Book Review

Atlas of Surgical Oncology

N Engl J Med 1996; 334:200-201January 18, 1996

Article

Atlas of Surgical Oncology
Edited by Kirby I. Bland, Constantine P. Karakousis, and Edward M. Copeland, III. 810 pp., illustrated. Philadelphia, W.B. Saunders, 1995. $145. ISBN: 0-7216-4223-3

This new atlas has been assembled by three highly regarded and widely experienced surgical oncologists. The book is devoted to “familiarizing residents, fellows and practitioners of general surgical oncology with state of the art surgical principles and techniques necessary for proper management of solid tumors.” The editors note that each chapter has a bibliography and that the text is extensively illustrated by drawings of the relevant anatomy and surgical techniques.

The atlas opens with a detailed chapter on the principles of oncologic surgery and assessments of operative risk, with a bibliography of over 200 items. This chapter covers virtually every element of the supportive treatment of patients with cancer, including assessment of operative risk, management of bleeding diatheses and postoperative life-threatening cardiac complications, and an algorithm of metabolic events resulting from invasive bacterial infections, which is more comprehensive than one would expect in a technical atlas of surgery.

A 60-page chapter on melanoma includes extremely detailed descriptions of every conceivable skin-incision placement and skin suture. Excellent line drawings outline the detailed conduct of an extended axillary dissection. More than 30 pages are devoted to regional-node dissections of the axilla and inguinal areas and even the popliteal fossa. In the subsequent chapter, on thyroid cancer, only two pages and two illustrations deal with neck dissection, which is not addressed at all in the chapter on melanoma.

In the five-page chapter on parathyroid surgery, there is no mention of the proportion of abnormal glands found in different anatomical locations, nor is there a discussion of the exact sequence of steps in an operative approach to a routine exploration of the parathyroid glands. Salivary-gland neoplasms are addressed in a chapter that has excellent line drawings, but the description of the planes of dissection in the text is at variance with the accompanying illustrations. The following chapter is devoted to a technical procedure, rather than a particular cancer, and is the second chapter that describes radical and modified neck dissections, this time in great detail.

A 50-page chapter on surgery for benign and malignant diseases of the breast includes extensive descriptions of incision placement; biopsy techniques; anatomical arrangements of nerve, lymphatic, and blood supply; and a very detailed elaboration of the entire lymphatics of the mediastinum, which is only marginally related to breast cancer. There is a thorough description of the large variety of incisions that are applicable to mastectomy. There is also a nice schematic diagram of how to arrange a surgical team at the operating table, which is useful for students.

The chapters on lung surgery and surgery for sarcomas have excellent illustrations, including many illustrations of super-radical, highly sophisticated techniques applicable to a very small number of cases. The chapter on soft-tissue sarcomas is nearly 120 pages long — much longer than any of the other chapters that deal with far more common cancers and wider varieties of useful surgical options — undoubtedly reflecting the particular interest of one of the editors and the author of the chapter on sarcomas.

The chapter on liver tumors is an adaptation of existing material rather than an original presentation. The chapter on the management of pancreatic cancer has some excellent line drawings, although two are 90 degrees out of orientation, as judged on the basis of the preceding and following illustrations. This chapter describes only the direct mucosa-to-mucosa anastomosis and lacks descriptions of the multiple ways of handling the pancreatic remnant and duct. In contrast to the description of the many surgical options in the chapter on breast cancer, only one method of pancreatoduodenectomy is described in this chapter; one of the most popular variations, preservation of the pylorus, is neither illustrated nor acknowledged. The chapter on surgery of tumors of the colon, rectum, and anus, nearly 30 pages long, has one section with only four recommended literature sources, and another part has no bibliography whatsoever. This chapter, perhaps reflecting the interest of the authors, is almost totally devoted to surgical stapling, with only scant recognition of hand-sewn techniques.

The section on gynecologic cancers has very small, detailed drawings that are difficult to read and interpret, in contrast to the lovely, simplified line drawings in most of the other chapters. Carcinoma of the penis, which is uncommon and largely under the purview of the urologist, is described in great detail in a 15-page chapter. The tumor–node–metastasis staging system for penile carcinoma is outlined in detail. No other chapter addresses tumor–node–metastasis staging, which could be an appropriate introduction in a textbook of surgical oncology.

Surgical management of local recurrences of metastatic colon cancer and aggressive management of peritoneal carcinomatosis have not been proved successful and are not widely accepted, yet are described in great detail by their one proponent. A chapter on new laparoscopic techniques for the management of intraabdominal cancer is useful in illustrating contemporary technical aspects of surgery for colorectal cancer.

This book is comprehensive but suffers from irregularities in organization, emphasis, and editorial guidance among the chapters, which vary greatly in length and in types of illustration. The book is nevertheless a useful reference for surgeons and students.

Blake Cady, M.D.
Deaconess Hospital, Boston, MA 02215