“He’s experienced.” The professor’s praise made Old Chief Physician Pan incredibly happy.
He shielded Zheng Ren from people’s anger but showed humility at the professor’s compliments.
Zheng Ren was like his own son. The boy was very talented and deserving.
“The superselection was well-done,” Professor Pei said a few minutes later, impressed.
The guide wire moved from the hepatic to the branching artery. The path got narrower as Zheng Ren maneuvered deeper into the network of vessels, each branch requiring him to enter a new vessel. The process was extremely difficult.
Manager Feng’s face was tense as he watched the surgery.
This was the first challenge in his field and he had used a lot of resources to bring Professor Pei from Sorcery Capital to ensure the surgery was flawless.
As luck would have it, they had gotten into an accident right outside the hospital gates and now, Professor Pei was not fit to perform surgery.
Although Professor Pei had not suffered any major injuries, Manager Feng expected the surgery to be called off, leaving him to pack his bags and leave Sea City with nothing to show for it.
‘A roaring start that ends with a whimper,’ Manager Feng had thought as he despaired about his career.
An unexpected blessing had come in the form of a young chief resident from the emergency department.
Manager Feng’s worries had been quelled by Professor Pei’s assent to a guided surgery.
Five minutes passed and the superselection was done. The guide wire was maneuvered through the femoral artery and into the 4th-grade vessel that was 1cm away from the tumor.
The guide catheter made its entrance, followed by the guide wire, which was established for the catheter—a thick and flexible tube—to follow its path to the tumor.
Zheng Ren’s technique was delicate, accurate and flawless in execution.
Professor Pei watched the screen, rapt. Although he said nothing, his look of admiration was evident.
He expected this level of performance from himself, but did not expect to find another surgeon with similar skills in this small city. Clearly, there was hidden talent to be uncovered.
When the catheter reached the tumor site, Su Yun switched off the imaging system. He waved to the control room while his other hand held onto the guide wire and catheter.
Xie Yiren took the cue and went through the heavy lead door. It was time for drug administration.
The chemotherapy drugs had to be prepared on the spot as there was the possibility of a prolonged or failed superselection.
Hepatocellular carcinoma was unlike other forms of cancer with first-line and second-line chemotherapy. For many years, surgical excision of the tumor was the only effective treatment.
In the last decade, the rise of interventional radiology-assisted techniques and the development of targeted medicine such as sorafenib gave hepatocellular carcinoma patients a better chance.
Through clinical studies, doctors realized a combination of chemotherapy drugs and the embolization of the artery supplying nutrients to the tumor produced the best results.
Chemotherapy drugs were known as ‘poisons’ as their efficacy lay in their cytotoxicity. During surgery, the drug would be delivered to the tumor before the artery was embolized, effectively steeping the tumor in poison. After the artery was embolized, there would be no more nutrients supplied to the tumor.
It was a successful two-pronged strategy.
Xie Yiren was quick with her hands. The drugs were prepared and loaded into the pressure injector. She gave Zheng Ren an encouraging fist pump before closing the heavy lead door behind her.
After the drugs were administered, Zheng Ren performed the iodized oil embolization of the artery.
Once the process was complete, he started up the imaging system.
This step was akin to the saline rinse of normal surgeries. It allowed the surgeon to check for mistakes.
Professor Pei was in a relaxed mood. Jovially, he said, “I had thought that I would need to step up to perform the superselection, but your subordinate managed it admirably.”
“Oh, you’re being too kind,” Old Chief Physician Pan said with a wide smile.
The image was transmitted to the control room screen.
The smile on Professor Pei’s face froze as it gazed upon it.
Zheng Yunxia had only one tumor, but it was 8cm big. It was half the height of her liver.
In the image, the bottom half of the tumor was not visible, indicating a successful embolization.
However…
The top half of the tumor was still there.
“Tsk…” Professor Pei’s expression darkened.
“Professor Pei, this is…” Old Chief Physician Pan had read up on interventional-radiology assisted surgery earlier, but his 60-year-old brain no longer retained information well. Without any practical knowledge, he could not make out what the situation was.
“The image differs from the CT scans taken prior to the surgery.” Professor Pei walked up to the screen and pointed. “The lower half of the tumor is being sustained by the hepatic artery branch but the upper half must be getting nutrients from another artery.”
“Which artery could it be?” Old Chief Physician Pan asked.
“I’m not sure. It could be any vessel since tumors can stimulate angiogenesis.” Professor Pei shook his head. “The worst case scenario would be a branch from the spinal artery. If that’s the case, the embolization procedure has a high risk of causing paralysis.”
The room was silent.
Everyone but Xie Yiren looked worried. She, however, seemed to have utmost confidence in Zheng Ren’s abilities.
In her opinion, no procedure was out of Zheng Ren’s reach.
“Of course, the difficulty lies in locating the blood vessel that supplies nutrients. You need a little bit of luck for that.” Professor Pei shook his head.
Soon, Zheng Ren appeared in the control room in his surgical scrubs.
“Professor Pei, what do you think?” Zheng Ren asked.
“If you don’t have confidence in it, end the surgery,” Professor Pei said grimly as he looked straight into Zheng Ren’s lead glasses. “Although it will not be a total success, this surgery would inhibit the lower half of the tumor and extend the patient’s life expectancy by three to six months.”
Zheng Ren remained silent.
“The other choice would be to find the artery that supplies blood to the top half of the tumor, but it’s not going to be easy.”
The Chu sisters and Xie Yiren did not want a slipshod surgery. In their few days of knowing Zheng Yunxia, they had all become good friends. They had a personal stake in this, apart from their professional background.
However!
The surgeon would have to endure prolonged radiation exposure.
Although there was protective gear, it was only helpful against short-term exposure. Prolonged exposure to X-rays would make even Iron Man queasy.
A twelve-hour surgery was vastly different from a twelve-hour interventional surgery.
One was exhausting, but the other could lead to the death of the surgeon.
The room was once again silent.
Should they encourage Zheng Ren to try his best?
Should they ask Zheng Ren to forfeit?
They were all caught in a bind.
“Let me try,” Zheng Ren answered with a determined nod.
