Cutting to the Chase: My Month in Surgical Oncology

Starting with a Whipple

The pancreas is not supposed to be easy to remove.

It sits deep in the abdomen, closely nestled against the duodenum, and surrounded by some of the major blood vessels in the abdomen. A single mistake can have devastating consequences.

The highly skilled surgeon gently mobilises the duodenum and separates the pancreatic neck from the underlying portal vein. Small veins draining the pancreas are carefully cauterised and divided, all while constantly visualising the major vessels beneath. Further along, the dissection moves to within millimetres of the superior mesenteric artery (SMA), one of the largest arteries supplying the intestines.

There is little room for error. The tissue is dissected away layer by layer, with the SMA remaining in constant view. Every movement is deliberate. Every structure has to be recognised before it is touched.

Suddenly, the anatomy I had been casually revising felt very real.

This was one of the operations I observed during a month at Tata Memorial Hospital in Mumbai, India

A month at Tata

During my second-year summer break, I had the opportunity to do a 1-month observership at Tata Memorial Hospital in India. Tata Memorial is the country’s premier cancer institution, treating patients from across India and South Asia. I was an observer in the Department of Surgical Oncology, which gave me the opportunity to observe surgeries across various specialities, including colorectal, head and neck, breast, neurosurgery, and urology. Apart from watching surgeries, I also sat in colorectal clinics and observed cystoscopies.

Coming from Aberdeen, the experience was very different from what I was used to. Of the 14 operations I saw, there were a few that particularly stood out to me. The first was the Whipple I mentioned earlier, which was also my first time seeing pancreatic surgery up close.

Cool surgeries

Whipple

The Whipple procedure is an operation used to treat pancreatic cancer. It involves removing the head of the pancreas, the duodenum, gallbladder and part of the bile duct, before reconnecting what remains so that everything can continue to function. I know that sounds like a lot! And it is. It is one of the most complex operations in surgery and, for some patients with pancreatic cancer, can offer the possibility of a cure.

The Whipple I watched was performed robotically and lasted around eight hours. Seeing it firsthand gave me a new appreciation for just how much training and knowledge goes into performing an operation like this. What I found most interesting was seeing anatomy I had learned in lectures actually being used in front of me.

Structures I had only seen in diagrams were suddenly right there in front of me. The surgeons used their knowledge of anatomy to guide every step of the operation. It made me realise that there is a lot more to anatomy than remembering diagrams for an exam.

Head and neck cancer

The head and neck operation was another one that really caught my attention. I watched the surgeons remove a tumour from the anterior neck, with part of the mandible also being resected. Compared to the eight-hour Whipple, it felt relatively quick, lasting around three to four hours.

What I found really cool was seeing the anatomy of the neck in person. Seeing the hyoid muscles without the different colours and labels I was used to from anatomy diagrams took a bit of getting used to. Seeing the surgeons carefully identify and dissect the recurrent laryngeal nerve made me realise how important it is to preserve. I don’t think I’ll ever forget that damaging it can leave a patient with a hoarse voice now.

Colorectal cancer

Another operation that stayed with me was a robotic anterior resection of the rectum. For me, the most memorable part, apart from the operation itself, was the questions.

The surgeon would occasionally turn to me during the operation and ask me something about the anatomy. I wasn’t doing particularly well. Then, halfway through the surgery, he pointed to an opening in the lesser omentum.

“If you can tell me what that is, I’ll buy you a drink.”

Somehow, I remembered the opening between the greater and lesser sacs of the peritoneum from anatomy teaching. “The epiploic foramen?”

He turned around, looking genuinely surprised.

“Very good.”

I probably won’t remember every operation I saw at Tata, but I remember that moment. Being asked questions in theatre can be nerve-wracking, especially when you haven’t got the answer straight away. But getting one right after struggling with the others feels pretty good.

What surprised me 

The first thing that struck me was the sheer number of patients. Tata felt incredibly busy, with hundreds of people waiting to see a doctor and long queues outside clinics. As one of the biggest tertiary cancer centres in India, the number of patients coming through the hospital was enormous. What surprised me was how many patients were presenting with advanced cancers. With primary healthcare in India facing challenges with access and early detection, many patients can present later in the course of their disease, when treatment is more difficult. Seeing this first-hand made the importance of early diagnosis much more obvious to me.

Speaking to patients who had travelled hundreds of miles for treatment really stayed with me. Before accommodation was available for relatives, many would sleep on the streets around the hospital just to be close to their loved ones. Hearing these stories was difficult, and it made me reflect on how much patients and their families can go through beyond the illness itself.

I could also see how working in such a high-volume environment gives doctors the opportunity to see a huge variety of cases and build experience quickly.

Consultants and residents ran clinics and often operated several days a week. Resident doctors also had more opportunities to scrub in for a wide range of surgical procedures. The downside was the workload, with very little separation between work and life during training.

Another difference I noticed was a sense of respect and hierarchy the team had with consultants. Senior consultants were treated with a level of respect that felt more pronounced than what I was used to in the UK. At first, I found this a little intimidating, but I quickly got used to it and came to appreciate the experience and responsibility that came with those senior roles.

Why surgical oncology matters

Cancer is becoming an increasingly significant global health challenge, with cases continuing to rise. Despite advances in clinical medicine and cancer treatments, surgical removal remains one of the best treatment options when feasible. With national cancer prevention and early detection programmes, more cancers may be diagnosed at a stage when they are operable. Hence, training in various oncological surgical specialities is increasingly important.

As cancer services in the UK become increasingly concentrated in tertiary centres, it becomes all the more important to train surgical residents in a range of complex procedures during their training programme.

What I took back to Aberdeen and what I’d recommend

As a medical student, surgical oncology is one of the best ways to develop an understanding of surgical anatomy and appreciate the level of training, knowledge and teaching involved in becoming a surgeon.

Practice makes perfect. The more you observe and the more you learn, the better your understanding becomes. Exposure to high-volume centres early in your career gives you a glimpse into the realities of surgical training, how long it takes to develop these skills, and the pressures that come with working in demanding specialities. It also helps you think more carefully

about which speciality you might want to pursue in the future.

Beyond surgery, experiencing a different healthcare system allows you to see how things are done elsewhere. It gives you the chance to reflect on differences in healthcare equity, how teams manage busy workloads and where things could work more efficiently. Seeing these differences can also give us ideas that could be adapted to improve parts of the NHS. As a medical student, there is still so much to learn, and experiences like these offer a different perspective on healthcare that you can carry with you into your future career.

Written by Prithvi Saklani

General Member and BASOt Representative