Book Review

Hepatobiliary Malignancy: Its multidisciplinary management

N Engl J Med 1995; 332:1655June 15, 1995

Article

Hepatobiliary Malignancy: Its multidisciplinary management
Edited by John Terblanche. 672 pp., illustrated. Boston, Edward Arnold, 1994. $175. ISBN: 0-340-588985

The term “multidisciplinary” has become the buzzword for cancer care in the 1990s. Hepatobiliary cancers, although not particularly common in the United States, are very common worldwide. And no set of diseases requires more dexterity by clinicians, who have a dizzying array of unproved therapeutic approaches and innovative technological wizardry at their fingertips.

This textbook, with an international cast of contributors, assembles the literature spanning the fields of epidemiology, gastroenterology, hepatology, surgery, diagnostic and interventional radiology, radiation therapy, and medical oncology as they relate to hepatobiliary cancers. To review it, I called on my colleagues in some of those specialties to critique selected chapters, and I read the chapters dealing with the management issues that I thought were most poorly addressed in other available books.

In general, this book is well written, understandable, balanced, and thoroughly referenced. In line with what is known about these diseases and their effective management, more attention is paid to epidemiology, gastroenterology, surgery, and radiology than, for example, to radiation or medical oncology. After all, there is only so much one can say about external-beam radiotherapy and fluorouracil. As befits a book directed at the clinician, there is only a modicum of molecular biology and DNA-speak. The editor, John Terblanche, exercises his privilege to give a critique and recommendations after each section, offering his perspective on an often conflicting or inconclusive literature. This format allows the clinician engaged in triage to see the spectrum of issues laid out plainly.

As in any textbook, some chapters are better than others. The one on endoprostheses and biliary stenting is superb in its practical and technical detail and includes a paragraph on cost effectiveness. Unfortunately, the terms “cost” and “effectiveness” are found almost nowhere else in the book, a serious omission given the climate of health care today. The chapter on terminal care gets to the point, but the chapter on palliative care seems almost an afterthought, focusing more on the rarely useful nerve block than on more practical topics, such as oral and transdermal analgesic and antiemetic agents.

An exceptional effort is made to balance controversial topics. For example, regional chemotherapeutic treatments are explored in at least four chapters, each representing perspectives and interpretations by different authors. Similarly, the sections on radiologic imaging of liver tumors are exhaustive (excepting the material on positron-emission tomography) and noncommittal. Although such broad presentations allow readers to draw their own conclusions, they also lead to duplication and sometimes even to confusion about the facts. A series of point–counterpoint discussions of topics in dispute might have served the nonexpert better.

In general, this is a complete reference work on the care of patients with hepatobiliary cancer. Given the numerous uncertainties in such care, it is up to the principal physician to sort through the available options at the various steps in the management algorithms. Such triaging requires the wide range of expertise most conveniently found in a multidisciplinary textbook.

Alan P. Venook, M.D.
University of California, San Francisco, San Francisco, CA 94143