Book Review

Gastroenterology — Surgical and Medical

Surgery of the Pancreas

N Engl J Med 1994; 331:554August 25, 1994

Article

Surgery of the Pancreas
Edited by Michael Trede and David C. Carter. 655 pp., illustrated. New York, Churchill Livingstone, 1993. $225. ISBN: 0-443-04427-9

Over the past few years, several textbooks on pancreatic surgery have been published; Trede and Carter have made a fine addition to this important area with their Surgery of the Pancreas. Preparing such a book is a formidable undertaking because of the many diseases of the pancreas, the new interventional and diagnostic techniques, the ongoing development of intraoperative diagnostic maneuvers, including fine-needle aspiration, and the controversies about the treatment of pancreatic cancer. This book, to its editors' credit, touches on many of these important areas. Almost all the topics are timely, some are controversial, and many are changing quickly and may also be quickly out of date. Surgery of the Pancreas is a bold undertaking, and its success is remarkable.

The editors have collaborated with experts from throughout the world. Their textbook has 11 sections, of which the first is an excellent introduction that deals with the history of pancreatic surgery and the embryology and physiology of the pancreas. The discussion of the history of pancreatic surgery is extremely well done, giving credit to the giants of the field. Sections 2 and 3 deal with preoperative and intraoperative diagnostic procedures, and sections 4 and 5 with acute and chronic pancreatitis (with seven and nine chapters, respectively). Section 6 covers congenital abnormalities. Carcinoma of the exocrine pancreas and periampullary region are dealt with in section 7, in 13 chapters. Section 8 contains two chapters on endocrine tumors of the pancreas, and the final three sections discuss injuries, pancreatic transplantation, and anesthetic management in pancreatic surgery.

The book emphasizes pancreatitis and cancer; its strength lies in the latter area. The discussion of the pathology and classification of pancreatic tumors by Becker and Stommer is excellent. Trede's chapter on surgical options, presenting his philosophy about embarking on large surgical extirpative procedures for this deadly cancer, is nicely done. I strongly recommend these chapters to younger surgeons for a clear and concise evaluation of the problem related to surgical approaches to carcinoma of the pancreas.

The inclusion of some of the results of pancreatic transplantation and some authors' philosophical views regarding the procedure in this textbook works out very well. As increasing experience is gained with pancreatic transplantation, I hope future editions will deal with long-term results more completely. Of particular interest would be an assessment of whether pancreatic transplantation really can halt or reverse the progression of complications of diabetes.

My criticisms of this book are minor. Any attempt to deal with diagnostic maneuvers mandates radiographic images. In almost any textbook it is difficult to reproduce ultrasound images, and a number of the ultrasound illustrations in this textbook are very hard to evaluate. In addition, several short chapters on conventional radiography, ultrasonography, and percutaneous transhepatic cholangiography in the section on the preoperative diagnosis of pancreatic disease make for a rather choppy presentation. Could not the points in these chapters have been presented more efficiently within a single chapter?

The chapters on techniques of surgery of the pancreas are excellent and nicely illustrated. One such chapter is that on the technique of Whipple pancreatoduodenectomy by Trede, but the section on postoperative care could have been expanded to take advantage of Trede's extensive experience. What is the evidence that patients can begin to take oral feedings within 48 to 72 hours after such an extensive procedure? Why is the author so specific about removing a drain or “shortening” a drain on the fifth postoperative day and removing it on the seventh?

This excellent textbook deals with many germane and controversial topics in pancreatic surgery in a clear, concise fashion. It is an excellent resource for medical students and residents as well as for young faculty members entering the difficult field of pancreatic surgery. Virtually every chapter is a learning experience. Updated future editions will be eagerly awaited.

John B. Hanks, M.D.
University of Virginia, Charlottesville, VA 22908