Sugarbaker Procedure

The Sugarbaker Procedure is an aggressive multi-step surgery for pleural mesothelioma, most commonly referring to extrapleural pneumonectomy (EPP) combined with removal of the diaphragm and the pericardium (the sac around the heart), followed by reconstruction of those structures with surgical mesh. The goal is to remove all visible tumor along with the entire lung on the affected side. It is typically part of a multimodality plan that also includes chemotherapy and sometimes radiation.

Origin

Named for Dr. David J. Sugarbaker (1953–2018), a thoracic surgeon at Brigham and Women's Hospital in Boston, who refined and standardized the trimodality approach to pleural mesothelioma in the 1990s and early 2000s. (He is sometimes confused with his brother, Dr. Paul Sugarbaker, who developed a separate procedure for abdominal cancers.)

Significance in Asbestos Context

For patients with pleural mesothelioma, a cancer almost always linked to asbestos exposure, the Sugarbaker Procedure represents one of the most aggressive surgical options aimed at long-term survival. It is not appropriate for everyone: candidates typically have early-stage epithelioid disease, good lung function, a healthy heart, and the ability to tolerate losing an entire lung. In recent years many specialized centers have shifted toward lung-sparing surgery (pleurectomy/decortication) because outcomes are often comparable with less morbidity, so a recommendation for EPP versus P/D is a major decision worth a second opinion. In legal matters, surgical records describing this procedure are strong documentation of a mesothelioma diagnosis and the seriousness of the disease, and the substantial medical costs and lasting disability are recoverable as damages.

Example Sentence

After her mesothelioma was staged as early epithelioid disease, Maria's thoracic surgeon discussed whether she was a candidate for the Sugarbaker Procedure or a lung-sparing pleurectomy/decortication.

Related Terms

Mesothelioma, Extrapleural Pneumonectomy, Pleurectomy/Decortication, Trimodality Therapy, Epithelioid Mesothelioma, Cytoreductive Surgery

Notes

• Ask your thoracic surgeon directly whether you are a candidate for EPP (Sugarbaker) versus pleurectomy/decortication (P/D), and request the reasoning in writing for your records.
• Seek a second opinion at a high-volume mesothelioma center (for example, Brigham and Women's, MD Anderson, Memorial Sloan Kettering, UCLA, or NCI-designated centers) before consenting. Surgical outcomes depend heavily on the center's experience.
• Preserve all operative reports, pathology reports, and hospital bills; these document both the diagnosis and the scale of damages in any asbestos claim.
• Confirm cell type (epithelioid, biphasic, or sarcomatoid) on biopsy before surgery. Sarcomatoid mesothelioma is generally not treated with EPP.
• Do not confuse this with the Paul Sugarbaker procedure (HIPEC with cytoreduction) used for peritoneal mesothelioma and other abdominal cancers.