I Am Diagnosed as a Medical Titan

Chapter 25: Chapter 25: From Bottom to Top

An improved radical resection for hilar cholangiocarcinoma.

This was the city-level key research project that had Yang Xu completely stumped, the one he had poured the most effort into.

But... the project was too difficult, and he hadn’t made a breakthrough in a long time.

And now a third-year undergraduate student dared to tell him, to his face, that he had progress to report?

”You’ve read my papers?” Yang Xu asked. ”Which one specifically?”

”The one published last month in the Chinese Journal of Surgery, discussing the scope of resection for Klatskin tumors.”

Jiang He said, ”Professor, in your paper, you mentioned that for type III and type IV hilar cholangiocarcinoma, the R0 resection rate with existing surgical methods is extremely low, and the prognosis is exceedingly poor.”

Yang Xu remained silent, waiting for him to continue.

”I’ve reviewed the relevant literature from the past five years,” Jiang He continued. ”Currently, the mainstream approach, both domestically and internationally, for treating high hilar cholangiocarcinoma often involves either not resecting or only partially resecting the caudate lobe. However, I believe that without a total caudate lobectomy, tumor cells can easily remain in the connective tissue surrounding the bile ducts. This is the fundamental reason for the persistently high postoperative recurrence rate.”

A flicker of light appeared in Yang Xu’s eyes.

A total caudate lobectomy.

A department head had brought up this concept in a group meeting before.

But he himself had shot it down.

The reason was simple: the risk was too great.

”The line of thinking is sound. A total resection would indeed increase the R0 resection rate.”

Yang Xu’s tone was no longer as casual as it would be with an ordinary student.

”But, Jiang He, the caudate lobe is pressed right against the inferior vena cava, and the anatomy of the first hepatic hilum is incredibly complex. Without occluding blood flow to the portal vein, how would you handle the dense network of short hepatic veins? The slightest slip would lead to massive hemorrhage, and the patient would die right there on the table.”

”That’s why you can’t dissect from above; you have to approach from below,” Jiang He said without the slightest hesitation. ”By using a bottom-up, retrohepatic dissection method.”

”From the bottom up?”

”Correct,” Jiang He said. ”First, ligate and divide the round ligament of the liver. Dissect the structures within the hepatoduodenal ligament, skeletonizing the main portal vein and hepatic artery. Then, starting from the lower margin of the caudate lobe, ligate and sever the short hepatic veins that drain into the inferior vena cava one by one under direct vision. As long as you avoid occluding the main trunk of the portal vein, you can minimize ischemia-reperfusion injury to the liver. This retrohepatic approach completely exposes the anatomical blind spots of the first hepatic hilum.”

Yang Xu narrowed his eyes.

He mentally ran through the procedure Jiang He had just described.

On the whole, it seemed to be without issue.

’It seems... feasible?’

Yang Xu thought for a moment, then said, ”Follow me.”

He led Jiang He toward the administration building.

The two of them walked down a tree-lined path to the teaching and research office area behind the affiliated hospital’s surgery building.

He pushed open the door to his office.

Inside, a metal filing cabinet against the wall was stuffed with manila folders, and a bulky Dell desktop computer sat on the desk.

”Have a seat.” Yang Xu walked to his desk, casually pulled out a sheet of A4 scrap paper, and handed Jiang He a black felt-tip pen.

”Can you draw out the retrohepatic dissection method you just described?” Yang Xu asked. ”Especially the approach for handling the caudate process and the right short hepatic veins.”

”I can.”

Jiang He uncapped the pen and began to draw as he explained:

”The key is here, the dissection of the caudate process. The conventional method is a median incision, but that provides limited visibility. If we flip the liver up and to the right and approach from the anterior wall of the inferior vena cava, this space here is a natural avascular plane...”

Yang Xu pulled over a chair and leaned forward.

He would interject from time to time, raising extremely sharp questions about potential clinical complications.

”What if you encounter invasion of the right portal vein?”

”Perform a partial resection followed by an end-to-end anastomosis. If the tension is too great, harvest a segment of the patient’s own great saphenous vein for an interposition graft,” Jiang He answered.

”What about tension on the cholangiojejunostomy?”

”Abandon traditional interrupted sutures. Instead, use a continuous suture for the posterior wall and interrupted for the anterior wall, utilizing the tissue elasticity of the anterior wall to compensate for the tension,” Jiang He continued to answer.

The questions and answers flew back and forth, rapid-fire, with no wasted words.

「Twenty minutes later.」

Yang Xu stared at the anatomical sketch on the scrap paper—a drawing so clear it could almost be used as a surgical atlas—and nodded silently.

’Very good.’

’This kid... he really has done his research, and in meticulous detail.’

Moreover, the direction of his research, including his overall approach, unexpectedly aligned perfectly with his own.

How should he put it? It almost felt like he had encountered a kindred spirit...

Yang Xu put down the red pen in his hand, leaned back in his chair, and pulled half a pack of Double Happiness cigarettes from his pocket. He asked, ”Smoke?”

Jiang He shook his head. ”I don’t. You should smoke less, too. It’s bad for your health.”

Yang Xu chuckled, pulled out a cigarette, and stuck it between his lips. He fumbled for a lighter and lit it.

Through the swirling smoke, Yang Xu asked half-jokingly, half-seriously, ”Jiang He, are you really just a third-year undergraduate?”

”Yes, Professor.”

”Talking with you for the past twenty minutes, I almost had a strange delusion,” Yang Xu said. ”I thought the person sitting across from me wasn’t one of my students, but an Attending Physician from the Provincial People’s Hospital.”

Jiang He went along with it, saying, ”Professor, I’d actually like to become an Attending Physician as soon as possible, too.”

Yang Xu nodded and said,

”It’s good to have that ambition, but haste makes waste. You’re very talented, but the road to becoming an attending is a long one.”

”You’re only a third-year now. First, you have to successfully get your bachelor’s degree.”

”Then you have to intern at a hospital and pass the medical licensing exam.”

”After getting licensed, you’ll have to spend several years as a resident, writing case files, changing dressings, holding retractors, and pulling all-nighters in the department every day.”

”Once you’ve put in enough years to qualify, you’ll take the promotion exam for Attending Physician. Those are the country’s strict regulations; no one can bypass them.”

After listening, Jiang He said, ”I’m well aware of all these rules. The Physician’s Law is what it is, and I have no intention of crossing any legal lines.”

Yang Xu asked, ”From the way you’re talking, it sounds like you have an idea?”

”Yes. I want to save lives, and I don’t want to wait ten years to do it...”

Jiang He took a deep breath and said, ”Professor, I want to know... if I want to advance this improved surgical technique to the clinical trial stage as quickly as possible, with me leading the core of the project... is there any workaround within the current system?”

Yang Xu shook his head. ”There’s no workaround. You don’t even have the authority to write a doctor’s order. You’d never get past the hospital’s ethics committee. How could you possibly lead the project?”

”That’s why I need you,” Jiang He said. ”On paper, you’ll be the one heading the project. In the operating room, you’ll be the legal person-in-charge and the chief surgeon. But when it comes to the protocol design, the animal experiments, and even when you’re in the OR, you’ll have to listen to me. I need the position of first assistant.”

With half a cigarette dangling from his lips, Yang Xu was struck speechless.

He had mentored so many arrogant and prideful doctoral students, but he had never met one who dared to make such a demand.

’This kid... just what is his deal?’