Sugarbaker protocol and pseudomyxoma peritonei of appendiceal origin. He is the general secretary for the peritoneal surface oncology group international psogi. Outcomes of repeat cytoreductive surgery with hyperthermic. Sugarbaker, facs, frcs graduated from cornell university hipec and epic are an essential planned part of. Hyperthermic intraperitoneal chemotherapy and cytoreductive. P h sugarbaker s 282 research works with 15,969 citations and 4,670 reads, including. Hipec may offer patients a variety of benefits, such as extended life expectancy and symptomatic relief. The time for 80% clearance has not been determined. Adverse events experienced as an inpatient are based on the individual resections performed, with additional hipec specific considerations. Surgical technology and pharmacology of hyperthermic. First, basic principles of colorectal pm and the crs and hipec in and further introduced by paul sugarbaker in the early s. C a n gery sugarbaker and glehen cancer surgery os angeles.
He has seen success in using this twopart procedure over. Cytoreductive surgery and hipec for peritoneal carcinomatosis. Sep 18, 2020 the second part of the procedure involves hyperthermic intraperitoneal chemotherapy hipec, which is a process that flushes the abdominal cavity with a warm chemotherapy agent. The application principles of hipec for use in peritoneal disease were also summarized. Jun 03, 2020 hipec sugarbaker pdf hipec sugarbaker pdf dr. The 30 day morbidity after the second crs hipec was 48.
Hipec surgery is also referred to as cytoreductive surgery and debulking. However, when intraperitoneal chemotherapy is administered by repeated cycles of treatment over many months, the free access of the chemotherapy solution to all peritoneal surfaces would be limited by adhesions. Is peritonectomy and hyperthermic intraperitoneal chemotherapy a. Hyperthermic intraperitoneal chemotherapy hipec in conjunction with. Longterm outcomes after cytoreductive surgery and hipec for. Paul sugarbaker washington cancer center, washington d. Hyperthermic intraperitoneal chemotherapy hipec anticancer. Cytoreductive surgery crs and hyperthermic intraperitoneal. Longterm outcomes after cytoreductive surgery and hipec. Modified selection criteria for complete cytoreductive surgery plus.
This is because the surgeon cant remove what he cant see. Hipec can significantly influence overall and disease free survival. Sugarbaker is the medical director for the center for gastrointestinal malignancies at medstar washington hospital center in washington, dc. Dec 11, 2019 as indications for cytoreductive surgery crs and heated intraperitoneal chemotherapy hipec have expanded, so have the number of procedures performed, with their attendant complications. Heated intraperitoneal chemotherapy hipec for patients. Hipec, or hyperthermic intraperitoneal chemotherapy, in conjunction with cytoreductive surgery crs provides specially trained surgeons with the ability to apply concentrated doses of heated chemotherapy directly within and throughout the peritoneal cavity, for the purpose of killing any hidden tumor cells that may not have been removed during crs cytoreductive surgery. Longterm survival is possible using cytoreductive surgery plus hipec for sarcomatosiscase report of 2 patients. The concept of cytoreductive surgery crs and hyperthermic intraperitoneal chemotherapy hipec as first described by sugarbaker et al. This article discusses the technique of peritonectomy and hipec, the evidence for its. The duration of hipec when pegylated liposomal doxorubicin is used is 3 hours. Hipec ensures that most of the cancer is removed or killed. Paul hendrick sugarbaker born november 28, 1941 in baltimore is an american surgeon at the washington cancer institute. Complications of cytoreductive surgery and hipec springerlink. The intraoperative staging of pc from ovarian cancer, as in other forms of psm, relies mainly on pci classification proposed by sugarbaker, although other.
In fact, the operation is sometimes called the sugarbaker procedure. Diagnostics free fulltext hyperthermic intraperitoneal. P h sugarbakers research works washington hospital center. Paul sugarbaker is a leading peritoneal mesothelioma oncologist who perfected and popularized cytoreductive surgery with hipec. The evaluated 5years diseasefree survival for patients with. Combined liver resection and cytoreductive surgery with hipec for metastatic colorectal cancer. Prognostic factors influencing infectious complications. This regimen showed better 3 years disease free survival and 3year overall survival if administered intravenously with radiation pautier et al. Sugarbaker and glehen cancer surgery os angeles calif. The aim of this study was to report postoperative infectious complications and investigate possible correlations with the preoperative nutritional status and other prognostic factors in patients with. Intraoperative hyperthermic intraperitoneal chemotherapy.
Adherence molecules on free cancer cells may aid in. P h sugarbakers research works washington hospital. Median overall os and progression free pfs survival were 63. In multivariate analysis the r status of the second crs hipec p0. Sep 29, 2020 the goal of hipec is to destroy microscopic cells left in the abdomen.
After cytoreduction has been completed, drains and temperature probes are placed, the abdomen closed, and heated d5w solution is circulated until. Regarding the hipec regimen, we used cisplatin 50 mgm 2, doxorubicin 15 mgm 2 and ifosfamide 0 mgm 2 as it has been used safely in our institution. Cytoreductive surgery and hipec seem to be associated with promising results in patients with recurrent ovarian cancer. Peritoneal carcinomatosis index predicts survival in. Heated intraperitoneal chemotherapy hipec for patients with. The multimodal treatment approach for patients with peritoneal carcinomatosis, which had been conceived and developed, consists of what is known as cytoreductive surgery, followed by hyperthermic. Cytoreductive surgery crs and hyperthermic perioperative chemotherapy hipec have evolved over three decades and is now a standard of care for peritoneal metastases from appendiceal epithelial cancers, colorectal cancer and peritoneal mesothelioma 1,2. The survival curve reached a plateau after 7 years. Sugarbaker, facs, frcs graduated from cornell university hipec and epic are an essential planned part of these combined surgical and. The combined treatment of peritoneal carcinomatosis with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is a rigorous surgical treatment, most suitable for young and good performance status patients. Sugarbaker is the son of a cancer surgeon, so perhaps it was inevitable that his path should take him into medicine.
Reputed for its rigidity, versatility, and flexibility, it has been utilized in the common openabdomen hipec treatment or coliseum technique as pioneered by dr. Promising results for hipec in recurrent ovarian cancer have been published 3,4 as a result of continued research efforts. His preferred form of treatment is a highly effective combination of cytoreductive surgery and heated chemotherapy that has been dubbed the sugarbaker procedure. The chemotherapeutic agents generally infused during iphc are mitomycinc and. Secondary outcomes were disease free survival and overall survival. The sugarbaker peritoneal carcinomatosis index pci modified. Hyperthermic intraperitoneal chemotherapy wikipedia. Intraoperative hyperthermic intraperitoneal chemotherapy hipec. The peritoneal cancer index pci jacquet sugarbaker19. Hes the most accomplished peritoneal mesothelioma specialist in the united states, and is responsible for developing the cytoreduction with hipec, a highly successful multimodal therapy for. Hipec cytoreductive surgery was developed in the 1980s by oncologist cancer doctor dr. We evaluated the outcomes of elderly patients undergoing crs and hipec for peritoneal carcinomatosis with careful perioperative care. He is known for developments in surgical oncology of the abdomen, including cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy, or hipec, a treatment alternately referred to as the sugarbaker procedure.
Intraperitoneal doxorubicin achieves access to mesenteric. Hyperthermic intraperitoneal chemotherapy hipec is currently delivered after cytoreductive surgery in patients with several kinds of peritoneal surface malignancies. In our series, the most common grade 12 infectious complications were surgical site infections and central lineassociated. This method is often referred to as the sugarbaker technique, named after the developer and advocate of this procedure. Sugarbaker has pioneered specialty treatment procedures including cytoreductive surgery crs with heated intraoperative intraperitoneal chemotherapy hipec and hyperthermia treatments using the thermotron rf8. Sugarbaker is chief of the peritoneal surface malignancy program and director of the center for gastrointestinal malignancies at the medstar washington hospital center in washington, d.
Dec 18, 2019 hipec sugarbaker pdf posted on december 18, 2019 by admin dr. Large international prospective studies are required to further quantify the true efficacy of hipec and identify the optimal treatment protocol for a maximum survival benefit. May 15, 2019 details of our hipec procedure has been previously described. Cytoreductive surgery with hipec surgery for peritoneal. The last two patients underwent a third crshipec, 25 and 36 months, after the second procedure. Prognostic factors influencing infectious complications after. David sugarbaker, is an internationally recognized thoracic surgeon who specialized in the treatment of mesothelioma. Sugarbaker is a strong critic of surgical tradition, the medical journal future medicine said. Intraperitoneal hyperthermic chemoperfusion hipec or iphc is a type of hyperthermia therapy used in combination with surgery in the treatment of advanced abdominal cancers. Hipec surgery is a procedure to remove peritoneal mesothelioma tumors. Paul sugarbaker top peritoneal mesothelioma surgeon.
Surgical approach including hyperthermic intraperitoneal. Ryancytoreductive surgery plus hipec to treat peritoneal metastases from colorectal cancer. Longterm survival is possible using cytoreductive surgery. Median diseasefree survival and progressionfree survival were 10. From a pool of 100 patients, with a diagnosis of pc who underwent crs and hipec in our center, we have included 30 patients at an age of 70 years or older and the results were compared to the patients younger than 70 years. Current applied cisplatin based hipec regimens are the sugarbaker regimen 49 and. Peritonectomy procedures and hipec for peritoneal metastasis. Drugs, doses, and durations of intraperitoneal chemotherapy. Paul sugarbaker is one of the leading specialists currently treating peritoneal mesothelioma. In this procedure, warmed anticancer medications are infused and circulated in the peritoneal cavity abdomen for a short period of time. Pleura and peritoneum volume 2 issue 2 special issue. Jan 01, 2019 no differences in the pharmacology of open versus closed hipec procedures have been reported. Different methods for delivering hipec have been proposed all of them being. Paul hendrick sugarbaker born november 28, 1941 in baltimore is an american surgeon at.
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