Book Review

Surgery for Gastrointestinal Cancer: A multidisciplinary approach

N Engl J Med 1997; 337:208July 17, 1997

Article

Surgery for Gastrointestinal Cancer: A multidisciplinary approach
Edited by Harold J. Wanebo. 864 pp., illustrated. Philadelphia, Lippincott-Raven, 1997. $175. ISBN: 0-397-51518-9

Gastrointestinal cancers are extremely common worldwide, and for most of them, surgical excision remains the main potentially curative treatment. The emphasis of this book is thus on surgical therapy, although adjunctive radiotherapy, chemotherapy, and endoscopy receive adequate attention. The book has six sections. The first addresses the biology of gastrointestinal malignant processes, and the following sections discuss esophageal, gastric, pancreatic, hepatobiliary, and colorectal cancers. Cancers of the small intestine, such as lymphomas and carcinoids, are discussed only briefly; there is no chapter devoted solely to this part of the gastrointestinal tract. One of the strengths of this book is the broad international representation among the 131 contributors, especially in view of the wide variations in incidence and types of gastrointestinal cancers around the globe.

The many inherent qualities of a multiauthored textbook are readily apparent to the reader. A distinct advantage is the availability in one book of the opinions of a number of experts on a given subject. The reader will find a large variety of surgical approaches to cancers of the esophagus, pancreas, and rectum. But the missing ingredient is an overall perspective or a reconciliation of the different techniques, which might have helped the reader in dealing with these difficult problems. Repetition and redundancy are almost inescapable, and although sometimes they are helpful, describing the surgical anatomy of the rectum in three separate chapters seems a bit excessive. Similarly, the diagnostic role of laparoscopy is considered in two chapters by different authors, as are lymph-node dissections for gastric cancer.

The excellent color photographs of a variety of endoscopic views and pathological specimens at the beginning of the book are unrelated to each other and seemingly out of context. The reason for including a chapter on the pathology of lesions in the upper gastrointestinal tract (esophagus and stomach) without consideration of some of the difficult pathological problems of the liver, biliary tree, pancreas, and colon is unclear. The illustrations and photographs vary in quality and could have been improved in many instances.

These criticisms aside, the book has many laudable qualities. The chapters on the biology of cancer are clearly written, and the nonspecialist will understand them. The chapter on pain control is especially good and is applicable to many areas of medicine. Although there is a heavy emphasis on surgical treatment, the role of adjuvant radiotherapy and chemotherapy is covered thoroughly and well. The references for each chapter are selective and up to date. Overall, the book will be an excellent, comprehensive resource, especially for surgeons and oncologists interested in the treatment of gastrointestinal cancers.

William Silen, M.D.
Harvard Medical School, Boston, MA 02115