Professor John Neoptolemos

Professor of Surgery and Head of the Institute of Cancer Studies, University of Liverpool
Division of Surgery and Oncology, Royal Liverpool University Hospital
Honorary Consultant Surgeon at the Royal Liverpool University Hospital

Professor Neoptolemos grew up in London. As an undergraduate he studied Natural Sciences and then Philosophy at Cambridge (Cambridge: BA 1973, MA 1976) before completing his clinical undergraduate training at Guys Hospital (Cambridge: MB, Bchir 1976). Following housejobs in London he completed his academic and clinical training in Leicester, being awarded a Doctorate in Medicine for his thesis "Effect of surgery on monocyte function in patients with colorectal cancer". In 1981 he became a fellow of the Royal College of Surgeons of England. During this time he spent a year in San Diego, California with a famous biliary gastroenterologist (Alan Hofmann) and an international pancreas surgeon (Babs Moossa). His education was completed following training with international liver and pancreas surgeons in Paris (Henri Bismuth) and Ulm (Hans Beger) respectively.

In 1987 he was appointed Senior Lecturer in Surgery at the University of Birmingham, where he refined his clinical and research interests towards pancreatitis and pancreatic cancer. In 1990 he became a Reader and then in 1994 Professor of Surgery still at the University of Birmingham. In 1996 he was appointed Professor of Surgery and Head of Department of Surgery, University of Liverpool, and Honorary Consultant Surgeon, Royal Liverpool University Hospital and now leads one of the most successful clinical and academic surgical programmes in the UK. He is responsible for about 50-60 staff in the university department and about 20 clinical staff.

His specific areas of research are gene therapy for pancreatic cancer, pre-symptomatic diagnosis, prognostic and biological predictors of treatment response to pancreatic cancer, clinical trials of pancreatic cancer, hereditary and chronic pancreatitis and acute pancreatitis.

He has received many awards and has been Visiting Professor in Hong Kong, South Africa, New Zealand, Singapore and Heidelberg. He has served on the committees of the United European Gastroenterological Federation, International Association of Pancreatology, European Pancreatic Club, Pancreatic Society of Great Britain and Ireland, British Society of Gastroenterology, Surgical Research Society. He was a member of the World Council of the International Hepato-Pancreato-Biliary Association and has been the secretary of the European Pancreatic Club and president of the Pancreatic Society of GB&I, and the International Association of Pancreatology.

He has had positions in many research committees and has published over 450 research articles, many in top Journals such as the New England Journal of Medicine and the Lancet and has published five books on the pancreas, pancreatitis and cancer.

Professor Neoptolemos is married with 2 grown-up children and plays team squash and is a strong supporter of Liverpool Football Club although his first club remains the Gunners (Arsenal). Finally he is keen ballroom and Latin American dancer (and has the medals to prove it).

More information on Professor Neoptolemos and the work of the Department of Surgery, University of Liverpool can be found on their web-site.

Question and Answer Session

Did you always intend to go into medicine as I see that you studied natural science as an undergraduate at Cambridge?
I planned to join the Army but when I got good A-level results it was medicine (it had been at the back of mind - I especially liked biology etc at school, although academically I was an all rounder).

Why did you become a surgeon?
I love operating and only gifted people do it well.

Why did you specialise in pancreatic disease?
Most challenging organ - I was naturally very good at this.

Can you elaborate on why you found the pancreas a challenging organ?
What was often written about pancreas disease was blatantly wrong or very confused compared to how I perceived the clinical problem.

What motivated you to develop a large research group to investigate pancreatic disease?
Big challenge - big research group.

What has given you most satisfaction in your career?
To see major research organisations begin to take a serious interest in pancreas diseases.

What has caused most frustration?
The slow road to pancreas regionalisation.

Where do you see the advances coming in the field of pancreatic cancer surgery?
More and more resections with low morbidity and mortality.

(ed: this refers to the fact that studies show that the more operations performed by a single surgeon/centre the better the results in terms of morbidity and mortality and that there appears to be no upper limit)

Where do you see the advances coming in the treatment of the disease in general?
Biological targeted therapy - probably at an individual genetic level.

What changes would you make to current management of pancreatic cancer that would have most impact on outcomes for patients?
Regionalize services to an ABSOLUTE minimum of 3 million population.

Why are you keen to help Pancreatic Cancer UK?
To help patients and their relatives.

Can we define a simple message that we can try to get across to the public and GPs about symptoms and diagnosis?
Not really, there is no simple set of symptoms that can identify early pancreatic cancer, just any persisting upper GI discomfort. (And of course, nausea, vomiting, weight loss, abdominal pain, back pain etc).

Of course ultrasound is insufficient for diagnosis and CT is required.

Use of ultrasound in a GP set-up to diagnose pancreatic cancer is frankly useless and dangerous (false sense of security). I have come across this SO many times - it is really SO very sad.

Ultrasound is definitely 'bad' - too, too many tragic experiences. It's the professions' view as well.

CT costs about £200 - peanuts! The new multi-slice CTs are everywhere now and complete a full examination in a matter of seconds!

What is the problem with the ultrasound? Is it just that it doesn't pick it up early enough as it doesn't have enough resolution? Or that the GPs don't have the skills to recognise small tumours?
It is not sensitive enough! It is the difference between a pair of opera binoculars and the Hubble telescope for looking at the stars.

How can we improve diagnosis of pancreatic cancer to achieve higher surgical resection rates over the whole UK?
In my view upper GI symptoms for which there is no obvious explanation in an otherwise healthy person warrants an URGENT CT.

Referral to the regional pancreas centre should be made as soon as the diagnosis is made or reasonably suspected.