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A surgical life by Takeshi Sano, MD, PhD

I am a surgeon specializing in gastric cancer. I graduated from the University of Tokyo in 1980, and after surgical training, spent 15 months at Institut Curie, Paris as a research fellow with a French Government scholarship. This flavoured my subsequent life with a European taste. For the past 30 years, I have concentrated on surgery and clinical trials on gastric cancer in the two largest cancer centres in Japan,  the National Cancer Center and the Cancer Institute, traveling around the world for lectures and live demonstrations of gastrectomy. I have been also involved in formulating domestic and international classifications and guidelines for gastric cancer. Nowadays, I have almost left the operating room and am engaged in management as Hospital Director of the Cancer Institute.

What made you decide to become a surgeon?

I was born in to a medical family going back many generations in a small castle town and had no alternative but to become a doctor! During the clinical classes in medical school, I was bored with reading the thick medical records written by earnest residents of internal medicine: lots of data, differential diagnoses, copies of references, but no clear solution. Surgeons’ patient notes were fascinating: simple description of surgery with drawings, uneventful postoperative days, sometimes followed by unexpected pathological results. A senior surgical resident confessed that he was not a diligent medical student (too busy with his soccer club) but was able to stand on the same starting position as other brilliant classmates. The story was quite convincing.

Who were your influences?

At National Cancer Center, Tokyo, my senior Dr. Mitsuru Sasako and I formed a partnership as gastric surgeons and played a leading role together in a series of randomized controlled trials for gastric cancer. He made me abandon my old family policy to live without disturbing others. I started to force myself to make noise to change my surroundings.

What were your training highlights?

Before specializing in gastric cancer, I worked at a provincial hospital as a general surgical trainee for 3 full years. I was young, single, and eager to become an all-round clinician, and used to tell duty doctors to call me whenever they saw “interesting” cases, which they did. I experienced a great variety of surgical and non-surgical patients. This has become a treasure for an extremely specialized surgeon who went on to treat only gastric cancer in my subsequent life.

Tell me about a surgical triumph

A Japanese proverb says “the soul of a child of three is the same at 100”. My first surgical instructor repeatedly told me “The faster, the better”. He was indeed a fast surgeon who completed a gastrectomy with lymphadenectomy within 90 minutes. My goal was set for a fast surgeon, and I always attempted fast surgery. At first, the attempt often did not work well, but I succeeded in establishing my style of surgery concentrating on rapid and only essential movements. A dilemma was for cancer surgery which required meticulous, time-consuming lymphadenectomy, but I tried to balance its extent and the time. I usually completed gastrectomy one hour faster with less postoperative complications than my colleagues, but the innovation with minimally invasive techniques has made this policy obsolete.

Tell me what you learned from a surgical disaster

I was dissecting the para-aortic lymph nodes in a patient with gastric cancer when a sudden massive bleeding started from the aorta. I stopped it by finger pressure, and when the first try of suturing failed, my heat began beating fast. I furiously thought what to do but in vain and called a colleague who was operating in the next room. He was cool and suggested a proximal aortic clamp which I should have come up with normally. It worked well. Since then, whenever something very unusual happens, I never hesitate to call other people, even my juniors, instead of trying to solve it alone.

What was your proudest achievement?

Through discussion with surgeons during my world tour (lectures and live gastrectomy in 43 and 13 countries, respectively), I keenly felt the fundamental differences in the concept between the AJCC/UICC TNM classification and the Japanese Classification of Gastric Carcinoma that  represented the West and East respectively. I was determined to bridge the gap and set up an international project by inviting active gastric surgeons in the world. Based on the data of 25,000 cases of curative gastrectomy with 5-year follow-up from 15 countries, we proposed a new classification of pathological stage, that  has been adopted in the current TNM classification. I succeeded in persuading the Japanese Association to change the long traditional staging system and  adopt the TNM classification.

What are your hobbies outside surgery?

Traveling abroad visiting historical places and good restaurants was my greatest hobby before COVID-19. My French driving license I obtained during my fellowship in Paris 35 years ago is still valid, and I can’t wait for the day I drive around Europe again.

What advice would you give a young surgeon?

As surgeons have low expectations of securing a good work-life balance, it is ideal to have a partner with good understanding of your work. Surgeons’ life is not monotonous: some periods of intensive work are  required  both during in  initial and  more specialized phases of  training, but you may have quiet times when you can support your partner’s work. Do not forget constant efforts need to be made to create  reciprocal understanding.

What would you be, if you had not been a surgeon?

I seriously looked for an answer to this question, but did not think of anything. I did have several dreams in my early life, but none of them would have brought me  the same satisfaction as I have  had as a surgeon.

Any regrets?

I have known two types of surgeons who lead surgical oncology: those who are ambitious to develop new techniques, and others who try to standardize and diffuse safe techniques. The former does not fear failure, while the latter is extremely fearful of it.  I am a perfect example of the latter. I regret not having tried pioneering new techniques in my high-volume circumstances.


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