Chapter 556: Pre-Surgery Insights: The Two Most Overlooked Cancer Risks

“This is Director Tan Shengli from our Gastroenterology Department!”

Song Qian took the lead in introducing a middle-aged man at the forefront.

“This is Dr. Zhou Can from Tuyu, and this is his surgical nurse, Jiang Wei, a PhD who studied abroad. And this is his colleague, here to observe and learn.”

When introducing the trio, Zhong Ming was mentioned last.

No one bothered to ask for Zhong Ming’s name during the entire exchange.

If it weren’t for Zhou Can’s presence, Zhong Ming might not have even been allowed into the Operating Room.

“I’ve long heard of your reputation, Dr. Zhou. Thank you for your efforts!”

Tan Shengli didn’t shake hands with Zhou Can, instead offering a nod and a polite smile as a greeting.

In the Operating Room, conversations were common, but physical contact was kept to a minimum. In theory, everything above the waist needed to remain sterile. Every pair of gloves, surgical gown, mask, and head cover used in a procedure was paid for by the patient.

Every penny should be spent wisely.

Wasting resources, even if patients or their families might not notice due to lack of understanding, was still frowned upon within the hospital. Of course, the Operating Room had always been the heart of the hospital, and oversight here was relatively lax.

It was rare for leaders from the Medical Department, Quality Control Office, or Administration Office to enter the Operating Room and scrutinize the doctors at work.

After all, making a doctor nervous could lead to a surgical mishap. Who would bear the responsibility for that?

Moreover, the chief surgeons often held significant status, serving as the hospital’s technical backbone. With a few years of experience, many also took on administrative roles within the hospital. No department head was eager to offend them.

At most, after a surgery, staff from infection control might occasionally inspect the Operating Room.

They’d check if infection prevention measures were properly implemented and whether trash was disposed of correctly.

In the Operating Room, medical waste and regular trash had to be separated. Failure to do so could result in reprimands or fines. Some doctors, for convenience, tossed medical waste into black plastic bags meant for regular garbage.

A diligent Circulating Nurse, upon noticing, would often correct the mistake on the spot.

But even she might have moments of oversight.

Especially during emergencies when a patient’s condition turned critical, everyone focused on saving a life. Who had time to worry about such minor details?

“Director Tan, you’re too kind!”

After exchanging pleasantries, Zhou Can’s gaze instinctively shifted to the patient on the operating table.

“And that’s our anesthesiologist, Director Hei.”

“Director Hei, it’s a pleasure to work with you.”

Zhou Can clearly placed more importance on the anesthesiologist, greeting her with notable humility.

During surgery, the surgeon and anesthesiologist needed to work in close coordination, almost like comrades in arms. This person was essentially Zhou Can’s ally in this operation.

Naturally, building a good rapport was essential.

The chief surgeon held a high status in the Operating Room, akin to a team captain, but they couldn’t work alone. Completing a surgery smoothly required at least the anesthesiologist, surgical nurses, and assistants—all working together.

Missing any one of them would be a problem.

This was especially true for slightly more complex procedures like this one.

As the saying goes, even a hero needs a team. It’s not just empty words.

“Looking forward to a successful collaboration!”

Director Hei, a woman in her early forties, wore black-framed glasses and carried a stern demeanor.

When greeting Zhou Can, not a trace of a smile appeared on her face.

Most anesthesiologists tended to be like this.

It wasn’t entirely due to aloofness or arrogance. The unpredictable nature of surgery demanded constant vigilance, keeping them on edge with a perpetually serious expression.

Over time, maintaining a stern face during work became second nature.

“Has the patient already been placed under general anesthesia?”

Zhou Can noticed upon entering that the patient appeared to be in a deep sleep. While speaking with the other doctors, the patient showed no reaction.

“Yes, the patient is fully anesthetized. Vital signs are stable, and we can begin surgery at any time.”

Seeing Zhou Can inquire about the patient, Director Hei provided a detailed response.

“I noticed a surgical incision on the outer side of the patient’s left chest. Was that from the previous surgery?”

Zhou Can had carefully examined the patient’s incision, noting its shape, condition, whether there was swelling or infection, and the quality of the suturing. These details could roughly indicate the skill level of the surgeon who performed the last operation.

However, considering that major surgeries in large hospitals were often performed by multiple doctors, a poorly made incision or rough suturing didn’t necessarily reflect the chief surgeon’s skill.

It could have been an assistant who opened the chest.

As for closing the chest cavity, some capable resident doctors might get the chance to handle that task.

In a major surgery, the number of people allowed at the operating table was very limited.

Many resident doctors could only hope for a chance to observe from the sidelines, which was already a valuable opportunity.

Even in a top-tier laminar flow Operating Room, the number of medical staff allowed inside was strictly controlled to minimize risks.

Unless absolutely necessary, access was tightly restricted.

For instance, in a third-tier surgery, the anesthesiology team was limited to a maximum of three people. Often, it was just one experienced anesthesiologist and a nurse, making a team of two.

Sometimes, they might bring along an apprentice, rounding it out to three.

On the surgical nurse side, there would be one or two instrument nurses and a single Circulating Nurse. The Circulating Nurse acted like the housekeeper of the operation, an indispensable role.

As for the doctors, the setup was more flexible.

Typically, there was only one chief surgeon, though in special cases, there might be two. This happens when two chief surgeons each handle a different part of the procedure. For example, if a patient needed simultaneous abdominal and thoracic surgeries, dual chief surgeons might be assigned.

That said, dual chief surgeons were quite rare.

It usually occurred in life-threatening emergencies where two areas needed surgery at the same time. There was no other choice.

Otherwise, the priority would be to address the life-threatening issue first, postponing less urgent parts of the surgery if possible.

Operating on two areas of a patient’s body at once posed significant harm and multiplied the risks in every aspect.

Only chief surgeons with extensive experience and exceptional skill would dare take on such a challenge.

In reality, it was more common for two teams to take turns performing surgery on a patient.

For example, with a pregnant woman suffering from an aortic dissection, the Obstetrics team might first perform a cesarean to deliver the baby, followed by the Cardiovascular Surgery team stepping in to address the dissection.

Zhou Can’s team was still young and in its early stages of development.

His dream was to build a comprehensive surgical team composed of top-tier specialists from various fields—Cardiac Surgery, Thoracic Surgery, General Surgery, Orthopedics, Anesthesiology, Nutrition and Care, Surgical Nursing, and Post-Operative Care teams.

There was still a long way to go to achieve that vision.

For now, it was just an idea he held close, quietly working toward that goal.

Teams for Cardiac and Thoracic Surgery, for instance, were already in the process of being trained.

Once he grew stronger, he could directly recruit the best Cardiac and Thoracic Surgery teams. The same went for General Surgery.

When that day came, Tuyu would boast the most formidable surgical team in history.

Its surgical prowess could very well become the best in China.

“During the previous surgery to repair the patient’s esophageal rupture, we made the incision on the outer side of the left chest, entering through the fourth intercostal space.”

Tan Shengli, standing nearby, provided the explanation.

It seemed likely that he had overseen the previous surgery.

“The incision is very precise, and the suturing is impeccable. It’s clear that your hospital invested top talent into this procedure, and the chief surgeon paid great attention to detail. I’d wager that without twenty or thirty years of suturing experience, no one could achieve this level of precision.”

Zhou Can subtly praised the other party.

This kind of praise, without naming anyone specific, could be called a blind compliment.

By focusing on the work rather than the person, it avoided any hint of flattery while still making the recipient feel genuinely appreciated.

Zhou Can hadn’t even started the surgery yet, but he was already showering Director Tan with praise. Naturally, he had his reasons.

As a newcomer in an unfamiliar setting, he was treading carefully.

Cleaning up after someone else’s work was tricky. If he could gain the full cooperation of the previous chief surgeon, it would significantly reduce the risks. Details not visible in reports, medical records, or surgical notes could be pointed out in real time.

“You’re too kind! To be honest, I personally handled both the incision and the closure during that surgery.”

Even with a mask on, Director Tan’s eyes crinkled with a smile.

Zhou Can’s praise clearly struck a chord with him.

“So it was you who performed the incision and suturing. No wonder the skill level is so high! Were there any challenges during the patient’s surgery back then?”

Zhou Can seized the opportunity to inquire about the previous procedure.

Since the patient was returning for a second surgery, the original chief surgeon might downplay certain issues to save face.

Yet, those very issues could be the key reason behind the esophageal fistula.

“Speaking of challenges, we did face a few. I remember that after opening the chest, the patient’s thoracic cavity was filled with food residue, including a mix of alcohol and various foods. The smell was quite strong.”

Director Tan strained to recall the details of that day.

“Cleaning out the thoracic cavity took a lot of effort. My assistant and I worked hard to remove all the food debris, then flushed the cavity thoroughly. When suturing the torn esophagus, I noticed it felt much harder than a typical esophagus. Based on experience, a hardened esophagus tends to be brittle, so to prevent a secondary tear, I used a very cautious suturing technique with tight stitches. Yet, despite all that, a fistula still formed on the third day post-surgery.”

Mentioning the post-operative complication, Director Tan seemed visibly frustrated.

More than that, he felt a sense of resignation.

Sometimes, it just worked out that way.

Even when the chief surgeon and medical staff poured their hearts into a procedure with flawless technique and vast experience, and even when post-operative care was handled with utmost caution, complications could still arise.

There was no way to completely avoid such outcomes.

“The information you’ve provided is incredibly valuable. I suspect the esophageal fistula has nothing to do with the quality of the surgery. It’s likely tied to the patient’s own physiology. Was an endoscopic examination of the esophagus performed?”

While reassuring the other party, Zhou Can grew more convinced that the patient’s esophagus had an underlying issue.

Without a thorough investigation, repairing the fistula rashly might lead to a second one forming.

At the very least, based on his clinical experience, he believed they should examine the interior of the esophagus and stomach first.

“At the time, we were in a rush to save the patient’s life, so we didn’t perform that check.”

Director Tan’s gaze flickered as he shook his head.

In truth, with the esophagus already torn, an endoscopic probe wasn’t feasible.

“Well, I see the patient hasn’t had a gastric tube inserted yet. How about I perform a gastroscopy first? Director Hei, would that be alright with you?”

Zhou Can was shrewd. He didn’t bother asking Song Qian or Director Tan for their opinions, instead directing the question straight to the anesthesiologist.

To put it a bit cynically, up to this point, he hadn’t let his guard down regarding the First Hospital.

And it wasn’t just him. Most doctors on external assignments would tread with extra caution.

Especially when taking on the role of chief surgeon, they’d be even more careful.

“That’s fine.”

Director Hei nodded in agreement.

“But be extremely careful during the procedure. The patient’s esophageal wall is likely very fragile and could easily tear.”

Out of responsibility for the patient, she offered a well-meaning reminder.

If she knew the extent of Zhou Can’s endoscopic surgery skills, she might not have said that.

The gastroscope was quickly brought over. Preparations were minimal since everything was mostly ready. Zhou Can carefully maneuvered the endoscopic probe, inching it into the patient’s esophagus.

During this examination, the patient’s head needed to be tilted back as much as possible.

The human throat naturally curves.

Tilting the head back helps align the throat, trachea, and esophagus into a straighter path, making examinations or tube insertions easier.

As the endoscope slowly advanced, Zhou Can kept his eyes glued to the display screen.

The condition of the esophageal lining became clearly visible.

“There are ulcers in the esophagus!”

Zhou Can spotted traces of ulceration and silently suspected this was a major factor behind the fistula.

The human esophagus is much thinner than most people realize.

But it’s also elastic.

When a patient chronically abuses alcohol or regularly consumes heavy, spicy foods, the esophagus gets worn down over time, losing its elasticity and becoming fragile.

This patient’s esophageal condition was among the worst Zhou Can had ever seen.

As the gastroscope delved deeper, the stomach’s condition came into view.

It aligned with the earlier ultrasound and CT results. The stomach’s condition was relatively acceptable.

No particularly severe issues were found.

There were some superficial gastric ulcers, but with medication and a proper post-operative diet, they could be managed and would gradually heal.

If gastric ulcers persist over a long period, they can easily turn cancerous.

This isn’t fearmongering; it’s a risk tied to the unique environment of the stomach.

Similarly, chronic oral ulcers, especially if they repeatedly occur in the same spot and struggle to heal, warrant serious concern. Oral cancer can develop quite easily.

According to a research study and statistical report by an international health organization, patients with long-term unhealed oral ulcers often show signs of compromised immunity.

Such patients are at a higher risk of developing oral cancer.

In China, chewing betel nut is widely recognized as a major trigger for oral cancer due to the fibrosis it causes in the oral cavity.

For many severe cases, by the time cancer is detected, the patient’s mouth can only open to half its normal size.

Stomach cancer, much like oral cancer, is often overlooked.

Occasional stomach pain, bloating, or a burning sensation are symptoms many people simply endure, brushing them off. Little do they know, these could be warning signs of potential cancer.