A surgeon at 92
Pioneering Chinese hepatobiliary surgeon Wu Meng-Chao is probably the world’s oldest surgeon active at the operating table
Wu Meng-Chao is a hepatobiliary surgeon and academic. He performed the first successful liver resection for hepatocellular carcinoma (HCC) in China in 1960, and has been operating on HCC for more than 50 years. His longest surviving patient is alive 47 years after the operation. China has a high incidence of hepatitis B and liver cancer.
At 92 years, Wu is probably the world’s oldest surgeon active at the operating table. He founded the world’s largest hepatobiliary surgery centre carrying out over 5000 surgeries each year. He was awarded the National Top Science and Technology Award of China. In 2011, the Minor Planet Center decided to name the minor planet No 17606 after him.
How did you start your career when hepatic surgery was almost an empty field in China at that time?
Shortly after the second world war in the 1950s, we only had very limited access to textbooks and research papers from colleagues outside China. Everything [all hepatic surgical science] had to start from scratch. Working with colleagues nationwide, we established the first injection cast model of a liver in China, with materials used to make table tennis balls. Later, by using these injection cast models, I proposed a new concept of dividing the liver into five lobes and four sections, which I hoped would pave the anatomical foundation for hepatic surgeries.
What’s a normal day for you?
I am physically an old man, but I would say that working keeps me young. On a typical working day, I spend most of the time before noon in the operation theatre doing one to two surgeries. At busy times I will have four to six liver resections every week. I spend my afternoons reading and reviewing academic papers, doing administrative work for the hospital, or seeing outpatients. The latter one is my favourite: talking and listening to my patients is like greeting old friends, which keeps reminding me that I must not stop.
You have spent your entire life working and performing operations. Don’t you feel fatigued or bored?
I feel extremely happy to concentrate on the job that I enjoy and have chosen to devote my life to. As long as I am able to hold a scalpel, I will stand by the side of the operating table. Hepatocellular carcinoma (HCC) is my greatest enemy and the operating room is my battlefield. Although I am in my 90s, there is still too much to do ahead of me. Seeing the happy faces of my patients is always the source of my motivation.
What’s unique about hepatocelluar carcinoma in China?
Chinese patients account for nearly 50% of HCC patients worldwide. Many of them come from rural areas with poor living conditions. It is vital to solve their problems with the most affordable, simplest, and most effective treatment so as to minimise their financial burdens. Hepatitis B virus (HBV) infection is the main aetiological cause of cancer. As HBV is infectious, carriers of the disease experience considerable social discrimination despite governmental efforts. Effective actions to eliminate discrimination are urgently needed. (See Comment. Lancet 2011;78:9796).
What do you think are the differences in HCC treatment between China and Western countries?
There is controversy in the treatment modalities and concepts for HCC. For tumours that are advanced or where there is portal tumour thrombosis, most surgeons in the West would consider surgery absolutely contraindicated, whereas our experience tells us that these tumours can sometimes be resectable, provided there is sufficient functional liver reserve and it is technically feasible to remove the tumour and the thrombus simultaneously. I feel happy that there are different opinions and I believe it is smart to seek common ground while preserving differences. I hope that more consensus will be reached in the future to further improve the prognosis of patients with HCC.
What do you expect to see in the future in the treatment of HCC?
Surgery is only one of the solutions for resectable HCC. We expect to see breakthroughs in basic and clinical research regarding the treatment strategies for HCC, including medical and interventional therapies. I have faith that we shall finally win the war against the greatest enemy of human health in China.
What do you think about the problems between doctors and the public in China?
It is sad that the deteriorating doctor-patient relationship has struck a rare chord of dissonance in modern Chinese society. Firstly, the media should take responsibility. Once honoured as “Angels in White” during the SARS (severe acute respiratory syndrome) epidemic in 2003 and the earthquake rescue in Sichuan in 2008, doctors nowadays are sometimes dubbed “White-Eyed Wolf.” Irresponsible reports of doctor-patient conflicts are more about pouring salt into the already wounded health system than appealing for improvement. Secondly, we have to admit that the worsening doctor-patient relationship is just part of the various social conflicts coming along with China’s economic expansion. Policy makers should raise the healthcare budget and increase the legal income of healthcare workers. More weight should be put on the education of patients aiming at building a relationship with mutual trust and a sufficient sense of safety.
In such conditions, what can we do to protect our legal rights, as doctors and would-be doctors?
Doctors in China have long been a group of people whose low financial incomes and social positions are in sharp contrast to their high training costs, academic degrees, and professional risks. And even more unfortunately, in the eyes of many ordinary Chinese people, the term “doctor” is likely to be linked with “grey income,” [income that does not fall into a tax category] “prescription abuse,” or “excessive examination.” As doctors and future doctors, we should always remember to keep our minds clear and our hands clean. A profession like this should not tolerate corruption. Additionally, we should appeal together to the government to increase financial investment in healthcare, appropriately raise the price of quality health services, and give true expression to the value of medical workers by giving them rewards that are appropriate to their work.
What advice would you give a student thinking of training to be a surgeon?
First and foremost, always remember that medical science is human oriented. It focuses on communication between human beings. An outstanding doctor cares about the disease and the patient. It’s our priority to take good care of the patients and to treat them well. Patients deserve our patience, sympathy, and care. A minor gesture like warming your hands before touching the patients in winter would let the patients know that you care for them. For those trained to be surgeons, I would like to remind you that focusing solely on surgical techniques is not enough, that’s more of a craftsman’s job. A qualified medical scientist should be able to speak and write to inform others of what you are interested in and what you have done.Tian Yang, final year medical student1, Han Zhang, fourth year medical student1
1Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
Correspondence to: email@example.com
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.
Cite this as: Student BMJ 2013;21:f4073