RBCT Chapter 1458 Confidence
Chapter 1458 Confidence
Chapter 1458 Confidence
In the conference room, Xu Zhiliang had already arrived and was adjusting the slides on the projector. Seeing Yang Ping enter, he nodded: "Professor, the family members... have... have arrived. I've asked... the nurse... to take them... to... to the ward first. They'll be back at two... two o'clock."
“Okay.” Yang Ping sat down at the conference table, opened his laptop, and projected the case data sent by Lu Xiaolu onto the screen.
At exactly 2:00, there was a knock on the door.
"Come in," Yang Ping said.
The door opened, and a man in his forties entered, wearing a faded polo shirt, with graying hair and a haggard face. Behind him followed a woman, presumably his wife, whose eyes were red and swollen, and who was clutching a bag tightly in her hand.
"Professor Yang, Director Xu." The man walked to the conference table, his voice a little hoarse. "I am Lin Xiaoyu's father, and this is her mother."
"Please sit down," Yang Ping said, gesturing to the chair opposite him.
The two sat down, and Lin Xiaoyu's mother kept her head down, not daring to look Yang Ping and Xu Zhiliang in the eye. She had probably heard too much bad news; every doctor she met had told her bad news, despair, and "I'm sorry, we did our best."
“I have reviewed the medical records and imaging data.” Yang Ping’s voice was calm, without any deliberate attempt to comfort or be serious, simply stating the facts. “Director Xu and I have also discussed this in detail. I invited you here today to see if there is any way to help.”
Lin Xiaoyu's father nodded, his lips moved, but he didn't say anything.
"Let me first share my assessment." Yang Ping turned on the projector, and the screen displayed Lin Xiaoyu's latest MRI images. "This is the MRI you had done at Peking Union Medical College Hospital last week. It shows that the tumor is located in the pons, which is part of the brainstem and controls the most basic life functions such as breathing, heartbeat, and blood pressure. Therefore, the surgical risk in this location is extremely high, and it is almost impossible to remove it completely."
Upon hearing this, Lin Xiaoyu's mother trembled slightly, and her husband reached out and took her hand.
“However,” Yang Ping switched to another film, displaying a diagram of the mechanism of K therapy, “surgery is not the only solution. I have a new therapy currently in clinical trials called K therapy. Its principle is not to directly kill tumor cells, but to activate the tumor cells’ self-clearance mechanism…”
He explained the core mechanism of K therapy in plain language, turning these complex concepts into vivid metaphors.
"K therapy is not a magic bullet. It is currently in phase III clinical trials and is not effective for everyone. However, for DIPG, even stopping the growth of the tumor is a huge step forward."
After listening, Lin Xiaoyu's father remained silent for a moment, then asked a question that left a deep impression on Yang Ping.
"Professor Yang, has this K therapy you mentioned been used on patients like Xiaoyu?"
“I’ve used it.” Yang Ping flipped through the data of the eight cases that Lu Xiaolu had compiled. “I have compiled data on eight patients with brainstem gliomas here, two of whom are DIPG like Xiaoyu. Of these two, one case had a very good outcome, with the tumor shrinking by 40 percent and the clinical symptoms significantly improving. The other case did not have such a good outcome, but the tumor also shrank.”
He recounted the specifics of both cases, including the patients' age, gender, pre-treatment condition, post-treatment response, and current follow-up results. Every piece of data was presented clearly, without exaggeration or concealment.
"Of course, the sample size of two cases is too small to draw definitive conclusions," Yang Ping concluded. "But it at least shows that K therapy is effective for a portion of DIPG patients. As for whether Xiaoyu is one of those 'patients,' we won't know until we do the experiment. Since it's an experimental study, it carries certain risks and uncertainties."
Lin Xiaoyu's father fell silent again. This time, he didn't look at Yang Ping, but instead lowered his head and looked at his hands.
“Professor Yang, I have another question.” He looked up, his eyes holding a light that Yang Ping recognized but which always made him feel uneasy.
"Please speak."
"If... I mean if... Xiaoyu accepts K therapy, what if... what if it doesn't work, does she have any other options?"
Yang Ping was silent for a few seconds, then laid out all the options.
"Yes, but the prognosis is not optimistic. Further radiotherapy could be tried, but the brainstem has limited tolerance to radiotherapy, and the effectiveness of a second treatment would be diminished. Chemotherapy could be tried, but DIPG is generally insensitive to chemotherapy. Targeted therapy could be tried, but genetic testing is needed to identify specific targets, and even if a target is found, the corresponding drug may not be effective. Clinical trials could also be attempted; there are some new drug trials for DIPG both domestically and internationally, but the inclusion criteria are very strict, and it's not something anyone can just join. Moreover, currently, the most advanced treatment for these tumors in the world is K therapy, bar none."
He paused, looking into the father's eyes.
"I'm not saying this to scare you or to guide you, but to give you a clear understanding. DIPG is one of the most difficult diseases to treat in the field of neuro-oncology, and no treatment can guarantee effectiveness. K therapy is what we currently consider the most promising option, but it's not 100% effective, less than 50%, because it's not perfect yet. Although it works very well for some tumors, its effectiveness for others is still under investigation."
The meeting room fell silent.
Lin Xiaoyu's mother finally raised her head, her eyes filled with tears, but her voice remained steady.
"Professor Yang, let's try it. No matter what the result is, let's try it."
She turned her head and looked at her husband. He didn't say anything, but just nodded vigorously.
Looking at the couple, Yang Ping felt a complex mix of emotions.
"Okay! I'll make the arrangements for you. First, there's the pre-enrollment assessment, which requires a comprehensive examination, including MRI, blood tests, liver and kidney function tests, electrocardiogram, and echocardiogram. Once all of these are satisfactory, we'll proceed with the ethics review and informed consent process. It will take about one to two weeks to complete all of this. The first treatment can begin as early as two weeks from now."
"We will cooperate, we definitely will." Lin Xiaoyu's father stood up and bowed deeply. "Thank you, Professor Yang, thank you, Director Xu."
Yang Ping stood up, walked to his side, and patted him on the shoulder.
"Don't thank me yet, thank me after it works."
After seeing off the family members, Xu Zhiliang returned and sat down opposite Yang Ping.
"Professor, do you think... K therapy... will be effective... for this child?"
Yang Ping was silent for a while, then said, "I don't know. Theoretically, it should be effective. Her spectrum shows a high lactate peak, which indicates a typical hypoxic microenvironment, which is theoretically beneficial for K therapy. But DIPG is too cunning. It has many escape mechanisms. Whether K therapy can suppress it can only be known after it is done. After all, K therapy is still in the pioneering experimental stage for this type of tumor."
"By the way, have someone send Lin Xiaoyu's biopsy sample to the oncology lab so Lu Xiaolu can do some genetic testing. If K therapy doesn't work, we still have targeted therapy as an option. Let's try both."
"Okay, I'll arrange it."
Yang Ping walked out of the neurosurgery department and headed down the corridor toward the research institute.
The corridor was long, with off-white walls on both sides and fluorescent lights overhead emitting a soft white glow. Occasionally, a nurse would push a treatment cart past, the wheels making a soft gurgling sound on the tiled floor. A family member carrying a thermos came out of the boiler room, and when they saw Yang Ping, they stepped aside to let him pass.
Yang Ping walked out of the neurosurgery department and glanced at the window at the end of the corridor. Sunlight was streaming in through the glass, casting a bright patch of light on the floor.
He had planned to go straight back to the research institute, but then he paused.
The surgery that Director He performed to reconstruct the carina should be underway.
Yang Ping glanced at his watch; it was 2:40 PM. According to the plan, the surgery should have been underway for nearly half an hour. Without hesitation, he turned and walked towards the operating room.
Yang Ping changed out of his white coat in the locker room, put on scrubs, a hat, and a mask.
"Professor Yang!" The head nurse from the operating room happened to pass by and was somewhat surprised to see Yang Ping. "Are you going to go up on the operating table?"
“No, let’s go see Director He’s surgery in the thoracic surgery department,” Yang Ping said.
Yang Ping walked down the corridor toward Director He's operating room. Red "Operating" indicator lights illuminated the operating room doors on both sides of the corridor, and through the small windows in the doors, he could see the busy figures inside. Anesthesiologists, nurses, and surgeons—each was in their own position, like cogs in a finely tuned machine.
Director He's surgery had begun. He stood in the surgeon's position, with his two assistants on either side of him. The anesthesiologist sat beside the patient's head, his eyes fixed on the numbers on the monitor.
"Professor Yang!" Director He looked up, immediately feeling a strong sense of security.
"How is it?" Yang Ping walked to the operating table, his gaze falling on the surgical field. The chest cavity had been opened, and the retractor had spread the ribs, exposing the right pleural cavity and mediastinum. The tumor was located in the carina region; the grayish-white mass was like a stubborn stone, stuck at the bifurcation of the trachea, compressing and deforming the right main bronchus.
"What were the results of the investigation?" Yang Ping asked.
Director He took a deep breath. He knew that Yang Ping wasn't testing him, but helping him organize his thoughts.
"The tumor has just been exposed. It has invaded the carina and the proximal end of the right main bronchus. The opening of the left main bronchus is okay, but it is also a bit suspicious. I plan to follow your plan and first free the superior vena cava and put on a occlusion band, just in case. Then I will also free the main pulmonary artery and its left and right branches, assess the length and angle required for replacement, and prepare for the artificial blood vessel."
Yang Ping nodded and stood in front of the high-definition display screen on the wall. This screen, which was broadcasting the surgery live, was connected to the camera on the operating light.
The surgical field was more complex than he had seen on the imaging; the adhesion between the tumor and the surrounding tissues was denser than expected. However, Dr. He handled the situation very well, freeing what needed to be freed and protecting what needed to be protected. His surgical skills were very solid, and it seems he has devoted a lot of time and effort to learning over the past few years.
"You continue, let me take a look." Yang Ping went to the operating table again, positioning himself so that he wouldn't interfere with the surgery while still having a clear view of the surgical field.
Director He picked up the surgical instruments again and began the surgery.
The superior vena cava was freed, a occlusion band was applied, and then the main pulmonary artery and its left and right branches were also freed. The required length and angle for replacement were assessed, and the assistant prepared the artificial blood vessel.
After finishing all that, Director He looked up to give his neck a break before starting the removal and reconstruction of the ridge.
This is the most crucial step in the entire surgery.
Director He first switched the ventilation to the left main bronchus using endotracheal intubation, then cut the distal end of the right main bronchus, temporarily isolating the right lung. Next, he cut the left main bronchus at the lower edge of the tumor, and then removed the carina along with the tumor.
Three openings appeared in the surgical field: the stump of the trachea, the stump of the left main bronchus, and the stump of the right main bronchus. The three circular openings were like three black holes, and air flowed out from these three openings with each breath.
“It matches!” Director He said in a low voice.
He picked up an absorbable suture and began the tracheo-left main bronchus anastomosis. This was the first and most crucial anastomosis. The trachea's diameter was larger than the left main bronchus's, and a direct end-to-end anastomosis would lead to poor alignment. Therefore, he adopted the "side-end-side" anastomosis method suggested by Yang Ping, first anastomosing the left main bronchus to the side wall of the trachea, and then anastomosing the right main bronchus to the side wall of the left main bronchus.
Director He moved slowly, each stitch carefully considered. Sew, knot, sew again, knot again... each stitch as delicate as embroidery.
Yang Ping watched from the side, secretly approving.
Director He's progress is evident to the naked eye. A year ago, when he performed this complex tracheal surgery, his hands trembled slightly, and the stitches were not very even. But today, his hands are as steady as a precision instrument, the edge distance of each stitch is almost equal, and the knot is tied with just the right amount of force, neither too tight to cause tissue ischemia nor too loose to cause air leakage.
The first anastomosis was completed. Director He instructed his assistant to rinse it with saline solution, and then had the anesthesiologist inflate the lungs to check for air leaks at the anastomosis.
“There’s a tiny bit.” Director He frowned. “There’s a small pinhole here, on the posterior wall of the left main bronchus.”
He picked up a thin needle and pricked the hole again. He checked his lungs again, and this time there was no leak.
“Very good!” Yang Ping said. “Continue.”
The second anastomosis is located on the lateral wall of the right main bronchus to the left main bronchus. This anastomosis is technically more challenging because the two bronchi do not run in a straight line but at an angle. Director He trimmed the cut end of the right main bronchus into a bevel, then made a longitudinal incision on the lateral wall of the left main bronchus, aligned the bevel and the incision, and began suturing.
This time, he sewed even more slowly. He would first measure the angle of each stitch to make sure it was correct before putting the needle in.
Yang Ping noticed that Director He's hands were trembling slightly. It wasn't from nervousness, but from fatigue. The surgery had been going on for nearly four hours, requiring a high level of concentration and meticulous operation; anyone's hands would tremble under such circumstances.
"Would you like to take a break?" Yang Ping asked softly.
Director He shook his head, neither looking up nor stopping what he was doing.
"No need, it'll be ready soon."
Director He almost held his breath while stitching the last few stitches.
After tying the knot, I checked my lungs again. This time, there was no leak.
Director He straightened up and let out a long breath.
"The anastomosis is done. Next is the pulmonary artery replacement," Yang Ping said. "You've done simulations for this. Just follow the procedure. I'm here."
Director He nodded, took the artificial blood vessel handed to him by his assistant, and began to perform end-to-end anastomosis.
Pulmonary artery replacement is technically less challenging than carina reconstruction, but it's still no easy feat. The pulmonary artery wall is thin and brittle, and it can easily tear if not handled carefully during suturing. Moreover, the patient's pulmonary artery had undergone some degeneration due to long-term tumor compression, making it even more brittle than a normal pulmonary artery.
Director He switched to a finer needle and began suturing. The first stitch went through the cuff of the artificial blood vessel, then through the pulmonary artery wall, and was tied. The second stitch was done in the same way. The third stitch, the fourth stitch… stitch by stitch, he sewed on, as evenly and steadily as a sewing machine.
Yang Ping noticed that Director He's hands did not tremble this time.
Perhaps it's because the most difficult part, the carina reconstruction, has been completed, reducing psychological pressure. Or perhaps it's because he was performing a familiar procedure and felt confident. Whatever the reason, Director He's condition was noticeably better than before.
"Open up the blood flow!" Director He said to the anesthesiologist after finishing the last stitch.
The clamp was released, and blood flowed into the pulmonary artery system through the artificial blood vessel. Director He stared at the anastomosis, observing for any bleeding.
"There's a little seepage at the right pulmonary artery anastomosis site; spray a tiny bit of biological adhesive," Yang Ping advised.
Director He took the biological adhesive and sprayed a small amount onto the bleeding point. The adhesive solidified the moment it came into contact with the blood, and the bleeding stopped.
"Okay, close the chest."
Yang Ping glanced at the timer on the wall: 6:25 PM. The surgery had already lasted for more than four hours, which was faster than Yang Ping had expected.
"Well done." Yang Ping patted Director He on the shoulder. "You performed this surgery independently. I just stood here and watched. You're confident you can do this kind of surgery yourself in the future."
Director He turned his head, and there was a complex light in his eyes above the mask.
"Professor Yang, if you hadn't been here, things might not have gone so smoothly. With you by my side, I feel reassured."
Director He was speaking from the heart. Even if Professor Yang were just standing by, he would have much more confidence in performing such difficult surgeries. If he could do more of these surgeries, he would be able to become a skilled surgeon himself.
Yang Ping smiled.
"Alright, close the chest, I'm leaving now. Postoperative management needs to be in place. Anastomotic leakage and pulmonary artery anastomotic bleeding are the two most dangerous postoperative complications, so keep a close watch on them."
"understand!"
Yang Ping walked out of the operating room, changed out of his scrubs in the changing room, and put his white coat back on.
He washed his hands, dried them with a paper towel, and then walked out of the operating center.