Dr. David Sugarbaker: Mesothelioma Pioneer

Key Facts

• Dr. David Sugarbaker died on August 29, 2018, at age 65
• He pioneered the multimodal treatment approach combining surgery, chemotherapy, and radiation
• He founded the International Mesothelioma Program at Brigham and Women’s Hospital
• Sugarbaker trained over 80 thoracic surgery residents, placing most in academic positions
• His surgical techniques extended survival for thousands of mesothelioma patients

For nearly three decades, mesothelioma patients seeking aggressive surgical treatment were likely to hear one name: David Sugarbaker. The thoracic surgeon, who died six years ago today, transformed a disease that had been considered uniformly fatal into one where some patients could hope for years of additional life.

“He still is the gold standard when it comes to mesothelioma care,” said Dr. Abraham Lebenthal, one of Sugarbaker’s former trainees, after his death. “He is Dr. Mesothelioma.”

That assessment, while perhaps hyperbolic, captures a fundamental truth. Sugarbaker did not cure mesothelioma—no one has. But he proved that aggressive surgical intervention could extend survival far beyond what had been thought possible, and he built the institutions and trained the surgeons who continue this work today.

The Multimodal Revolution

Before Sugarbaker, mesothelioma treatment was largely palliative. Surgeons might drain fluid to relieve symptoms, or perform limited procedures to slow tumor growth. But the prevailing view was that the disease was too diffuse, too aggressive, and too prone to recurrence for surgery to offer meaningful benefit.

Sugarbaker challenged this orthodoxy. Beginning in the late 1980s, he developed a multimodal treatment protocol that combined three aggressive interventions:

Cytoreductive surgery: Complete removal of all visible tumor, including the lung lining, diaphragm, and sometimes the lung itself. Sugarbaker championed the goal of macroscopic complete resection—leaving no visible cancer behind.

Heated intraoperative chemotherapy: During surgery, Sugarbaker pioneered the use of heated chemotherapy drugs delivered directly to the chest cavity. The heat and direct application killed cancer cells that might otherwise seed recurrence.

Radiation therapy: Following surgery, patients received targeted radiation to eliminate microscopic disease that might remain.

This three-pronged approach—surgery, chemotherapy, and radiation—became known as trimodal therapy. It required extraordinary coordination between surgical, medical, and radiation oncology teams. It was physically demanding for patients. And it carried significant risks.

But for carefully selected patients, it worked.

By the Numbers

Sugarbaker was meticulous about tracking outcomes. His published research documented survival improvements that had been unimaginable a generation earlier.

In one influential study of 328 patients who underwent extrapleural pneumonectomy (EPP) with heated chemotherapy, median survival reached 19 months—well above the historical average of 12 months for mesothelioma. More significantly, some patients lived five years or longer, a duration that would have been considered miraculous before aggressive surgical intervention became available.

The results were even better for patients with certain favorable characteristics:

Sugarbaker’s data showed that when patients were carefully selected based on these factors, multimodal therapy could extend median survival beyond two years.

Building Institutions

Sugarbaker understood that advancing mesothelioma treatment required more than individual surgical skill. It required dedicated programs with multidisciplinary expertise, sufficient patient volume to maintain competence, and research infrastructure to test new approaches.

In 1993, he founded the International Mesothelioma Program (IMP) at Brigham and Women’s Hospital in Boston. The program brought together surgeons, oncologists, radiologists, pathologists, and researchers in a coordinated approach to mesothelioma care.

The IMP became a destination for patients from across the country and around the world. Its patient volume provided the data necessary for rigorous outcomes research. Its concentration of expertise allowed refinement of surgical techniques and treatment protocols.

When Sugarbaker moved to Baylor College of Medicine in Houston in 2014, he set about building a similar program. As director of the Lung Institute, he worked to establish Texas as another center of excellence for mesothelioma surgery.

Training the Next Generation

Perhaps Sugarbaker’s most lasting contribution was his commitment to surgical education. In 1992, he developed the first dedicated general thoracic surgery training track in the United States, recognizing that thoracic surgery required specialized preparation beyond general surgical residency.

Over his career, Sugarbaker trained more than 80 thoracic surgery residents. Approximately two-thirds of his graduates went on to academic positions, where they now lead programs and train the next generation of surgeons.

This multiplier effect is difficult to quantify but enormous in impact. When a mesothelioma patient today receives care at a major cancer center, there is a reasonable chance their surgeon was trained by Sugarbaker or by someone Sugarbaker trained.

His teaching philosophy was demanding. Former trainees describe an environment where excellence was expected and mediocrity was not tolerated. Sugarbaker pushed his residents to question accepted practice, to analyze their outcomes rigorously, and to never stop improving.

“He pushed every trainee to the limit,” one former resident recalled, “not allowing them to accept the status quo and to always demand excellence from others and most importantly from themselves.”

The Sugarbaker Family Legacy

David Sugarbaker’s dedication to mesothelioma ran in the family. His brother, Dr. Paul Sugarbaker, became an equally prominent figure in treating peritoneal mesothelioma—the form that affects the abdominal lining rather than the lungs.

Paul Sugarbaker, based at MedStar Washington Hospital Center, pioneered cytoreductive surgery combined with heated intraperitoneal chemotherapy (HIPEC) for peritoneal mesothelioma. His protocols have become standard of care for the disease.

The brothers’ parallel paths created a unique situation: patients with pleural mesothelioma could seek care from David in Boston (and later Houston), while those with peritoneal mesothelioma could consult Paul in Washington. Together, the Sugarbakers shaped treatment approaches for both major forms of the disease.

Controversy and Debate

Sugarbaker’s aggressive approach was not without critics. Some oncologists questioned whether the risks of major surgery—including mortality rates of 3-5% and significant morbidity—were justified by the survival benefits.

The debate centered on a fundamental question: was longer survival worth the physical toll of aggressive multimodal therapy? Sugarbaker believed the answer was clearly yes for appropriate patients. Others argued that less aggressive approaches, including chemotherapy alone or limited surgery, might offer similar survival with better quality of life.

This debate continues today. The surgical approaches Sugarbaker championed remain options for selected patients, but the field has evolved. Newer techniques, including pleurectomy/decortication (which preserves the lung), have gained favor for some patients. Immunotherapy has emerged as an effective non-surgical option.

What is not debated is that Sugarbaker’s work established that aggressive treatment could work. Even surgeons who favor different approaches operate within a framework that Sugarbaker helped create.

A Life Cut Short

David Sugarbaker died on August 29, 2018, at age 65. The cause was undisclosed, though it was known he had been dealing with health issues.

His death came before he could complete his goal of building the Baylor program to match what he had achieved at Brigham. It came during a period of rapid change in mesothelioma treatment, with immunotherapy approval on the horizon. He did not live to see how the field he shaped would continue to evolve.

What Sugarbaker left behind was substantial: a body of research proving surgical intervention could extend survival, institutions dedicated to mesothelioma care and research, a training program that produced dozens of leading surgeons, and thousands of patients who lived longer because of his work.

For mesothelioma patients today, the question is often whether aggressive surgery is appropriate for their specific situation. That this is even a question—that surgery is an option rather than a futile gesture—is largely because David Sugarbaker spent three decades proving it could be.

Continuing the Work

The programs Sugarbaker built continue to operate. The International Mesothelioma Program at Brigham and Women’s remains a leading center for mesothelioma surgery and research. Similar programs exist at major cancer centers nationwide, many led by surgeons Sugarbaker trained.

Research continues to refine patient selection, improve surgical techniques, and integrate new therapies. The multimodal approach Sugarbaker pioneered has evolved but not disappeared. For patients with early-stage disease and good overall health, aggressive surgery remains a cornerstone of treatment.

Six years after his death, mesothelioma remains a challenging disease with limited treatment options. But the landscape is fundamentally different than it was when Sugarbaker began his work. Patients have choices. Some achieve long-term survival. Research continues to advance.

That is David Sugarbaker’s legacy: he showed that mesothelioma could be treated aggressively and successfully, and he built the infrastructure to ensure that work would continue after he was gone.