Patient Care

Gastric Surgery

1. A struggle through hardships - historical evolution and the progress of academic and clinical achievements

The fifty-year of struggle elapsed through hardships. As the Cancer Center was founded in 1964, the team of abdominal and thoracic surgery was set up. Twenty years later along the tough journey of development, the Department of Abdominal Surgery was established with 19 doctors taking charge of 59 sickbeds. In 1998, with the rapid development of specialties, the Department of Hepatobiliary Surgery was separated from the Department of Abdominal Surgery. As the East Building was completed in 2002, the Department of Urology emerged and the Department of Abdominal Surgery almost ceased to receive patients with hepatobiliary tumor and urologic neoplasms. By then, there were 70 sickbeds altogether in the wards of the Department of Abdominal Surgery, covering an area of 2,600 square meters.

The specialties advances in development; while the historical lineage leads to accumulations of experience. In 2009, to further strengthen the power of the specialties, the Department of Gastric and Pancreatic Surgery came into existence to keep up with the times as one of the currently youngest departments at Cancer Center. Zhou Zhiwei serves as the Chief for the Department of Gastric and Pancreatic Surgery; Li Wei is the Associate Chief; Sun Xiaowei is the Secretary and Yuan Xiuhong is the Service Director. Among the 14 doctors at present, 3 are chief physicians, 4 are associate chief physicians and 3 are attending physicians. Among the 29 nurses, 1 is an associate chief nurse practitioner and 3 are nurses-in-charge. There is one technician in Prof. Zhou Zhiwei’s laboratory.

As a nationally renowned research center of gastric and pancreatic specialty integrated with medical treatment, scientific research and teaching, the Department of Gastric and Pancreatic Surgery assumes the front-line clinical and research work on gastric carcinoma, single disease of pancreatic cancer, melanoma and soft tissue neoplasm; meanwhile, it is the chairman unit of the Guangdong Provincial Anticancer Association Gastric Carcinoma Committee. The Department of Gastric and Pancreatic Surgery has been developing flourishingly at high speed with remarkable achievements within five years.

2. Taking the lead bravely to be at the top - constant improvement of medical treatments
The Department of Gastric and Pancreatic Surgery focuses on the standardized diagnosis and treatment and scientific research of gastric carcinoma, pancreatic cancer, gastrointestinal stromal tumor, melanoma, and soft tissue neoplasm, especially the comprehensive treatment of gastric carcinoma. By virtue of the accumulated experience passed down through the generations, the strict inspection of Chief specialist of single disease, the great strength of relevant departments at the Cancer Center as well as the untiring struggle of the Department colleagues, the Department has become the model of standardized gastric carcinoma treatment across Guangdong Province and even South China; it has been fully devoted to promoting the prevention and treatment of gastric carcinoma and improving the overall prognosis of gastric carcinoma in China. As shown by the data from 1990 to 2010, the one-year, three-year, five-year, and ten-year survival rates of gastric carcinoma patients after the gastrectomy in our Department were 84.1%, 56.9%, 48.1%, and 41.8% respectively; the one-year, three-year, five-year and ten-year survival rates of patients who received radical excision were 88.0%, 62.7%, 53.7%, and 46.8%. The above survival rates have ranked top in China and are getting gradually close to the international advanced level. Additionally, during the last ten years, the five-year survival rate of patients receiving the gastrectomy in our Department has risen to the present 51.5% from the past 40.1% in the 1990s; the five-year survival rate of patients who received radical excision in our Department has risen to the present 57.1% from the previous 45.7%. The overall curative effect has been significantly improved.

Over the past five years, the Department of Gastric and Pancreatic Surgery has adhered to its principle of medical treatment, “caring for patients, developing techniques fundamentally featuring individualized treatment”. It has enhanced the hardware construction and kept optimizing the internal management to further its development with high quality. It has vigorously applied the new techniques to clinical purposes and striven to build a developmental medical team. It has dramatically raised the five-year survival rate and life quality of gastric carcinoma patients by successively performing cutting-edge techniques such as the stomach-neoplasm therapy combined with laparoscopy and endoscopy, intraperitoneal hyperthermic perfusion chemotherapy, the digestive tract reconstruction after radical proximal gastrectomy for gastric carcinoma (functional jejunal interposition reconstruction) and laparoscopic splenic hilar lymph node dissection. In terms of comprehensive treatment, the Department is at the leading level nationwide. It has particularly explored and thus acquired plentiful experience in postoperative adjuvant therapy, perioperative chemotherapy, and perioperative chemoradiotherapy, laying a solid foundation for upgrading the overall prognosis of gastric carcinoma patients.

3. Blossoms and fruit - teaching achievements
The Department assumes the task to cultivate undergraduates and foreign students through specialty internships, teaches and trains undergraduates, postgraduates, and visiting students. Right now, one doctoral advisor and 4 advisors of master’s degree students serve in the Department. Altogether 18 master’s degree students and 11 Ph.D. students, including 2 international students, have been admitted during the five years since the establishment of the Department.

In 2008, the Department initiated the organization of the continuous medical continuing program “the standardized treatment class for advanced gastric carcinoma”. One year later, it ascended as the state medical continuing education program. So far, six sessions of the class have been successfully held and attended by medical peers in the gastric carcinoma field across the country. Through the five years, Prof. Zhan Youqing and Prof. Zhou Zhiwei have upheld the spirit of “being practical and innovative to serve the clinical purposes” and endeavored to provide a learning and exchange platform with distinct features and strong practicality. The increasingly improved quality and expanded scale of the class attracted over 400 participants merely in the sixth session in 2013, which contributed a great deal to the popularization of standardized gastric carcinoma treatment in China.

Since 2012, the Department has organized the “training class of new techniques and ideas for gastric carcinoma surgical treatment” every quarter of the year. Five to 8 participants are enrolled from different hospitals throughout China in each session. Visual operation observation, postoperative discussion, and specialty-based teaching are designed to actualize the standardization of gastric carcinoma operations; new techniques, ideas, and equipment are incorporated to lift the level and curative effects of gastric carcinoma operations. Until now, seven sessions of the training class have been completed and nearly 50 participants have been well trained.

To keep the theoretical teaching updated, Prof. Zhou Zhiwei specially arranged excellent teachers to revise certain chapters of the textbook -- Clinical Oncology. In addition, the Department has compiled the following works: Health Education on Cancer Prevention in Communities (edited by Zhou Zhiwei), Stoma Therapy and Rehabilitation -- Theory and Practice (edited by Zhou Zhiwei), and Melanoma -- Basis and Clinical (edited by Chen Yingbo). The Department has been involved in the editing of the following books: Principles of Personalized Medicine, Gastric Cancer (Peking University Medical Press), and International Comparative Study on the Scientific and Technological Innovation Ability of Chinese Modern Medicine. Gastric Cancer, the professional journal of gastric cancer single disease sponsored by the Department, has been regularly published to present the latest research on and hot issues about gastric cancer. Eight hundred to 1000 copies are printed for each issue and sent for free to experts and medical peers in the gastric cancer field across China. The latest Issue, number 9, has been published. Moreover, the professional website of gastric cancer was launched by the Department in 2009 to popularize the knowledge of gastric cancer and create a proper platform for facilitating the exchange among medical personnel and between medical personnel and patients.

For a young department, teaching is both the basic task to undertake and the essential basis for vigorous development. Since the construction of the Department, Zhou Zhiwei, the Chief for Department, has naturally regarded teaching as one of its focuses and development directions and spared no efforts to cultivate the educational awareness and teaching ability of the Department members. All the efforts paid off. Each member has become more enthusiastic about education and more capable to teach. In the annual teaching competition for youth teachers at Sun Yat-sen University Cancer Center, Yuan Shuqiang, the attending physician, and Qiu Haibo, the physician, won the third prize of the English group in 2011 and 2013 respectively. In 2014, Prof. Zhou Zhiwei won the title of SYSU Excellent Medical Manager of Clinical Work and Teaching. Such a title highly praised the individual dedication of Prof. Zhou Zhiwei to the medical profession and education for 30 years and acknowledged the outstanding contribution of the Department to teaching in recent years.

4. Looking ahead based on the present - scientific research principles which keep pace with the times
By sticking to the overall idea of clinical scientific research “top-level design, resource integration, advantage highlight, comprehensive promotion”, the Department has formed a sturdy research basis and rigorous scientific research tradition, trained an academic team with the reasonable echelon structure and substantial comprehensive strength, centered on stable research interest and exerted tremendous academic influence on the whole nation. It has presided over 20 programs supported by scientific research foundations, including 8 programs of state foundation and 10 programs of provincial and ministerial foundations. It has published over 50 papers on domestic and foreign journals, including more than 40 SCI papers respectively on such well-known oncology journals as Stem Cells, Annals of Surgery, PLOS ONE, and the Annals of Oncology.

The progress of scientific research requires a large amount of historical data and cases. Therefore, the Department has attached utmost importance to the construction of a basic database for scientific research. The operation database, specimen database, serum bank, cell bank, and so on have been soundly constructed during recent years. The gastric cancer database collects detailed data of nearly 4,500 gastric cancer cases performed since 1964. The operation imaging database started in 2013, has taken shape so far.

The year 2012 witnessed the establishment of the research group laboratory under the instruction of Prof. Zhou Zhiwei in the Department of Gastric and Pancreatic Surgery. In 2013, the Cancer Center specially invited Prof. Liang Chun from Hong Kong University of Science and Technology to be the guest professor to practice the reform idea of scientific research “walking out and inviting in” and to boost the efficient integration of clinical work and scientific research as well as the discipline construction. The team of Prof. Liang Chun and the research group of Prof. Zhou Zhiwei will cooperate closely and strive for mutual progress in the aspects of scientific research, talent cultivation, and especially the application of gastric cancer clinical accomplishments and international exchange.

At the moment, the Department takes the lead to undertake a multitude of multi-center clinical researches, including Sun Yat-Sen University Clinical Research 5010 Program “A Randomized Controlled Study of Preoperative Chemoradiotherapy Combined with Operation & Adjuvant Chemotherapy and Preoperative Chemotherapy Combined with Operation & Adjuvant Chemotherapy for Advanced Gastric Cancer Treatment”, “A Randomized, Controlled, Multi-Center, Open Phase III Clinical Research on S-1 Combined with Oxaliplatin and S-1 Single Drug for Adjuvant Chemotherapy of Advanced Gastric Cancer Patients after D2 Radical Gastrectomy”, and “A Clinical Research on Neoadjuvant Therapy with Trastuzumab Combined with XELOX for HER2-neu Positive Gastric/Gastroesophageal Junction Adenocarcinoma”. Apart from these, the Department, as the important experimental base of gastric cancer single disease in South China, has participated in many multi-center clinical studies, including the 11th Five-Year National Science & Technology Supporting Program “A Randomized, Controlled, Multi-Center, Phase II Research on Oxaliplatin Combined with Fluorouracil and Leucovorin Two-Week Plan (mFOLFOX7) for Advanced Gastric Cancer Perioperative Chemotherapy” and Classic research, which by a large margin increases the academic level and international influence of the Cancer Center in terms of gastric cancer clinical trials.

5. Being inclusive while following the best - talent cultivation and trans-national exchange unified with international standards 
The Department cultivates interdisciplinary talents of clinical work and scientific research by sending them for overseas studies and organizing talent exchange. In 2003, Prof. Zhou Zhiwei pursued advanced studies in the Surgery Department of Royal Adelaide Hospital, South Australia; in 2010, Chen Yingbo, chief physician, set out for advanced studies in Melanoma Institute Australia, Sydney; from Sept. 2011 to Sept. 2013, Xu Dazhi, associate chief physician, furthered his studies in the MD Anderson Cancer Center in the United States; from April 2009 to May 2011, Yuan Shuqiang, attending physician (a Ph.D. student at the time of going abroad), paid a visit to and studied in the MD Anderson Cancer Center in the United States; in 2011, Qiu Haibo, physician (a Ph.D. student at the time of going abroad), studied in the Harvard Medical School - Harvard University; in 2013, Wang Wei, attending physician, headed for Fujian Medical University Union Hospital to study laparoscopic surgery for gastric cancer; on February 19, 2014, Sun Xiaowei, chief physician, left for Xinjiang Kashi to assist in the construction of Xinjiang for one year and a half under the organization of Health and Family Planning Commission of Guangdong Province.

The Department has practiced the idea to cultivate talents by teaching students by their aptitude and letting them give full play to their respective talents. Under the leadership of the head of the Department, the Department members have been provided with spacious room for development and granted with numerous chances to share resources. Xu Dazhi, associate chief physician, and Wang Wei, attending physician, won the first and the third batch of funds respectively supported by the Youth Talent Training Program of Sun Yat-sen University Cancer Center.

To reinforce the influence of the Department and master the cutting-edge techniques and ideas, the Department has organized a variety of academic seminars on an irregular basis to invite domestic and foreign well-known specialists in gastric cancer and pancreatic cancer for exchange. The Department has also performed friendly academic exchange and close scientific research cooperation with such prestigious medical universities as Harvard Medical School,and Hong Kong University of Science and Technology.

Initiated and organized by the Department, the Guangdong Provincial Anticancer Association Gastric Carcinoma Committee was founded on November 20, 2009. Prof. Zhan Youqing served as Chairman of the First Committee. As the chairman unit of the Guangdong Provincial Anticancer Gastric Carcinoma Committee, the Department prepares and hosts the Guangdong Province Gastric Carcinoma Academic Symposium once a year to invite notable gastric cancer experts in mainland China to come and teach and especially invite gastric cancer experts and scholars from the United States, Japan, South Korea, and Taiwan to come and exchange. To date, five sessions of the symposium have been hosted and it has risen to be the honorary platform for medical specialists to impart professional knowledge and the supreme platform for medical peers to exchange academically. As such, it has laid the substantial foundation for popularizing the professional-consensus-based gastric cancer standardized diagnosis and treatment as well as promoting the profound clinical application of the scientific research accomplishments.

6. Creating a new chapter - starting a new journey to achieve more in the new era
As a State-level cooperation project between China and Singapore, the China-Singapore Guangzhou Knowledge City has a permanent population exceeding 130,000 inside a total planning area of 232 square kilometers. In terms of medical and healthcare, the knowledge city has introduced our hospital in 2010, and Unit III of the gastric surgery department opened in March 2021. Although Unit III has only 25 beds, various high-level treatments have already been performed successfully, including robotic surgery, total laparoscopic D2 gastrectomy, functional surgery, peri-operative chemotherapy, (neo)-adjuvant chemoradiotherapy, and hyperthermic intraperitoneal chemotherapy. 

Notably, Unit III focuses on and is specialized in treating neuroendocrine tumors and gastric cancer with peritoneal metastasis (GCPM). With the establishment of the multi-modality treatment of GCPM, an interventional, multi-center, and open-labeled phase II study to explore the safety and efficacy of intraperitoneal chemotherapy of Nab-paclitaxel combined with intravenous SOX plus Sintilimab systematic therapy for gastric cancer with peritoneal metastasis (GC-IP001 study) is about to start soon. In addition, enhanced recovery after surgery (ERAS), multiple disciplinary team (MDT), and nutritional therapy are performed as routine clinical practice in Unit III to carry on the excellent tradition. Moreover, minimally invasive surgery is appreciated and preferred to lower morbidity and mortality to put the patient first.

“The song of time resounds in waves; the game of career renews in rounds”. In the next five years, we are sure to inherit the excellent traditions, keep pace with the times, pioneer our work with innovation, and advance against adversities to actualize the grand vision of “being the leading nationwide and the first-class worldwide” and upgrade the level of gastric cancer prevention and treatment in China and realize the China dream of public health.

Zhou Zhiwei, Director, Professor of medicine, Chief Surgeon
Chen Yingbo, Deputy Director, Party Branch Secretary, Chief Surgeon 
Li Yuanfang, Deputy Director, Associate Chief Surgeon 
Sun Xiaowei, Chief Surgeon 
Yuan Shuqiang, Associate Chief Surgeon
Qiu Haibo, Associate Chief Surgeon
Wang Wei, Associate Chief Surgeon
Chen Yongming, Branch Secretary, Surgeon-in-Charge
Liang Yao, Associate Chief Surgeon
Yuan Xiuhong, Associate Professor of Nursing
(Drafted by Liu Wenwu, Luo Caibing and Liang Yao; Reviewed by Zhou Zhiwei, Li Yuanfang and Chen Yongming)

Updated November 2021

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