Akihiro Fujino: What a Pediatric Surgeon Secretly Thinks

2024/03/22

I am one of just over 1,000 general pediatric surgeons in the country. While surgical diseases in children are rare, they often require urgency. On the other hand, one is considered a full-fledged surgeon only after gaining the knowledge and experience to promptly diagnose and treat rare and intractable diseases. Consequently, the training to become a pediatric surgeon is actually quite demanding.

Now, when I first started my apprenticeship in pediatric surgery, there was a child with a giant lymphangioma of the neck. This disease occurs when parts of the lymphatic network, where lymph fluid circulates, swell into sac-like structures (lymphatic cysts) due to malformations during the embryonic stage, forming a mass. Although not malignant, it can cause significant cosmetic issues or compress the airway. Treatment is difficult, and some patients must live with the disease for the rest of their lives. However, at the time, there was no detailed research and no promising treatments. Therefore, I felt I had no choice but to figure it out myself. Since then, I have pursued research in various directions, including studying cell properties from excised lesion tissue, conducting nationwide surveys to provide medical cost subsidies for patients with intractable cases, making recommendations for designation as an intractable disease, creating websites for the public and medical professionals, and developing and conducting clinical trials for new treatments.

My activities gradually became known within our field. However, partly because there are few researchers working on a fundamental solution for lymphangioma, I began to believe that the mission imposed on me by fate was a great one, and along with that, I started to feel a dilemma. In other words, while keeping an eye on lymphangioma, I also wanted to aim to be a first-class surgeon who appropriately treats all kinds of diseases as the primary duty of a pediatric surgeon, so I did not restrain myself from immersing myself in various fields. As a result, I have reached my current position, but I cannot help but feel a sense of regret that if I had focused solely on lymphangioma without distraction, I might have furthered the understanding of the disease and improved its treatment much more, potentially helping many more patients—yet I did not make that choice.

There are many doctors who, through their own fateful encounters, dedicate their lives to seriously working on the elucidation and advancement of treatment for a single disease. I do not know how much I can achieve, but I am renewing my resolve to do my absolute best to bring about a breakthrough treatment for lymphangioma and fulfill the promise I made to my first patient—who is now an adult—and their family.