• Mr Satya Bhattacharya

Health

Q&A: Mr Satya Bhattacharya

Consultant surgeon at The London Clinic on dealing with diseases of the pancreas

Interview: Viel Richardson
Portrait: Alice Mann

What is the pancreas and what does it do?
The pancreas is a carrot-shaped gland with a bulbous head and a tapering tail, located underneath the back of the stomach. It does two jobs: one is producing the enzymes which digest the fatty component of your food and the other is making insulin, which controls your blood sugar.

What are the types of conditions and diseases that affect the pancreas?
There are three illnesses that commonly affect the pancreas. One is inflammation, which is called pancreatitis. In the acute form you might get very bad stomach pain and become very unwell, which could lead to a hospital admission. There is also chronic pancreatitis, which is where the pancreas may not be making enough of the enzyme needed to properly digest your food. This leads to malabsorption, which is where food doesn’t get absorbed properly and can cause diarrhoea and chronic abdominal pain. Then there is pancreatic cancer.

Pancreatic cancer has a fearsome reputation. Is it justified?
If you look at cancer deaths in the western world pancreatic is number four, even though it is quite a rare form of cancer. The reasons are twofold: firstly, the symptoms do not manifest until the disease is quite progressed and has often spread to other parts of the body. This means that surgery, which is the most effective treatment, is no longer a feasible prospect. The second is that chemotherapy or radiation treatments, which are your only options, do not have a very good success rate with this cancer.

Has there been much progress in treating pancreatic cancer since your time in the field?
There has. A lot of patients are now being identified sooner, as scanning facilities have become more accessible and people are more likely to have ultrasound or CT scans for other reasons. There is also a growing awareness of this type of cancer within the medical field, so clinicians are more likely to advise a scan sooner rather than later. The surgery has also become a lot more refined and skillful since I started training. Finally, while it is still early days, some chemotherapy drug trials are beginning to produce encouraging results.

Is it difficult to operate on these tumours?
It is one of the more complex and challenging operations we do. The reason for that is that it is not just about cutting the tumour out. If the tumour is at the head end of the pancreas, the operation very often involves removing the part of the bowel which runs adjacent to the pancreas and a bit of the bile tube that runs through the pancreas into the gut. If it is at the tail end, its next door neighbour is the spleen, so you may lose your spleen.

What has been the nature of the surgical improvement?
One big improvement has been in our ability to manage the complexity of the operation more effectively. We also have better tools to help us do the operation: better critical care facilities, better anaesthesia, better ways of controlling the pain after the surgery. All of these put together have led to improved outcomes for patients.

What have been the big sticking points?
The main challenge is that, unlike many other cancers, we do not have a good biomarker for pancreatic cancer. By biomarker, I mean a test that confirms that you have this form of cancer. The lack of a reliable biomarker means it is difficult to get a handle on the disease early, which is critical for successful treatment. A reliable method of getting an early diagnosis could transform treatment of the disease.

Where do you see treatment in the future?
In 10 to 20 years I hope we have developed a way to identify a reliable biomarker, have access to better chemotherapy drugs and a more sophisticated way of doing surgery with reduced damage to nearby organs.

Did you always know you wanted to be a surgeon?
I always thought surgery was an exciting thing to do, but there were other aspects of the medical side that really interested me. As I spent more time on the surgical wards and in operating theatres, I realised that surgery was what I wanted to do.

Were you always interested in the pancreas?
After training as a surgeon in Mumbai, I was fortunate enough to get into the Royal Free Hospital here in London as a surgical registrar. The hospital has a world famous liver and pancreas surgical unit and I really enjoyed being there when I was on rotation.

I undertook a period of research looking at liver cancer, while keeping one foot on the clinical side, and became a senior registrar and lecturer in the department. In the space of four years I had mutated from a general surgeon to a liver and pancreas surgeon, which I have remained ever since.

What is it about this field that attracts you?
Partly, the complexity of the work. There is very little that is an easy option; they are all long, difficult, challenging operations. Each patient’s situation is like a very complex puzzle that needs to be resolved—and I enjoy that challenge.

Do you think this work particularly suits some aspect of your personality?
Unlike some specialities, I get to fix things. Providing everything has gone well, the patient goes away happy. With cancers, you’re not always sure, but you do have a clear idea of whether the surgery has gone well. There is an element of real satisfaction for both the patient and myself when it does go well and they are discharged.

What gives you the most satisfaction about what you do?
There are several aspects to my work that I really enjoy, the first is being in the operating theatre. During an operation you are in a zone, doing something very complicated with your hands, and you’re entirely focused on it. You have a team who are completely tuned in to what you are doing and there is a feeling of a group of people working in superb harmony, which is wonderful.

There is also a creative element to the surgery—you take some things away and join others together. Once the operation is over, there is a feeling similar to that of being a sculptor who has finished a piece, or a painter completing a canvas. This, combined with the knowledge that what you see will serve the patient better, gives me real satisfaction.

Finally, I really enjoy the interaction with the patients—getting to know them as people and seeing them through their treatment. While I love being in the theatre, in the end what I do is about helping other human beings.