Chapter 325 - 220: The Top Knife of Peking Union

Chapter 325: Chapter 220: The Top Knife of Peking Union

At Peking Union Medical College Hospital, a surgical video was playing in a large demonstration room.

The footage showed the moment the abdominal cavity was opened, exposing the surgical field.

Zhong Shouxian was alone, reviewing the procedure, thinking...

In the video, as the chief surgeon explored and attempted to dissect the surrounding tissue, the depths of the surgical field revealed an unusual sight, different from what the radiological images had suggested.

The cancer’s invasion was extensive, having already entangled the superior mesenteric artery.

A suction device continuously aspirated the surgical field, but it could never completely clear the pooled blood from view...

Zhong Shouxian hit the pause button.

He stared quietly at the screen.

’What if, at this step, the surgeon had abandoned the conventional right-to-left dissection and started from the left instead?’

’No, the tumor had already completely enveloped the celiac trunk...’

Zhong Shouxian put down the remote, looking somewhat weary.

He was that chief surgeon.

He was also the top surgeon at Peking Union Medical College Hospital.

Zhong Shouxian, a titan in the field of hepato-pancreato-biliary surgery in China.

He had started working at Peking Union Medical College Hospital back in 1960.

In 1986, he traveled to Harvard University’s Massachusetts General Hospital for advanced studies. After returning to China, he pioneered the country’s first uses of Percutaneous Transhepatic Cholangiography (PTC) and Percutaneous Transhepatic Biliary Drainage (PTBD).

He proposed the standard for the scope of resection in an extended pancreatoduodenectomy (the Whipple procedure) and was the first in China to apply the pylorus-preserving Whipple procedure.

His innovative technique for pancreaticojejunostomy, which involved invaginating the pancreatic stump, reduced the incidence of fatal postoperative pancreatic fistulas to just 2.5%.

In 1985, he achieved the miraculous record of performing 51 consecutive pancreatoduodenectomies with zero mortality.

He co-authored *Pancreatic Surgery* and founded the journal *Hepatobiliary Surgery and Nutrition*.

And in 2006, he single-handedly established the Department of Liver Surgery at Peking Union Medical College Hospital.

In this field, he was both a pioneer and a standard-setter.

But now, as he watched the surgical video on the screen, his expression remained heavy.

—There was a limit to what one person could do.

The door to the demonstration room was pushed open gently.

Xu Wenpei walked in and said softly, "Professor Zhong."

Zhong Shouxian nodded. "Wenpei, come look at this. The scans gave the false impression of resectability, but once we opened him up, the tumor had invaded the superior mesenteric vein and the portal vein."

"Yes," Xu Wenpei said.

He pressed play.

After they finished watching the critical part of the surgery together, they fell silent for a long time.

Zhong Shouxian turned off the video. "Have a seat."

Xu Wenpei pulled out a chair and sat down.

Zhong Shouxian said, "I asked you here today to talk about the idea you mentioned at the last internal seminar: the posterior approach. I’ve been thinking about it a lot lately. The idea is to prioritize dissecting and exploring the superior mesenteric artery by entering from behind the pancreas, all without transecting any digestive organs first. That way, you can confirm if the tumor has invaded the artery. If it has and is unresectable, the surgery can be stopped immediately, avoiding irreversible trauma. If the artery is clear, you can complete the nerve plexus and lymphatic dissection directly from the back, and only then deal with the other organs."

Xu Wenpei replied, "Yes, Professor Zhong. The conventional approach is to go from easy to hard, but the posterior approach goes straight for the most difficult area. It’s a good idea, but it’s also very demanding on the chief surgeon."

Zhong Shouxian nodded slightly. "There are risks, but if it can be done successfully, it could be the only chance of survival for patients with borderline resectable pancreatic head cancer or high cholangiocarcinoma. Take yesterday’s surgery. If we had used the posterior approach to explore the artery from the start, perhaps the patient wouldn’t have bled so much on the table. At the very least, we could have closed them up and taken them off the table stably."

At this, Zhong Shouxian paused, then looked at Xu Wenpei and asked, "You mentioned before that this idea for a posterior approach was proposed by Director Yang Xu from Southern First Affiliated Hospital?"

Xu Wenpei answered immediately, "Yes, Professor Zhong. Director Yang mentioned this concept to me during a private conversation."

"Yang Xu has always been bold, and his clinical intuition is very sharp," Zhong Shouxian commented. "I was thinking of finding a suitable opportunity to discuss this with him in depth. Based on his posterior approach concept, I feel it might offer a breakthrough for some difficult cases in pancreatic surgery. But for now, this is all just theoretical. Many of the specific dissection planes are still uncertain. I’ll have to talk with him again to analyze it further."

As Xu Wenpei listened to Zhong Shouxian, a name suddenly flashed through his mind.

He sat up a little straighter and said, "Professor Zhong, if you want to discuss the specific details of the posterior approach, there might be an opportunity in the next couple of days. Director Yang’s student, Jiang He, just arrived in the Capital City."

"Jiang He?" The name wasn’t entirely unfamiliar to Zhong Shouxian.

He thought for a moment, then asked, "Was that the one connected to the patient we admitted with suspected pancreatic head cancer? The case where an urgent IgG4 test was requested?"

Xu Wenpei nodded. "Yes, that’s him."

Speaking of which, Xu Wenpei took the opportunity to report on the clinical impact. "Ever since that diagnosis proved correct, our general surgery department held a core group meeting. Now, at Peking Union, it’s gradually becoming standard practice to perform an urgent preoperative IgG4 test for patients who present with painless jaundice and are highly suspected of having a pancreatic mass on imaging, but who lack typical signs of malignancy."

Xu Wenpei’s tone was full of emotion. "A while ago, we admitted another patient with a similar condition. The scans looked terrible, and the family was already mentally prepared for a major Whipple procedure. But because of this optimized protocol, we tested his IgG4 levels preoperatively. The indicator was abnormally high, so we put him on hormone therapy instead. In less than two weeks, the mass had shrunk significantly. A single suggestion from that young man saved someone from a massive operation that would have removed half their digestive tract."

Zhong Shouxian’s eyes showed his approval.

A common mistake surgeons make is thinking that no matter the problem, cutting it out is the solution.

In reality, the best outcome is keeping the patient off the operating table altogether.

Zhong Shouxian brought his thoughts back to the present. "How much does this Jiang He know about the posterior approach?"

Xu Wenpei thought for a moment.

’How much does he know?’

’When Director Yang was bragging on the phone, he said that Jiang He was the one who came up with the posterior approach in the first place!’

’Jiang He doesn’t just know about it.’

’He knows it inside and out!’

But right now, the person sitting across from him was Zhong Shouxian.

In front of Professor Zhong, Xu Wenpei didn’t dare oversell it, lest he sound like he was exaggerating.

He chose his words carefully, opting for a conservative reply. "Jiang He... should be very familiar with the posterior approach. He was involved in all the core discussions when Director Yang was developing the concept."

Zhong Shouxian nodded, having made his decision. "Since he’s in the Capital City, let’s arrange a time. We can meet and chat, if he’s willing, of course."

"Of course, Professor Zhong. I’ll arrange it," Xu Wenpei immediately agreed.

With their conversation over, Xu Wenpei left the demonstration room.

The moment he stepped out the door, Xu Wenpei found himself secretly looking forward to it.

’Jiang He knows so much about the posterior approach.’

’When he meets Professor Zhong, is that kid going to pull out all the stops like he always does?’

’My god, a twenty-one-year-old medical student, wildly showing off his technique in front of the ultimate titan of Chinese hepato-pancreato-biliary surgery?’

Xu Wenpei laughed self-deprecatingly.

’I must be losing my mind to be having such a crazy thought.’