Book Review

The Pancreas: An Integrated Textbook of Basic Science, Medicine, and Surgery

N Engl J Med 2009; 360:428-429January 22, 2009

Article

The Pancreas: An Integrated Textbook of Basic Science, Medicine, and Surgery
Second edition. Edited by Hans Beger, Andrew Warshaw, and Markus Büchler, with five others. 1006 pp., illustrated. Malden, MA, Wiley–Blackwell, 2008. $489.95. ISBN: 978-1-4051-4664-7

There is a traditional belief that a physician can follow one of two distinct career paths: a medical specialty or a surgical specialty. Anyone working in pancreatic medicine, however, recognizes that the boundaries between these paths sometimes blur. To effectively diagnose and treat pancreatic diseases, gastroenterologists must recognize when surgical intervention is necessary, and gastrointestinal surgeons should understand how gastroenterologists approach and manage these illnesses. Furthermore, basic science forms the research foundation of pancreatology. This book, a consummate work on the pancreas edited by Hans Beger et al., is thus aptly named. Although the pancreas is a vital organ, the study of pancreatic diseases is a niche field. When it functions properly, the pancreas is a silent and unrecognized organ; when it malfunctions, extraordinary complications and even death may ensue.

The value of the multiperspective approach that is used in this textbook is evident. Comprehensive physiological, biochemical, genetic, and epidemiologic findings are covered in great detail. In addition, the medical and surgical management of both rare and common pancreatic disease processes are presented in succession, and with precision, by renowned scientists. The classification of numerous pancreas-related pathologies has suffered because of differences in how these illnesses are viewed in different regions; the most profound differences are between Eastern and Western nations. With editors from the United States, Germany, the United Kingdom, and Japan and with contributing authors from four continents, this book presents the most current knowledge of international experts while mitigating the biases that are typical of a book with editors or authors from a single nation or a single institution.

The most important topics in the realms of clinical and research pancreatology — from acute and chronic pancreatitis, to exocrine and endocrine neoplasia, to the role of pancreatic transplantation — are covered in the book. The tables, diagrams, and illustrations are extensive; a middle section consists of 32 pages of color images and illustrations that a surgeon or pathologist would surely admire. Chapter 17, “Acute Pancreatitis in Children,” and chapter 59, “Familial Pancreatic Cancer,” are pithy reviews, whereas the authors of other chapters such as chapter 66, “Role of Positron Emission Tomography in Diagnosis of Pancreatic Cancer and Cancer Recurrence,” and chapter 102, “Minimally Invasive and Local Ablation Techniques of Serous and Mucinous Cystic Lesions,” address obscure or less frequently examined areas of pancreatology.

The authors of “The History of the Pancreas,” the book's exquisitely documented second chapter, highlight the fascinating cast of characters whose discoveries fortified and stimulated the field of pancreatology. We become acquainted with Paul Langerhans, a promising young student of Rudolf Virchow in Berlin and a scion of a distinguished medical family, who first described structures called Zellhäufchen — or “little heaps of cells” — in his medical student thesis of 1869, then died prematurely. We are introduced to Ruggero Oddi, a 23-year-old medical student at the University of Perugia who first documented the choledochal sphincter that eventually bore his name, but as the authors of this chapter explain, “Sadly, his brilliant career was to end in ignominy amidst drug addiction, itinerant medicine, and fanciful cancer cures and culminated in his demise as a member of the French Foreign Legion.” And we meet Allen Oldfather Whipple, a true father of pancreatic surgery, who invented the Whipple procedure practically by happenstance while he was giving an amphitheater demonstration to distinguished American and foreign visiting surgeons on the surgery of a patient who was believed to have gastric cancer. During the operation, the patient was instead found to have a carcinoma of the pancreas, and Whipple performed an impromptu surgical revision that evolved into the modern Whipple procedure.

This textbook could easily serve as the most comprehensive written material on pancreatic diseases for laboratory scientists, gastroenterologists, gastrointestinal surgeons, and gastrointestinal or surgical fellows who work in the field. It will certainly be kept within reach on my bookshelf.

Julia B. Greer, M.D., M.P.H.
University of Pittsburgh School of Medicine, Pittsburgh, PA 15213