In talking with someone, they mentioned the Sugar Baker procedure, and it piqued my interest to the point that I wanted to know more about it. What did it entail? How did it get its name? Why did one do it? Thus, I went to the handy-dandy tool I often use--Google Scholar. I found some helpful articles, but nothing of particular interest. After resigning to the fact that I needed to do a more intensive search, I found a useful article: the treatment of peritoneal mesothelioma using the Sugar Baker procedure. Along with a type of advanced stage colon cancer, these two cancers are the primary indications for the Sugar Baker procedure.
Despite scouring sources for information on peritoneal mesothelioma, I found little to describe this rare cancer's pathogenesis. We have long associated asbestos as the primary cause of mesothelioma, but this applies when it develops in the lungs. To date nobody has developed a concrete pathway for the development of mesothelioma in the peritoneum--the lining of the abdomen. At least a third of patients with peritoneal mesothelioma have no history of asbestos exposure. Without an understanding of how asbestos could get into the peritoneum exclusively, and a detailed social history of all patients to rule out asbestos exposure, the link between asbestos and peritoneal mesothelioma remains merely a working hypothesis.
Nonetheless, as with its pulmonary counterpart, it has a grim outcome. Being rare doesn't help, since most money goes into the research of the more common malignancies. As with all cancers, the only potential cure revolves around the possibility of the removal of all cancer cells. To successfully rid the body of cancer, you must either completely remove or kill all cancer cells; typically done through surgery, radiology, or chemotherapy. Each of these methods has its limitations; not all cancers respond to chemotherapy, some parts of the body can't take radiation, and sometimes surgery just isn't feasible. In the case of peritoneal mesothelioma, surgery is the treatment of choice--the Sugar Baker procedure; only recently did surgeons come to recognize its efficacy.
Named after the physician who first employed it, the Sugar Baker procedure takes a lot of time and will have a heavy impact on the patient's life. Basically, you cut open the abdomen, and remove all visible cancer. Some things cannot be removed, but things that can come out include the colon, the spleen, the gallbladder, the omentum, and the peritoneum...as much as possible in so far as it is possible to remove the cancer. After surgical removal of as much cancer as possible with regard to what must stay, the abdomen is then filled with heated chemotherapeutics, such as cisplatin or doxyrubicin; again, in the hopes of killing any remaining cancer.
A 2010 study investigated the use of the Sugar Baker procedure for periteonal mesothelioma. In looking at 20 patients, it found that in the years following the procedure, only six of the patients survived without disease recurrence. Just over 25%, with further follow-up necessary to track the possibility of future cancer development.
I have heard people debate the use of the Sugar Baker procedure, given its possible outcomes. After all, living without a spleen and a colon does not come without consequence. But then again, it gives the potential of life to someone otherwise destined for death.
Tudor EC, Chua TC, Liauw W, & Morris DL (2010). Risk factors and clinicopathological study of prognostic factors in the peritoneal mesothelioma. The American surgeon, 76 (4), 400-5 PMID: 20420251
