General Surgery Center

‍National key clinical specialty

Laparoscope training base of the Ministry of Health

Shanghai Organ Transplantation Center

Shanghai Liver Transplantation Quality Control Center

The General Surgery Center was found by Professor Ren Tinggui (1894-1966, health technology class 1, grade I), a well-known domestic surgical specialist, in 1952. With the efforts of several academic leaders including Ren Tinggui, Li Baohua and Peng Zhihai for 60 years, the General Surgery now has become a national key clinical specialty and "211" phase III project to be constructed. Shanghai Organ Transplantation Center, Shanghai Liver Transplantation Quality Control Center, Pancreatic Cancer Diagnosis and Treatment Center of Shanghai Jiao Tong University and Laparoscope and Endoscopic Diagnosis and Treatment Technology Training Base of the Ministry of Health are affiliated to it. At present, the General Surgery Center has five inpatient areas and 243 beds at the Northern and Southern Branch. There are the Department of Hepato-Pancreato-Biliary Surgery, Department of Gastrointestinal Surgery and Department of Breast and Thyroid Surgery. The Center has an independent research office. There are 57 regular doctors, 3 technicians, 17 persons with senior professional title, 42 doctors, 8 persons with overseas study experience, 6 doctoral supervisors and 10 master's supervisors. In recent years, its annual outpatient and emergency visits and yearly average operation reach over 73,000 and 5,800, respectively. The clinical specialty is featured by large abdominal organs transplantation and digestive system tumor. Over the past 60 years, the Center created many firsts: the first case of enterocoelia cooling to prolong hepatic portal occlusion time and perform hepatic resection nationwide in 1958; the first case of portal vein and intestinal tract drainage type pancreas-kidney transplantation nationwide; emergency active secondary liver transplantation operation with incompatible blood type; the first pancreas-kidney transplantation and intestinal tract drainage type pancreas-kidney transplantation of Shanghai.

For the past few years, the General Surgery Center undertook and completed more than 30 national level and Shanghai municipal level topics including the National "11th Five-Year" science and Technology Support Plan, International Key Cooperative Project of Natural Science Fund, National Key "863" Strategic Project, Special Fund for Public Good of the Ministry of Health, Shanghai Clinical Crude Drug and Key Basic Research Project of Shanghai Science and Technology Commission and "Innovative Action Plan" Project of Shanghai Science and Technology Commission. It was granted scientific and research funds over RMB 33 million in total. It won 10 National Natural Science Funds in 2011 alone. In 2012, it won seven National Natural Science Funds, one of which is a major research project of international cooperation. More than 400 papers containing relevant research result were published on the overseas and domestic renowned magazines such as Hepatiology, Clinical Cancer Research, Cancer Research, Mol Cancer, J Am Pathology and J Infection and 151 on SCI. Its impact factor is 380.265. The Studies and Clinical Application Verified by Colon Cancer Related Gene Screening and Basis and Clinical Research of Biliary Complication After Liver Transplantation and Perioperative Treatment won the First Prize for Science and Technology Advancement of Colleges and Universities of the Ministry of Health. The Discovery of Colon Cancer Progress Related Molecule Group and Construction and Application of Biological Integration Detection Platform and Clinical Study on Liver Transplantation and Portal Vein and Intestinal Tract Drainage Type Pancreas-Kidney Transplantation won the First Prize for Shanghai Science and Technology Advancement. It has two patents and has declared three invention patents.

‍‍Subspecialties‍‍

The first Director of the General Surgery Center is Professor Ren Tinggui. Under the leadership of Professor Ren Tinggui, the Department cultivated a batch of academic successors and medical backbones who make great contributions to the development of the General Surgery Center of our hospital. In 1958, Professor Li Baohua firstly conducted the animal experiment study on enterocoelia cooling to prolong hepatic portal occlusion time and perform hepatic resection and clinically applied it. This study won the certificate of merit and medal issued by the Ministry of Health. The experiment and clinical application of ligaturing splenic artery to treat splenic trauma were conducted here in the 70s. Professor Li Baohua first proposed to treat severe pancreatitis with non-surgical treatment method through animal experiment and clinical study in China. It was clinically applied and lowered the death rate of such disease to less than 10%. In the late 1990s, under the leadership of Professor Peng Zhihai, an academic leader, all departments of the General Surgery Center have gained good achievement and cultivated a batch of middle-aged and young academic backbones such as Qiu Zhengjun of the Department of Gastrointestinal Surgery and Xia Qiang for liver transplantation who have become domestic well-known experts, Zhong Lin and Sun Xincheng returning home after study abroad through the talent plan who have become young members of national organ transplantation or national surgery society.

At present, the General Surgery Center includes the Department of Hepato-Pancreato-Biliary Surgery, Department of Gastrointestinal Surgery, Department of Breast and Thyroid Surgery and Surgery Intensive Care Unit.

The Subspecialty of Hepato-Pancreato-Biliary is composed of 15 persons led by Doctoral Supervisor Peng Zhihai and Zhong Lin. There are three doctoral supervisors. Those with doctorate and those with overseas study experience account for 90% and 60%, respectively. In particular, one person is included into the talent plan of the Ministry of Personnel and the Ministry of Education and two persons are leading talents of Shanghai Municipality. Professor Peng Zhihai is the Member of Chinese Organ Transplantation Society and Deputy Chief of Liver Transplantation Group, Chairman of Shanghai Organ Transplantation Society, FACS, Director of Shanghai Liver Transplantation Quality Control Center; Professor Zhong Lin is the Young Member of Chinese Organ Transplantation Society and Member of Pancreas and Small Intestine Transplantation Group and Member of the Transplantation Basis Research Group of National Organ Transplantation Society.

The Gastrointestinal Subspecialty comprises 17 persons under the leadership of Professor Qiu Zhengjun and Li Jikun, including two Doctoral Supervisors, seven senior professional titles and 60% doctors. That selected into Shanghai Rising-Star Program, Rising-Star Follow-Up, Pujiang Talent and Excellent Leaders in Health System Plan is one person each. Professor Qiu Zhengjun is the Member of Surgical Operation Group of Surgery Branch of Chinese Medical Association and Member of Shanghai Surgery Association.

The Subspecialty of Breast and Thyroid comprises 19 persons under the leadership of Professor Li Ke and Professor Xu Junming, including one doctoral supervisor and seven senior professional titles. All of them are postgraduates. Professor Ki Le is the Member of the Sixth and Seventh Specialized General Surgery Committee of Shanghai Medical Association, Member of the Specialized Breast Cancer Committee of Shanghai Anti-Cancer Association and Vice Chairman of Multidisciplinary Tumor Treatment Committee of Shanghai Municipal Center for Disease Control & Prevention.

Department of Hepato-Biliary-Pancreatic-Splenic Surgery

The primary clinical work includes general liver surgical operation, liver transplantation, living donor liver transplantation, multiple organs transplantation, pancreas, spleen, biliary tract and other complicated operations. Professor Li Baohua took the lead in performing hepatectomy in China in the 1960s. In recent years, it conducted complicated surgeries for liver, gallbladder and pancreas in the liver transplantation era under the leadership of Professor Peng Zhihai so that the Department reached a new level. It has performed more than 200 cases of accurate hepatectomy which needs meticulous liver dissection including hepatic trisectionectomy, middle lobe tumor resection for the affected hepatic vein and giant caudate lobectomy. According to the statistics, in recent decade, the success rate of operation is above 98%, the death rate in perioperative period is lower than 1% and the occurrence rate of complications is less than 5%. It has established the liver cancer treatment system integrating liver downstaging therapy-hepatectomy-salvage liver transplantation- and clinical specification and clinical specification. The pancreatic tumor surgery includes pancreas duodenum removal with annual operation quantity over 100 cases. The anastomotic method depends on the size of the residual pancreas and diameter of the pancreatic duct: nested end-end pancreaticojejunostomy, end side pancreaticojejunostomy and pure pancreatic duct anastomosis, making the pancreatic leakage rate after operation 1%. The hilar cholangiocarcinoma resection rate is low and the technical requirement is high. By combining hepatic artery resection, reconstruction after resection and semi-hepatectomy, the Bismuth Ⅳ type high bile duct carcinoma resection rate reaches to 50%, Ro resection rate exceeds 30% and the survival rate for one year increases by 20%.

Liver transplantation: Since Jan. 2001, the Department has completed 910 cases of various liver transplantation operations including 24 liver-kidney transplantations (first nationwide) and 26 secondary transplantations (first in Shanghai). It internationally advised to rescue the patient with fulminant liver failure by the active secondary liver transplantation with incompatible blood type for the first time. In 2001, the Department performed the first liver-kidney transplantation of Shanghai. Up to now, it has completed 24 liver-kidney transplantations with a survival rate of 85.71% for 10 years. In 2002, it conducted the first reduced-sized classic orthotopic liver transplantation and emergency liver transplantation of Shanghai. In 2003, it carried out a living donor liver transplantation for a child. The transplanted liver functions well according to the follow-up visit till now. In 2004, it successfully conducted the reduced-sized liver transplantation for the youngest child of Shanghai. In 2004, it successfully performed an emergency liver transplantation operation with incompatible blood type to cure emergency hepatic failure for the first time in China. Up to now, it has completed ten cases in total, of which, four active continuous twice transplantations with incompatible blood type were internationally reported for the first time. In 2005, it conducted the first cavoportal hemitransposition liver transplantation of Shanghai and achieved a complete success. It completed 55 completed surgeries for abnormal blood vessel of hepatic artery or portal vein embolization of the receptor, including 24 liver transplantations with abdominal aorta bypass and 12 liver transplantations with upper venous bypass of mesentery for the receptor, which all achieved a complete success. In 2007, it successfully transplant liver for living donor to treat the giant hemangioma with the largest diameter and heaviest in weight as reported by the literature. The patient still alive and healthy according to the follow-up visit. The survival rates of benign end-stage liver disease following liver transplantation for 1, 3, 5 and 10 year(s) are 91.9%, 89.4%, 75.2% and 60.1%, respectively; that of the liver cancer in line with Milan classification for 1, 3, 5 and 10 year(s) are 88.3%, 70.1%, 65.4% and 54.8%, respectively. All indexes reach the report level of UNOS of the US and ELTR of Europe. The occurrence rate of the complications of bile duct after liver transplantation is just 4.6% and the infectious and death rate 7.2%, which are significantly lower than the report of ELTR and UNOS. The above achievement won the First Prize for Shanghai Science and Technology Advancement in 2007 and the First Prize for Science and Technology Advancement of the Ministry of Education in 2008. Because of the great work in liver transplantation, Shanghai Liver Transplantation Quality Control Center is attached to it.

Pancreas transplantation: It successfully completed the first case of portal vein and intestinal tract drainage type pancreas-kidney transplantation of Shanghai in 2002 and the first case of portal vein and intestinal tract drainage type pancreas-kidney transplantation across the nation in 2003. So far, totally seven cases of difficult pancreas-kidney transplantation have been completed. Four of them are completely physiological portal vein and intestinal tract drainage type pancreas-kidney transplantation, after accepting which the patient can survive for a long time without taking insulin.

At the beginning of the 1990s, Professor Hua Tianfang performed the cholecystectomy with laparoscope. At the end of the 1990s, ERCP, EST and ENBD were performed. As the laparoscopic technology improves, it expands the items and scope of laparoscopic surgery. In 2003, Qiu Zhengjun conducted an operation of biliary tract with both laparoscope and choledochoscope, later further performed biliary tract detection under laparoscope and phase I common bile duct suture. It performed pancreatic tail resection and spleen resection procedures under laparoscope in 2007 and transumbilical single-hole cholecystectomy with laparoscop in 2009. Xu Junming and Zhong Lin carried out liver resection and hemangioma resection under laparoscope successively in 2010. At present, more than 1000 operations of biliary tract with laparoscope are completed each year.

Department of Gastrointestinal Surgery

The Department of Gastrointestinal Surgery combines NCCN guidance and Japanese gastric cancer treatment specification. Director Li Jikun prepared the diagnosis and treatment specification for gastric cancer and colorectal cancer, established a set of standard procedures of multiple discipline for comprehensive treatment of malignant gastrointestinal tumor. It performed radical operation for expansive gastric carcinoma, expansive colorectal cancer and skeletonization dissection, forming a characteristic surgical process and management mode. Professor Qiu Zhengjun chaired to conduct the radical operation for colorectal cancer with laparoscope in 2002 and radical operation for gastric carcinoma with laparoscope to treat early gastric cancer in 2004. In 2009, it performed transumbilical single-hole sigmoid colectomy with laparoscope. In recent years, the Department has conducted D2 radical operation for gastric cancer under laparoscope, total mesentery excision (CME) for colon cancer under laparoscope, total mesorectal excision (TME) and ultralow anus preserving surgery for colon cancer, which achieves good effect. Recently, over 70% of the patients with colon cancer accept radical operation of colorectal cancer with laparoscope each year. More than 300 radical gastric carcinoma surgeries and about 800 colorectal cancer operations are completed per year. A multidisciplinary discussion system was established. The treatment plan is formulated based on the stages before operation. The anus preserving rate increases by applying new adjuvant chemotherapy and operation after downstaging for middle and low rectal cancer above phase T3. A set of regulation on treatment of hepatic metastasis in colorectal cancer has been formulated.

Hernia and abdominal wall diseases: Since 1998, open surgery and laparoscopic surgery has had a synchronous development. After TAPP and TEP operations were performed in 2003, the IPOM for incisional hernia and parastomal hernia of abdominal wall under laparoscope were further performed. In the same year, Kugel and open IPOM operations were performed. At present, the unstressing herniorrhaphy of our department has become the primary operation. The annual operation quantity exceeds 500, of which laparoscopic surgery accounts for 1/3.

Department of Breast and Thyroid Surgery:

The Breast and Thyroid Surgery specialty was set up 20 years ago. In 2005, the breast diagnosis and treatment center was firstly founded to find the the most appropriate treatment plan for the diseases by collaboration of several disciplines with the existing equipment and technology of the hospital. In addition to the regular radical mastectomy and modified radical operation, it proactively carried out the radical mastectomy with the breast reserved for the patient with breast preservation indication. In the meantime, it performed the stage I breast implant reconstruction operation after the modified radical operation of breast cancer. From 2005, the Department conducted sentinel node biopsy with isotopic tracer to avoid the unnecessary oxter lymph node dissection for some patients. For the minimal disease that cannot be clinically contacted found in breast cancer screening, it made pre-operation wire localization and operation resection biopsy to avoid missing diagnosis of the breast cancer that cannot be clinically contacted.

VI area lymph node biopsy and neck lymph node dissection were performed for the patient with thyroid cancer. Parathyroidectomy and autoplasty were performed for the patient with sthenic secondary parathyroid function and the pathology of parathyroid hyperplasis. Ultrasound led cytologic examination with fine needle aspiration was conducted for the minimal substantial disease of thyroid.

Surgery Intensive Care Unit

Th Unit was established in Mar. 1993. Under the direction of Director Li Baohua, the Unit performed individualized treatment not based on operation for the acute severe pancreatitis. Up to Apr. 1994, the Unit had received and cured 44 cases with a death rate of 9%, which sets a precedent in the nation. During 1993-1997, under the direction of Director Hua Tianfang, the Surgery Intensive Care Unit gradually popularized and improved the implementation and management of ECG monitoring, deep venipuncture tube placing technique and intravenous nutrition supported configuration and implementation, the basic technique of how to use breathing machine and other professional technologies related to ICU. In addition, it received and cured various critical illnesses, laying a solid foundation for the development of ICU. From 2005, the Unit relearned the concept and new technique on surgical injury control and pioneered in applying open abdomen, temporary abdomen closure and VSD technologies for some special abdominal diseases in Shanghai, which achieves good curative effect.