeon and treatment center directly impacts survival outcomes for peritoneal cancer patients. Dr. Paul Sugarbaker, MD, confirms that the surgeon is a very real prognostic factor in peritoneal surface oncology. While the Peritoneal Cancer Index (PCI) is a crucial measure of disease extent, the location of treatment is equally important.
Dr. Anton Titov, MD, discusses this critical point, underscoring why patients must seek care at high-volume, experienced centers. This expertise significantly influences the success of cytoreductive surgery and HIPEC in achieving a potential cure for metastatic disease.
Full Transcript
Dr. Anton Titov, MD: How can one learn the Sugarbaker Procedure to treat peritoneal cancer metastases? Sometimes we have a surgeon who is interested in becoming an expert in cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). The Sugarbaker Procedure is lengthy and technically demanding from both the surgeon and the surgical team.
Dr. Anton Titov, MD: What is the best method to learn the Sugarbaker Procedure to treat peritoneal cancer?
Dr. Paul Sugarbaker, MD: Perhaps the best method to hear about it is from Dr. Sugarbaker! Several medical groups have studied the learning curve for safe and effective cytoreductive surgery with Hyperthermic Intraperitoneal Chemotherapy (HIPEC). The estimates of the learning curve are that over a hundred cases of peritoneal metastatic cancer treatment procedure need to be observed.
Dr. Paul Sugarbaker, MD: The surgeon needs to participate in the procedure, but he does not necessarily need to perform all of the cytoreduction and all peritonectomies himself. The surgeon who wants to learn the Sugarbaker Procedure needs to participate in over a hundred cases before he or she should move out on their own to perform peritoneal metastatic cancer treatment by cytoreduction and Hyperthermic Intraperitoneal Chemotherapy (HIPEC).
Dr. Paul Sugarbaker, MD: Therefore, you need to find a mentor who has considerable experience in peritoneal cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). You need to work with them over a couple of years to become good at removing metastatic cancer from the peritoneum.
Dr. Paul Sugarbaker, MD: Just visiting a Peritoneal Surface Oncology Center for a week or two doesn't make you an expert in treating peritoneal metastatic cancer. You really need an experienced mentor that you can work with on developing your peritoneal cancer removal skills over a couple of years.
Dr. Anton Titov, MD: Are there centers of excellence for peritoneal cancer metastatic disease treatment that you would consider to be high quality? Maybe you can name a few centers for peritoneal metastatic cancer treatment in Europe, the United States, or around the world.
Dr. Paul Sugarbaker, MD: Definitely. There are centers that have twenty years of experience and that have treated thousands of cases of peritoneal metastatic cancer. Just to mention a few peritoneal metastatic cancer treatment centers for cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC): in England, the two centers are Basingstoke and Manchester Christie Hospital. In Germany, the major center is in Regensburg and the Charité hospital in Berlin. In the Netherlands, there are five centers that are quite well geographically distributed. In Sweden, there are five centers for peritoneal metastatic disease treatment. France is well supplied with experienced centers for peritoneal metastatic cancer treatment.
Dr. Paul Sugarbaker, MD: The two centers of excellence that train surgeons in cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) are in Paris and in Lyon, and also in Marseille.
Dr. Anton Titov, MD: There are centers of excellence for peritoneal metastatic cancer treatment outside of your own hospital. Therefore, patients with metastatic peritoneal cancer from colon cancer, ovarian cancer, or gastric cancer can select the most experienced and high-volume treatment center for the successful application of the Sugarbaker Procedure to treat peritoneal cancer metastases.
Dr. Paul Sugarbaker, MD: Definitely, there is a wide range of peritoneal cancer treatment expertise available. Survival of patients with metastatic peritoneal cancer, of course, depends on their PCI, which measures the Peritoneal Cancer Index and the extent of peritoneal cancer disease. That's very important for prognosis.
Dr. Anton Titov, MD: But another very important determinant of survival in metastatic peritoneal cancer from colon cancer, gastric cancer, or ovarian cancer is where the treatment procedure is done.
Dr. Anton Titov, MD: The surgeon as the prognostic factor in cancer treatment?
Dr. Paul Sugarbaker, MD: Absolutely. It is very real in peritoneal surface oncology, the treatment of metastatic cancer spread in the peritoneal space by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC).