Famous Among Top Surgeons in the 90s-Chapter 1920 - 1921: Special Features

Chang Jiawei was estimating that the people from other departments present, including his old classmate Fu Xinheng, might not be able to explain the content of their orthopedics as fluently as Student Xie just did.

Doctor Liu curiously leaned forward, studying Student Xie Wanying, and posed another question to test her: "Can you explain en-bloc resection to him again?"

The senior was intrigued by her, wanting to explore in depth and discuss with her. Anyway, after her speech, it was just right to help them with the explanation work for the patient’s family, killing two birds with one stone.

"En-bloc resection is a surgical concept. It’s a non-specific concept that can be broadly applied to guide any surgical procedure, not just specifically referring to spinal surgery." Xie Wanying said while trying to help Student Geng recall relevant medical knowledge points, "For example, the radical cervix surgery we discussed in the gynecology department in the afternoon can be considered a form of en-bloc resection."

Such an analogy made it simple and easy to understand. Others listened and nodded frequently. 𝕗𝗿𝕖𝐞𝐰𝗲𝕓𝐧𝕠𝕧𝗲𝐥.𝚌𝐨𝚖

En-bloc resection directly translates to: entire block removal. This term doesn’t come with a specified prefix, indeed not referring to any specific surgery, just like Xie Wanying explained, it’s a principle applicable to any surgical department as a guideline. Simply put, it’s called total resection. Regardless of the tumor’s occupied area, as long as the entire anatomical region involved by the tumor is resected.

The biggest benefit of total resection is evident: it minimizes the issue of tumor spreading during surgery as much as possible. However, for patients and their families, hearing terms like total removal can be quite shocking, and it’s hard for them to accept the result of removing an entire block all at once.

Doctors’ choice whether or not to perform a total resection cannot rely on the feelings of the patient and their family; it’s necessary to look at the specific case and consider it separately.

Thinking back on his stepmother’s illness, he didn’t recommend a total resection. Now, they say his brother’s surgery will remove his entire vertebral body, and it’s the spine we are talking about; knowing what missing a vertebral body means is something he is very clear about as a medical student. Geng Yongzhe’s face turned pale, and he felt heartache, saying: "Didn’t they say it’s benign? Why remove the entire vertebra? Is there no other surgical option?"

Spinal surgery, like any other surgery, certainly has multiple surgical options. For example, there are the commonly heard palliative decompression surgeries for late-stage patients where only laminae are removed, early-stage surgeries that involve curetting and excising only the visible tumor parts, and the WBB staging resection surgeries developed on this basis where the tumor’s invaded range is judged to extend resection as much as possible while preserving tissues. However, clinical practice later proved that such staged surgeries in spinal surgery can’t always achieve great outcomes like breast-conserving or uterus-conserving surgeries. Bones are hard and not as easily distinguishable and dissected pathologically as soft tissues.

"The spine area is quite special. For instance, with spinal tuberculosis, entire vertebra removal is common. Doctors primarily look at the degree of bone destruction. If the bone destruction is significant, whether you remove the entire vertebra or not makes little difference. On the other hand, whether benign or malignant, as this area involves the spinal cord, it’s difficult for doctors to partially peel away and cleanly remove many tumors, making recurrence easy. Not all benign tumors are non-recurrent once removed, like the benign uterine fibroids we’ve seen in gynecology. Given your brother’s young age, doctors need to consider the possibility of recurrence more seriously. Total vertebra removal lowers the risk of recurrence to the lowest possible level, even if it’s a malignant metastatic tumor," Xie Wanying explained to Student Geng.