Renowned Harvard-trained American cancer surgeon reflects on how he overcomes skepticism. How Dr. Paul Sugarbaker overcomes resistance from peers about his groundbreaking metastatic peritoneal cancer treatment. Dr. Paul Sugarbaker has spent many decades of intense surgical career to develop and refine cancer treatment method. It now bears his name, The Sugarbaker Procedure. How does he find strength to overcome his critics? How leading cancer surgeon overcomes skeptics. Dr. Paul Sugarbaker overcame decades of criticism from other surgeons and oncologies about the results of cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Dr. Paul Sugarbaker, MD. He shares the source of his resilience in the face of adversity. Dr. Anton Titov, MD. Colon cancer, gastric cancer, ovarian cancer spread in the abdomen and peritoneal cavity. Peritoneal metastases in advanced stage 4 colon cancer treatment by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) [hot chemo bath, heated chemotherapy]. Medical second opinion clarifies colon cancer or ovarian cancer diagnosis. Medical second opinion confirms that cure is possible in metastatic colon cancer. Intraperitoneal chemotherapy treatment for advanced stage 4 cancer with metastatic lesions in the abdomen. Dr. Paul Sugarbaker, MD. 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 and regional chemotherapy. Dr. Anton Titov, MD. 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. Best cancer surgery requires leading dedicated surgeons. Dr. Anton Titov, MD. Everyone who develops and promotes a pioneering treatment or a pioneering discovery meets a lot of resistance. It is resistance from peers, from very smart men and women. we know that. A Nobel Prize for discovering H. pylori was given to Australian doctors who were neglected and ridiculed by peers for a long time. Dr. Paul Sugarbaker, MD. There is a saying by Gandhi: "First they ignore you, then they laugh at you, then they fight you, then you win." I have seen that criticism in science when I was doing my PhD studies. My scientific mentor has experienced a lot of criticism until his discoveries were clearly shown to be right. in surgical world you encounter criticism and you have to operate. every time criticism bears down on you. Dr. Anton Titov, MD. How do you overcome criticism? How do power through the critics? How do you keep going? Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. Well, what you say it was very true about this work. [cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)] Early on, when I was younger, there were a lot of criticism. Not at Harvard, not at the National Institute of Health but elsewhere. Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. One professor would evaluate my work as "extensive surgery in patients who will inevitably die of cancer”. Because the general surgeon at that time had never seen a patient survive peritoneal metastases. Dr. Paul Sugarbaker, MD. I guess it was asking a lot of these surgical leaders to believe that we could achieve this kind of success [in peritoneal metastatic cancer treatment by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)]. You just have to have enough faith in yourself and in the concepts that you are developing. That no matter what the criticisms are, you keep moving towards your goal. Of course, the answer to those criticisms is data. Luckily I was in a situation where I was allowed to accumulate reams of data about treatment of peritoneal metastatic cancer. First, we accumulated treatment results about appendiceal cancer (pseudomyxoma peritonei) patients. Patients with appendiceal cancer (appendix cancer) did actually unbelievably well. We then accumulated results of treatment of the peritoneal mesothelioma cancer patients. Dr. Paul Sugarbaker, MD. At this time they virtually all have died. Now we are looking at 60% to 70% log-term survival of patients with peritoneal mesothelioma. The colon cancer metastatic peritoneal cancer work is a little bit more challenging. and we're finding out that we just need to initiate the treatments for colon cancer with peritoneal metastases at a very small extent of metastases. We like to be curing a single peritoneal metastasis from colorectal cancer. then we can have 50% to 70% of those patients survive long-term. Data is what you need to generate. You need to critically evaluate what you are doing. You need to publish your results and publish not only your good results but your bad results too. Dr. Anton Titov, MD. This is a big issue in medicine as we well know. There is a bias of selection that only the good results of successful clinical trials are published. Publishing only good treatment results really prevents a lot of evaluation of new treatments and procedures. Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. Yes. Yes. We are struggling still in some cancer diseases. Surgery by itself is a failure for a large number of gastrointestinal malignancies. Cancer surgery for gastric cancer for the most part is a failure. More than 60% of the patients still die because of local recurrence and peritoneal metastasis after surgical operation for gastric cancer. Gastric cancer surgery is definitely flawed. Surgery for pancreatic cancer is flawed. A majority of patients with pancreatic cancer recur right where the surgeon was working. Dr. Paul Sugarbaker, MD. Pancreatic cancer recurs right at the pancreatectomy site. Pancreatic cancer surgery is extremely flawed and it should be improved. It used to be similar situation with rectal cancer. We had a large number of patients whose rectal cancer recurred locally. Dr. Anton Titov, MD. There are now surgical technologies that have shown us important insights. We don't need to have more than a 5% or so local recurrence for rectal cancer. Cancer surgery has as its first and foremost goal local control of cancer. Cancer surgeon should achieve local control of cancer first by correct operation. Then medical oncologist can achieve great treatment results for cancer patients around the rest of the body. Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. But cancer surgeon might not get local control of cancer. Then the surgeon does not have any opportunity really to help the cancer patient in the long term. Cancer surgery should recognize that it is seriously flawed with some of the diseases. For example, retroperitoneal sarcoma. Most retroperitoneal sarcomas recur. Sarcomas recur despite resection of retroperitoneal sarcoma. Dr. Anton Titov, MD. What I hear in your words is that would keep being focused on the fact. Despite all great achievements of surgical methods. There is so much to improve in cancer surgery treatment. That motivates you to go forward. You get the treatment results data, and you disregard the critics. Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. Dr. Paul Sugarbaker, MD. Yeah, yeah. That is true. People sometimes think "we have done all we can with cancer surgery, and cancer surgery is all going to be done the same method for all patients". But that is not true. There's a huge challenge that goes with being a cancer surgeon. Cancer surgery methods should be improved in the long term. This is our challenge in treating cancer by surgery. Dr. Anton Titov, MD. Most medical breakthroughs first meet skepticism and resistance of peers. How leading cancer surgeon Dr. Paul Sugarbaker overcomes skeptics in work and life?