Chen Zhiping, Professor of Surgery, Former Director of the Department of General Surgery, Renji Hospital, Shanghai 

Introduction:

Dr. Chen Zhiping’s career mirrors the development of modern Chinese medicine. From the turmoil of the 1930s to the prosperity of the post-Reform and Opening-Up era, he witnessed the evolution of China’s medical community from its nascent stages to maturity. He specialized in the surgical treatment of portal hypertension and gastric tumors. In the mid-1970s, he pioneered the emergency mesocaval shunt (end-to-side anastomosis between the superior mesenteric vein and inferior vena cava) to treat rebleeding after splenectomy for portal hypertension. In the 1980s, he was among the first in China to use indirect portography to study how pre- and postoperative hepatic hemodynamic changes in portal hypertension impacted surgical outcomes. He also initiated preoperative arterial interventional chemotherapy for advanced gastric cancer, achieving significant pathological responses.

However, Dr. Chen’s accomplishments extend far beyond these clinical innovations. As a dedicated educator, he nurtured generations of doctors with immense passion, passing on his deep love for medicine and his pursuit of excellence to every student. He often stated, “In a teaching hospital, clinical practice and education are equally important.” This commitment to education and sense of responsibility became a powerful driving force, inspiring future generations to continuously explore the frontiers of medicine.

Following in Dr. Chen Zhiping’s footsteps, we can revisit an era defined by challenges and idealism, appreciate profound appeal of medicine, and understand a physician’s mission to heal the sick.

The Genesis of a Vocation

In the comfortable living room of his home, nonagenarian Chen Zhiping sits at a tea table, carefully leafing through an aging, yellowed English medical book. The volume details the principles of portal hypertension hemodynamics, reflecting Dr. Chen’s deep expertise in gastrointestinal tumors, portal hypertension, and hepatobiliary diseases.

“Every time I flip through these old books and mementos, memories come flooding back,” Dr. Chen remarks, his voice slightly hoarse yet filled with nostalgia. “I remember when I first stepped into medical college in the early 1950s. The nation was recovering, rebuilding from ruins. Medical conditions were primitive compared to today; infectious diseases ran rampant, and people suffered immensely.”

He gently caresses the books and photographs that hold memories of the past, continuing his narrative: “I was frequently ill as a child, often bedridden for weeks. Shanghai experienced outbreaks of lobar pneumonia back then. Each time I fell sick, I could see the undisguised worry on my parents’ faces. However, one of my uncles was a respected practitioner of traditional Chinese medicine (TCM). His busy figure and the satisfaction he derived from relieving patients’ suffering quietly planted the seed in my heart to save lives and heal the sick. My uncle’s clinic was always filled with the aroma of Chinese herbs, and its walls were adorned with silk banners of gratitude from patients. He not only healed countless people with his medical skills but also earned their deep respect through his benevolence.” Chen Zhiping often accompanied his uncle on house calls. Watching his uncle use exquisite skills and warm hands to bring hope to patients solidified his dream of becoming a doctor.

In an era without television or the internet, Chen Zhiping’s childhood was spent immersed in books and stories. On summer nights, he would gaze at the stars in the courtyard, listening to elders recount medical legends from ancient and modern times, both Chinese and foreign. Stories of figures like Bian Que and Hua Tuo filled him with boundless admiration for the field of medicine.

When speaking of his childhood dream, Chen Zhiping’s eyes suddenly brighten, as if the ambitious young man stood before him once more. He recalls reading the novel The Sword in the Surgeon’s Hand about Dr. Norman Bethune, which solidified his resolve to study medicine. “The ‘sword’ in the doctor’s hand is the weapon against disease. Back then, I dreamed that one day I too could become such a physician, using my skills to conquer disease for my patients.”

In the spring of 1958, Chen Zhiping finally realized his childhood dream, becoming a doctor. Standing on the stage at the graduation ceremony of Shanghai First Medical College (now Fudan University Shanghai Medical College), the twenty-something graduate, clad in a crisp white coat, radiated determination and passion. This marked the beginning of his long and distinguished medical career.

Innovative Application of Mesocaval Shunt for PHT Rebleeding

Dr. Chen Zhiping’s years at Renji Hospital were the most brilliant chapter of his medical career. His dedication to tackling the formidable challenge of portal hypertension (PHT) became a defining bond with this historic institution.

It was a bright morning when the young Chen Zhiping, filled with enthusiasm, stepped through the gates of Renji Hospital. As a new member of the Department of General Surgery, he not only faced the dual challenges of portal hypertension and gastrointestinal tumors but also had the privilege of being mentored by Professor Kuang Yaolin. Professor Kuang was already a leading figure in the surgical treatment of PHT, one of the earliest experts in China to engage in this field. Professor Kuang’s profound academic achievements, rigorous medical ethics, and noble character deeply influenced Chen Zhiping.

In that era, portal hypertension (PHT) was a formidable challenge in clinical surgery. Chen Zhiping understood its complexity well. While PHT itself is not fatal, its complication—esophageal variceal bleeding (EVB)—posed a constant, life-threatening risk to patients. The therapeutic goal at the time was to control these complications rather than directly address the underlying cause, cirrhosis. Consequently, treatment often managed symptoms rather than curing the root disease.

“Of course, as physicians, we didn’t sit idly by in the face of this challenge,” Chen Zhiping recalls with a hint of pride regarding the progress made at Renji Hospital. “In 1953, Professor Lan Xichun performed the first splenorenal shunt in China, opening a new path for PHT treatment. Subsequently, in 1954, Professor Kuang Yaolin proposed an innovative method combining gastric fundic vein ligation with splenectomy to manage EVB. In 1963, Professor Lan returned from the Afro-Asian Medical Conference in Cairo, bringing back the pericardial devascularization procedure, further enriching Renji Hospital’s therapeutic arsenal. In 1964, Renji Hospital conducted a retrospective analysis of its surgical cases and found that PHT patients with jaundice or ascites had significantly higher surgical mortality rates. This discovery had crucial implications for treating PHT patients. The research was published in the Chinese Journal of Surgery and was promptly selected for abstract publication by the renowned international journal Surgery, Gynecology & Obstetrics (SGO), demonstrating Renji Hospital’s international influence. Then, in 1978, I innovatively employed the emergency mesocaval shunt to manage rebleeding after splenectomy. The application of this technique significantly improved surgical success rates and reduced patient mortality.”

Like every major breakthrough in medicine, the treatment of portal hypertension (PHT) was deeply influenced by its historical context. In the early 1950s China, schistosomiasis cast a shadow over the vast agricultural regions of the Yangtze River basin. This disease not only severely endangered public health but also posed a major obstacle to agricultural development. Responding to a nationwide call launched by Chairman Mao to “eliminate schistosomiasis,” a massive prevention and control campaign was initiated. As a surgeon at Renji Hospital, Chen Zhiping also joined this battle.

Surgical treatments for portal hypertension (PHT) are diverse but can be broadly categorized into two main types: shunt surgery and devascularization surgery. Shunt surgery creates an anastomosis to divert portal blood flow into the low-pressure systemic venous system, thereby reducing portal pressure and preventing bleeding. Devascularization surgery, on the other hand, blocks the collateral circulation between the portal and azygous veins to prevent bleeding, without reducing portal pressure.

In his clinical practice, Chen Zhiping discovered that while both types of surgery had merits in preventing bleeding, they also had significant drawbacks. Shunt surgery could lead to hepatic encephalopathy and liver function deterioration due to reduced blood flow to the liver. Devascularization surgery, while not reducing portal pressure, often saw the formation of new collaterals over time, leading to recurrent bleeding.

“The challenges we faced in that era were immense,” Chen Zhiping recalls. “Every PHT patient presented a unique clinical picture. Determining the optimal treatment plan for each individual was a daily preoccupation. Splenectomy was once a common surgical approach for PHT, but postoperative rebleeding occurred frequently, posing a serious threat to patients’ lives. Conventional treatments often struggled to effectively control rebleeding and carried high risks. Therefore, finding a more effective therapeutic solution became an urgent priority.”

Faced with this challenge, after in-depth research and repeated practice, Chen Zhiping pioneered the emergency mesocaval shunt (end-to-side anastomosis between the superior mesenteric vein and inferior vena cava). This procedure directly connected the superior mesenteric vein to the inferior vena cava, bypassing the portal system and effectively lowering portal pressure to control bleeding. The advantages of this shunt included simplifying the surgical process, rapidly reducing portal pressure to effectively control bleeding, and being particularly suitable for emergency situations involving rebleeding after splenectomy.

In 1964, Renji Hospital established the Schistosomiasis Research Institute, comprising both internal medicine and surgery departments. The surgical aspect was led by the PHT specialist group under Director Kuang Yaolin. They understood that no single surgical approach could perfectly suit all PHT patients. To overcome these challenges, Chen Zhiping utilized a then-new technology—indirect portography—to study the hemodynamic changes in PHT patients. This technique provided clearer vascular imaging, helping physicians better understand the blood flow dynamics within the portal system, thereby enabling the formulation of more precise treatment plans. The goal was to combine the advantages of shunt and devascularization surgeries while mitigating their respective disadvantages. This personalized approach allowed for adjusting the surgical plan based on each patient’s specific condition to achieve better therapeutic outcomes.

Spring Breeze: Renji Hospital’s Dialogue with World Medicine

The spring of 1984, amid China’s Reform and Opening-Up, brought unprecedented opportunities for the Department of Surgery at Renji Hospital. As the doors to international exchange opened, the visit of Professor John Price, a world-renowned authority in portal hypertension (PHT) surgery, became a landmark moment for the department.

On that sunny morning, Professor Price and his team arrived at the West Four Ward. They toured the large ward, focusing on the condition of PHT patients. Subsequently, Dr. Chen Zhiping presented the department’s recent research: “The Significance of Indirect Portography for PHT Surgery.” He detailed how this technique, involving selective arterial catheterization, provided clear visualization of the portal vein, offering a new perspective for the diagnosis and treatment of PHT.

Professor Price was particularly impressed by Dr. Chen’s introduction of the emergency mesocaval shunt (ES-MCS) developed by Renji Surgery to treat late-onset esophageal variceal bleeding (EVB) after splenectomy. This innovative procedure not only provided definitive control of bleeding but also had a low incidence of hepatic encephalopathy. Dr. Chen’s explanation captivated the visiting physicians. They inquired about the surgical details and remarked, “This angiographic technique is not commonly seen where we work either. Your work is truly impressive.”

“Professor Price’s evaluation centered on two keywords: ‘courage to take responsibility’ and ‘innovative’,” Dr. Chen recounts. “There are some events and feelings from this research process worth recalling.”

In the early 1980s, China’s medical community was in a period of transformation. Renji Surgery decided to undertake a large-scale study on PHT portal hemodynamics. Despite facing prolonged exposure to continuous X-ray radiation and numerous challenges, under the decisive leadership of Director Kuang Yaolin and his admonition to be “bold yet meticulous, with thorough planning,” the collaboration between Renji Surgery and the Department of Radiology commenced.

Faced with the difficulties of vascular interventional procedures, Dr. Chen and his team did not retreat. They adopted a rotational system with small teams to minimize individual radiation exposure. After navigating the initial learning curve, the procedures became increasingly smooth.

Dr. Shen Mouji from the Department of Radiology played a pivotal role, personally guiding each angiography session and refining everything from the procedural workflow to complication prevention. The dedication and teamwork of Drs. Wu Zhiyong, Jiang Guangjie, Zhou Haogeng, Huang An, along with numerous graduate students and resident doctors, led to the successful completion of 70 cases in 18 months, without a single complication.

In 1986, at the National PHT Surgery Conference, the research findings of Renji Surgery received high praise. The conference chairman recommended its adoption by qualified hospitals nationwide. That same year, the Chinese Journal of Surgery featured Renji Surgery’s research as the lead article in its November issue, reflecting the hospital’s leading position in the PHT field within China.

By the mid-1990s, Renji Surgery again earned recognition from domestic and international peers for its research on combined devascularization and shunt procedures. Behind these achievements lay the diligent work and relentless exploration of the Renji Surgery team. Their story is a clear example of the spirit of medical innovation and a testament to the power of teamwork.

In medicine, every breakthrough is forged through the dedication of countless healers. Professor Price’s visit and evaluation were not only recognition of the physicians’ professional standards but also a dialogue between Renji Hospital and the world of medicine.

A Tribute to the Era, The Physician’s Mission

In the early 1990s, China witnessed a revolution in medical technology. Amidst rapid economic and technological advancement, the treatment of portal hypertension (PHT) underwent transformative changes. Where physicians once relied on traditional portography for diagnosis, non-invasive techniques like Doppler ultrasound and magnetic resonance portography had taken their place, offering gentler, more precise imaging and bringing new hope to patients.

The rise of minimally invasive hemostatic techniques marked a new chapter in PHT treatment. The application of endoscopic technology significantly alleviated patient suffering and reduced reliance on traditional open surgery. Physicians were no longer limited to wielding the scalpel; they could now perform more refined endoscopic procedures, offering patients safer and more effective treatment options.

The success of liver transplantation technology offered new hope for patients with cirrhosis. This groundbreaking advancement made the radical cure of cirrhosis possible, allowing countless patients who had been in despair to see the chance for a new life.

Simultaneously, significant achievements were made in schistosomiasis prevention and control. Once widespread in the Yangtze River basin, schistosomiasis was nearing elimination thanks to comprehensive control measures and medical progress. This achievement was not only a major public health breakthrough but also a powerful example of medical progress.

The widespread application of hepatitis vaccines significantly reduced the incidence of hepatitis. This period highlighted the growing importance of preventive medicine.

Throughout this process, the role of the physician was also evolving. They were no longer merely executors of surgery but became architects and implementers of comprehensive treatment plans. They needed to continuously learn new technologies and master new therapeutic methods to better serve their patients.

The older generation of physicians passed on their experience and wisdom to the younger generation, while younger doctors embraced new knowledge with a more open mindset. This legacy was the transmission of not only knowledge but also a physician’s compassion.

The changing times and technological progress brought unprecedented opportunities and challenges to the medical field. The revolution in PHT treatment is just one microcosm. As physicians, we feel immense gratification to have witnessed and participated in this historical process. Yet, we also know that the pursuit of medical knowledge is endless, and a physician’s mission is never truly complete. We will continue to move forward—for the health of patients, for the advancement of medicine, and for that unwavering healer’s compassion.

In his office at Renji Hospital, silk banners and letters of gratitude on the walls are a testament to Dr. Chen Zhiping’s dedication to his patients. He often reminds young doctors: “Exquisite skill and excellent service—this is our creed as healers.” As an outstanding physician and mentor, Dr. Chen cultivated numerous medical talents, including 16 master’s students and 5 doctoral candidates.

Dr. Chen’s contribution to medical education lies not only in his research and clinical practice but, more importantly, in his dedicated mentorship of the next generation. He adhered to the “Three Fundamentals” educational philosophy—solid training in basic theory, knowledge, and skills, combined with the close integration of theory and practice. He encouraged his students to explore boldly and innovate courageously; his teachings became a guiding light on their academic paths.

As the years passed, Dr. Chen remained devoted to medicine and his students. On that quiet afternoon, he closed the photo album filled with memories, his gaze resting gently on a group photograph of Renji Hospital’s experts over the years.

“Although the path of medicine is arduous, I have never regretted it,” Dr. Chen reflects. “The smiles of recovered patients and their sincere gratitude are my most precious rewards.” He believes that no matter how the times change, as long as young doctors remain committed to the fundamental aspiration of saving lives and healing the sick, they will surely excel in the field of medicine.