"First Resect, Then Irradiate" to Make Tumors "Die in the Light": Shanghai First People's Hospital Pioneers Intraoperative Photodynamic Therapy in Complex Surgery

Recently, a team led by Dr. Chen Hao, Director of the Clinical Oncology Center at Shanghai First People's Hospital, successfully performed a complex secondary resection of retroperitoneal and massive mesenteric metastatic tumors in a patient with clear cell renal carcinoma. Innovatively, they applied intraoperative photodynamic therapy (PDT) to precisely eliminate residual cancer cells and reduce recurrence risk. Literature reviews confirm this as Shanghai's first application of PDT in such a complex procedure.

The patient had undergone right nephrectomy for renal clear cell carcinoma at another hospital over a year prior. In April this year, follow-up scans revealed intraperitoneal tumor recurrence, with poor response to antitumor therapy and conservative treatment. By July, the patient presented with abdominal pain, and CT scans showed massive retroperitoneal and mesenteric metastases (approx. 15cm x 13cm), some suspected of ruptured hemorrhage. Given the tumor's size, deep fixation near the small bowel mesentery root, and dense adhesions to critical vessels and organs, reoperation posed extreme challenges. The patient sought help at Shanghai First People's Hospital.

Dr. Chen's team initiated multidisciplinary (MDT) consultations involving anesthesiology, radiology, emergency/critical care, and nursing for thorough preoperative planning. To minimize recurrence, they devised a strategy combining tumor resection with immediate intraoperative PDT.

During surgery, the MDT team executed precise roles: anesthesiologists dynamically monitored hemodynamics and adjusted medications in real-time, while surgeons meticulously dissected the tumor from adherent vascular plexuses and organs under constrained visibility. After overcoming risks of hemorrhage and collateral damage, they achieved complete resection, followed by immediate PDT application to the tumor bed. The patient is now recovering well.

Dr. Chen explained that PDT leverages tumor-selective photosensitizer accumulation, which—when activated by specific light—generates cytotoxic reactive oxygen species to target residual cells. By administering PDT immediately post-resection when photosensitizers remain concentrated, the team achieved far greater efficacy against potential residual cells than delayed PDT could offer. This breakthrough approach, initially trialed for recurrence-prone retroperitoneal tumors, may soon extend to gastric, colorectal, and other high-risk abdominal cancers to refine precision therapy.