Despite their differences, Ryan said he respects Sugarbaker, calling him “the quintessential old-time surgeon. He’s a super-nice guy, hardworking. He’s kind to his patients. He’s very straightforward.”
Sugarbaker, who has founded a nonprofit group that funds cancer research and recently published a massive textbook on his technique, says the debate was settled long ago about his procedure’s effectiveness in battling appendiceal cancer that has spread to the abdomen and peritoneal mesothelioma, a rare cancer linked to asbestos exposure. Survival rates for patients suffering from those cancers are 50 percent for at least five years if they undergo his procedure, Sugarbaker said.
The surgeon said he would welcome a randomized study — in which some patients get the treatment while others do not — to prove it is effective in treating colon cancer, which spreads to the abdomen in about 10,000 patients each year.
The problem with setting up such a study, he says, is how to find participants for a truly randomized trial.
“How do you tell someone that you won’t treat them, operate, remove the cancer and then give them [heated chemotherapy], which you believe is their only chance at survival, and they are then certain to die?” he said.
Sugarbaker scrubs his hands in a sink outside of OR 1 and backs through the double doors. “What, where are we?” he asks Bijelic as a nurse puts on his surgical gown and gloves.
Bijelic reiterates what she had told him by telephone: The patient is bleeding at an unacceptable rate. Sugarbaker peers into her abdomen and sees that the normally orangish elixir is bright red from blood.
This is not good; Sugarbaker orders transfusions to make up for the blood loss.
“I think we have to cut this short; we’ll do it for 60 minutes, not the full 90,” he says.
It takes about 10 minutes for the chemo to drain. And after 10 more minutes of searching, Sugarbaker finds the “bleeder” and stitches it shut. Then he fixes four more while excising dozens of small tumors. After about an hour, he and Bijelic are ready to “close” the patient, meaning it’s time to sew her back together. While some surgeons leave this tedious part of the operation to underlings, Sugarbaker says his father taught him a valuable lesson as a youngster: “Cleanup is part of the job.”
By 9:10 p.m., King is being wheeled to intensive care and Sugarbaker is negotiating a warren of hallways to find King’s daughter, Michele; King’s close friend Shandler; and Shandler’s husband in the waiting room. With his surgical mask dangling around his neck, Sugarbaker escorts them to an oblong windowless office and explains that there were not a great many surprises, except for a large amount of tumor in the scar tissue from previous surgery.