Department of General Surgery

The Department of General Surgery at Peking Union Medical College Hospital has an indelible history and achievements in Chinese medical history, producing many nationally and internationally renowned medical experts, such as Professors Zeng Xianjiu, Zhu Yu, Zhong Shouxian, and Zhao Yupei. Since the 1980s, under the leadership of successive directors and discipline leaders, the department has been one of the earliest in the country to establish specialized groups based on the characteristics of general surgery, including pancreas, biliary, gastrointestinal, vascular, breast, liver, surgical nutrition, critical care, and related clinical specialty laboratories. After decades of relentless efforts, this department, with 158 beds and two molecular biology laboratories, has become a national center for the diagnosis and treatment of complex and severe diseases in general surgery, boasting a well-structured and highly qualified talent team, with many experts holding various leadership positions in the Chinese Medical Association and domestic and international journals.

The Department of General Surgery at Peking Union Medical College Hospital has unique characteristics in the clinical and research fields of pancreatic diseases, gastrointestinal diseases, biliary diseases, and enteral and parenteral nutrition, with some research at the leading level both domestically and internationally.

The Department of General Surgery has consistently emphasized the construction of academic teams, fully leveraging the mentorship of senior physicians, creating a healthy virtuous cycle, with a very reasonable age structure. Currently, it has 8 professors, 12 associate professors, and 25 attending physicians; among them, 21 hold doctoral degrees and 13 hold master's degrees; 90% of the staff are in the golden age range of 35-55 for surgical physicians. In each specialty group, the ratio of professors, associate professors, and attending physicians also presents a perfect triangular distribution.

General surgical diseases are mostly common diseases with high incidence rates, and the number of patients and surgeries accounts for the largest proportion in any hospital's surgical department, closely related to public health. The level of general surgery is an important indicator of a country's level of development. With the rapid development of the medical field, the construction of general surgery in China urgently requires more support, attention, and investment to keep pace with the times and align with international standards. The rich case resources and rigorous medical attitude of Peking Union Medical College Hospital align with these factors, leading to comprehensive and stable development. The department has unique strengths in early diagnosis and comprehensive treatment of pancreatic cancer, diagnosis and treatment of pancreatic endocrine and exocrine tumors, application of minimally invasive techniques for pancreatic diseases, genetic research on pancreatic diseases, early diagnosis and comprehensive treatment of benign and malignant gastrointestinal tumors, minimally invasive techniques for gastric and colorectal cancers, diagnosis and treatment of biliary diseases and minimally invasive techniques, surgical enteral and parenteral nutrition, diagnosis and treatment of thyroid diseases and minimally invasive techniques, and chemotherapy for tumors, with certain aspects at the leading position both domestically and internationally. The specifics are as follows:

1. Early diagnosis and comprehensive treatment of pancreatic cancer

(1) Definition and promotion of high-risk groups

Based on extensive epidemiological research, the concept of high-risk groups for pancreatic cancer was proposed for the first time in the country, establishing warning indicators for the pancreatic cancer population. Currently, the definition of 'high-risk groups for pancreatic cancer' has been included in the upcoming authoritative professional book 'Pancreatology' for nationwide dissemination and promotion.

(2) Establishment and application of a green channel for the diagnosis and treatment of pancreatic cancer

In response to the current clinical diagnosis of pancreatic cancer, the concept of a 'green channel for the diagnosis and treatment of pancreatic cancer' was proposed for the first time in the country, increasing the surgical resection rate for pancreatic cancer from 29% to 35.5%, while the international average level during the same period is about 20%. This treatment process has been recognized by domestic peers and has significant guiding significance for improving the diagnosis and treatment level of pancreatic cancer in China.

(3) Development of the pancreatic cancer diagnosis and treatment flowchart at Peking Union Medical College Hospital

Combining China's health economic conditions, optimizing existing diagnostic methods, and prioritizing the weight of various examination methods, the first pancreatic cancer diagnosis and treatment flowchart in the country has been developed, effectively avoiding excessive waste of medical resources, and has significant guiding significance for the diagnosis of pancreatic cancer in Beijing and many grassroots units.

(4) Preoperative resectability assessment system for pancreatic cancer

The first preoperative resectability assessment system for pancreatic cancer was established both domestically and internationally, and the concept of establishing a resectability scoring standard for pancreatic cancer was proposed, achieving good social and economic benefits, and this achievement is currently being promoted.

(5) Perioperative treatment protocols for pancreatic cancer

a. Preoperative jaundice reduction: Implementing preoperative jaundice reduction via ERCP or PTCD, and first establishing jaundice reduction standards that are simple and easy to operate, which have been adopted by many grassroots units.

b. Application of enteral nutrition support: Since 2002, research on perioperative nutritional support for pancreatic cancer patients has been conducted, achieving some results in early enteral nutrition support postoperatively.

c. Establishment and promotion of a modified gastrostomy method: Overcoming the shortcomings of traditional gastrostomy methods, the modified gastrostomy technique was established for the first time both domestically and internationally, which is simple, safe, and improves postoperative quality of life.

d. Establishment and application of indications and reasonable resection range for radical surgery for pancreatic head cancer: The indications and reasonable surgical resection range for radical surgery for pancreatic head cancer were proposed for the first time in the country. Clinical validation showed a surgical mortality rate and pancreatic fistula occurrence rate of 2.5%, which is at the international leading level; this standardized the surgical treatment plan for pancreatic cancer in China, allowing pancreatic head cancer patients to receive reasonable treatment and achieving certain social and economic benefits.

(6) Individualized and dynamic chemotherapy protocols for pancreatic cancer patients

Chemotherapy is an important adjuvant treatment for pancreatic cancer. In 1996, the first combined chemotherapy protocol for pancreatic cancer was proposed in the country, establishing the first-line chemotherapy regimen for pancreatic cancer in China. Over 2,200 cases of interventional chemotherapy for pancreatic cancer patients were completed, with a median survival time of 12.78 months and a one-year survival rate of 48.66%, marking that the treatment effect for pancreatic cancer in China has reached an internationally advanced level. In 2002, a new adjuvant chemotherapy regimen for pancreatic cancer was proposed, namely 5-FU combined with gemcitabine, which, after validation in over 1,000 cases, showed significant improvement in quality of life compared to traditional regimens. This research has received funding from two National Natural Science Foundation projects and two key clinical discipline projects from the Ministry of Health, with over 30 papers published domestically and internationally.

2. Comprehensive treatment of gastrointestinal tumors

An average of 250-300 cases of colorectal cancer surgeries are performed annually. The first transanal approach for rectal surgery (Mason procedure), intraoperative double anastomosis technique for rectal cancer, total mesorectal excision (TME) for rectal cancer, transabdominal rectal cancer resection with transanal colonic-anal anastomosis (Parks procedure), and preventive procedures for postoperative anastomotic leakage have been pioneered in the country. Laparoscopic techniques have been applied in colorectal cancer surgeries, and transanal endoscopic microsurgery (TEM) has been used for treating rectal diseases. Annually, 100-150 cases of gastric cancer are treated. To further improve the efficacy for patients with advanced gastric cancer, preoperative CT three-dimensional reconstruction for resectability assessment and multicenter and single-center clinical studies on neoadjuvant chemotherapy have been conducted, joining the national '11th Five-Year Plan' key project, with most patients achieving downstaging or remission, thereby increasing the radical resection rate.

3. Improvements in enteral and parenteral nutrition and prevention of complications

For patients with pancreatic cancer, gastric cancer, inflammatory bowel disease, and those undergoing major surgeries or suffering from malnutrition, perioperative parenteral nutrition support and early postoperative enteral nutrition support have been provided: a sequential therapy has been proposed, significantly improving patients' tolerance to enteral nutrition support. In terms of caloric and nitrogen supplementation, permissive low-calorie approaches have been applied to further prevent and reduce complications associated with enteral and parenteral nutrition. Percutaneous endoscopic gastrostomy and percutaneous endoscopic gastrostomy-jejunostomy feeding systems have been established, providing long-term enteral nutrition support for surgical patients, significantly improving patients' quality of life.

4. Clinical research and application of minimally invasive surgery.

Since 2002, based on the popularization of laparoscopic technique training and laparoscopic cholecystectomy, various laparoscopic surgeries for abdominal organs have been successively developed.

(1) Application of minimally invasive techniques in pancreatic surgery

Laparoscopic pancreatic surgery is technically challenging, with only a few centers worldwide mastering this technique. Since 2000, laparoscopic pancreatic resection techniques have been pioneered in the country, completing 22 cases of laparoscopic distal pancreatectomy, ranking first in the nation. In 2004, intraoperative exploration and staging for pancreatic cancer patients were performed, simultaneously obtaining histological evidence and selecting reasonable treatment methods, increasing the accuracy of preoperative resectability assessment to over 90%, reaching internationally advanced levels and filling a domestic gap.

(2) Research on the application of laparoscopic techniques in colorectal cancer surgeries has been conducted, and in 2006, transanal endoscopic microsurgery (TEM) for rectal diseases was pioneered in the country.

(3) Intraoperative endoscopic localization and laparoscopic resection of gastrointestinal stromal tumors have been developed.

(4) Laparoscopic repair of parastomal hernias has been conducted.

(5) Laparoscopic Nissen fundoplication has been performed.

(6) Laparoscopic splenectomy, appendectomy, and thyroidectomy have been conducted.

5. Currently, further deepening and refining clinical construction is underway or being prepared. This includes establishing a research center for general surgery, continuing in-depth research on early diagnosis and comprehensive treatment of pancreatic tumors and gastrointestinal tumors, improvements in enteral and parenteral nutrition methods, prevention of complications, surgical procedures and tumor nutritional immunity, organ transplantation (pancreas, small intestine), minimally invasive surgery, gene therapy, etc. Guidelines for the treatment of pancreatic diseases, gastrointestinal diseases, liver and biliary diseases, and thyroid diseases will be gradually formulated. This will undoubtedly promote and enhance the overall level of research and treatment in general surgery in China, improve patients' quality of life and treatment outcomes, and reduce medical costs.

Research is the foundation of clinical work. Recognizing this, every department leader since Professor Zeng Xianjiu has placed great emphasis on research and invested significantly. Between 2005 and 2007, the department applied for a total of 12 national-level research projects, with project funding of 10.94 million yuan. In 2006, Professor Zhao Yupei and the pancreatic specialty group successfully applied for a key national project and a clinical multicenter research project, with funding reaching 10 million yuan. The two specialized laboratories in the department are equipped with a large number of advanced devices, meeting the needs from animal experiments to molecular biology at various levels. The strong support from hospital and departmental leadership, along with ample funding, has led to significant achievements in research, including:

1. Establishment of a new theory on the origin and occurrence of pancreatic cancer cells

For the first time internationally, a real-time, dynamic demonstration of the progression of pancreatic cancer was established using an animal model, discovering that the main origin of pancreatic cancer cells is through the transdifferentiation of acinar cells, with ductal cells and islet cells participating to some extent (see Figures 1 and 2). This discovery provides a theoretical basis for studying the occurrence of pancreatic cancer and also offers molecular targets for early diagnosis and effective treatment (Lab Invest. 2003; 83(6):853-9, Impact Factor: 5).

2. Screening and identification of new diagnostic markers for pancreatic cancer

Using immunoproteomics technology, the membrane proteins of multiple pancreatic cancer cell lines were studied in depth, and antibodies against identified membrane antigens were used for staining human pancreatic cancer tissue microarrays to determine the expression of these membrane antigens in the tumor cell membranes in vivo. SLP-2, VDAC-1, VDAC-2, CHCHD3, and TOM40 were discovered as newly identified membrane antigens associated with human pancreatic cancer and possessing immunogenicity, and the detection of specific antibodies against these membrane antigens in the peripheral blood of high-risk groups for pancreatic cancer will aid in achieving early diagnosis of pancreatic cancer (see Figure 3).

Chemotherapy is one of the important adjuvant treatments for pancreatic cancer, but the presence of multidrug resistance severely hinders the application of chemotherapeutic agents. Using a human whole-genome expression profile chip, the gene expression profiles of pancreatic cancer cells resistant to multiple chemotherapeutic drugs were screened for the first time, studying the overall gene expression situation related to multidrug resistance in pancreatic cancer. Differentially expressed genes involved in multidrug resistance in pancreatic cancer were identified, and a comprehensive gene expression change map related to the occurrence of multidrug resistance in pancreatic cancer was established. New genes involved in pancreatic cancer resistance, such as aPHCA, TNKS2, GPX3, etc., were reported for the first time, along with some ESTs possibly related to resistance. Further research on these genes may provide new targets and strategies for understanding the molecular mechanisms of multidrug resistance in pancreatic cancer and its treatment.

4. Mechanisms of radioresistance in pancreatic cancer cells

The differences in radiosensitivity among six different pancreatic cancer cell lines were detected, and based on this, the induction of radioresistant pancreatic cancer cell lines was performed, resulting in relatively stable radioresistant pancreatic cancer cell lines. Gene chip screening was conducted to identify differentially expressed genes between the parental and radioresistant cell lines, and some of these differentially expressed genes were validated, with the newly discovered S100A2 being significantly related to the radiosensitivity of pancreatic cancer cells, which was verified through gene transfection and gene silencing.

5. Gene-targeted therapy for pancreatic cancer

Molecular targeted therapy and gene therapy have become hot topics in pancreatic cancer research in recent years. A recombinant expression vector for the ScFv gene was successfully constructed, and pancreatic cancer cell lines sensitive to the anti-EGFR monoclonal antibody C225 were screened from both proliferation inhibition and apoptosis induction perspectives, finding that the pancreatic cancer cell line AsPC-1 exhibited higher sensitivity to CA225 than five other cell lines.

6. Experimental research on photodynamic therapy for pancreatic cancer

Using the novel photosensitizer 2-butylamino-2-deoxy-hematochrome (BAHB) as the research object, in vitro experiments on photodynamic therapy for pancreatic cancer cells were conducted, discovering that apoptosis is the main pathway mediating the death of pancreatic cancer cells by BAHB photodynamic action. The novel photosensitizer derived from hematochrome has strong absorption in the phototherapy window, low dark toxicity, and strong phototoxicity, making it an ideal new photosensitizer. These research results have been reported for the first time both domestically and internationally.

γδT cells possess innate tumor immune surveillance and adaptive specific recognition of tumor antigens, with the ability to recognize tumor antigens independent of MHC molecules, directly identifying tumor antigens without the need for antigen processing and presentation. These characteristics greatly enhance the role of γδT cells in tumor immunotherapy, making them promising new and more effective effector cells. Peripheral blood γδT cells can compensate for the shortcomings of traditional effector cells, exhibiting strong tumor immune killing effects.

(1) Research on segmental small intestine transplantation in pig allografts

(2) The role of acetylheparinase in colorectal cancer and its metastasis

(3) Study on predictive factors for sensitivity to neoadjuvant chemoradiotherapy in rectal cancer

(4) The regulatory mechanism of K-ras on proteins related to colon cancer metastasis and tissue microarray studies

(5) The regulatory mechanism of K-ras on E-cadherin in colon cancer and its correlation with tumor metastasis

(6) Perioperative enteral nutrition and blood glucose control

(7) Application of fructose in perioperative management and blood glucose control

(8) Research on postoperative gastrointestinal motility recovery

(9) The effects of nutrients (glutamine, fish oil) and chemotherapeutic agents (5-FU, epirubicin, mitomycin, oxaliplatin) on the growth of gastric cancer cell lines.