The field of surgical oncology is
growing rapidly. As it assumes
a more dominant position in the multidisciplinary care of cancer patients,
additional resources will be needed to assist the surgical oncologist. This new
Atlas of Cancer Surgery meets an ever-growing need in today’s treatment of the
Among the more compelling aspects of this text is the
accumulated experience of its editors. Sadly, during final preparation of the
atlas, one of its editors, Dr. Edward Beattie, died. This book will be
remembered as a testament to his 50-year career of treating cancer patients and
educating cancer surgeons.
This new volume has many strengths, including the fact that all
the illustrations were done by one artist, Hugh A. Thomas, who does an excellent
job of translating complex surgical procedures into understandable yet profound
renderings. Additionally, there are a few remarkable, almost three-dimensional
illustrations, such as a figure depicting some challenging anatomic
relationships in the lungs and thoracic inlet (which I have never before seen
put together in a diagram so succinctly).
Indeed, another strength of this atlas is its emphasis on the
anatomic relationships that are important to the operating surgeon for each
procedure. In that light, many of the chapters are preceded by illustrations of
the anatomy of the operative area. Because the surgeon must be versed in both
embryology and anatomy to fully understand the anomalies that may be confronted
during a surgical procedure, this focus is a welcome addition.
Another strength is the use of case reports, which helps make
the information relevant to the practicing surgical oncologist. The clinical
cases are examples of the most complex situations a surgical oncologist may have
to deal with, such as a thoracic inlet desmoid tumor or a large retroperitoneal
sarcoma. These case illustrations underscore the point that the atlas is
directed to the practicing surgical oncologist, who may have an occasion to deal
with such surgical issues.
This volume addresses a broad cross-section of surgical
disciplines. All types of procedures are depicted, from oncology operations of
an orthopedic nature (ie, the Tikoff-Lindberg procedure) to urologic cancer,
thoracic, and general oncology operations. More than any other surgical
discipline, surgical oncologists often find themselves involved in procedures
that may be considered multidisciplinarymany cancers do not respect anatomic
boundaries and can involve abdominal and pelvic organs, urologic and general
abdominal organs, or thoracic and neck locations. This atlas recognizes that
fact and fills the need of the practicing surgical oncologist to be able to
operate comfortably in all these fields.
Another fine feature of this book is an abundance of surgical
pearls of wisdom, as exemplified in the chapter on parotidectomy. A nice
illustration here is accompanied by a good textual description of how to find
the trunk of the seventh cranial nerve during that procedure. In fact, numerous
complex surgical proceduresfor example, pelvic exenteration (which is neatly
divided into male and female sections), forequarter amputation, and
hemipelvectomyare presented in detail.
This comprehensive atlas has 58 chapters divided into six parts:
head and neck, chest, upper abdomen, lower abdomen, radical amputations, and
breast and soft-tissue tumors. Despite the large number of chapters, only six
experienced and senior surgeons contributed to its production. Clearly, a great
deal of work by each of them went into the development of this comprehensive
Like any text, however, the Atlas of Cancer Surgery could be
improved. Some shortcomings of this volume that could be addressed in future
editions include the lack of attention to some of the more common operations
performed by surgical oncologists as we enter the 21st century. Specifically,
there is no mention of laparoscopic approaches in cancer staging or of the
operations being performed laparoscopically by surgical oncologists, which
include a large portion of endocrine surgeries (specifically, adrenalectomy).
Additionally welcome would be a chapter on modified radical neck
dissection, because this procedure is being performed more commonly for diseases
mandating neck dissections other than the radical procedure, which is the only
type addressed in this volume. Another feature that clearly reflects the rapid
development of this field is the lack of mention of the role and technique of
sentinel lymph node biopsy, specifically for breast cancer.
Also, some technical descriptions would be better served by at
least some editorial explanation of a procedure’s use and relevance. For
example, the extended gastrectomy with radical lymph node dissection described
in the atlas is clearly the technique used most commonly in Japan, where the
pancreas is routinely resected to enhance the lymph node dissection; in the
West, this is almost never a feature of this type of operation. In fact,
randomized trials of the role of extended lymph node dissections for gastric
cancer have not convincingly shown it to be beneficial. Therefore, I believe
that future editions of this atlas would be enhanced by a consideration of the
appropriateness of such an operation.
These editorial details, however, should not detract from what,
in summary, is a fine addition to the armamentarium of any surgical oncologist.
Dr. Beattie and his colleagues have left us a valuable tribute that will benefit
all cancer surgeons who strive to better understand the complex surgeries they
In his lifetime, Dr. Beattie was quoted as saying, "We have
only one standard of patient careit’s all first class, and that in itself
is a significant landmark in American medicine." Making that statement
during his tenure as chairman of the department of surgery at Memorial
Sloan-Kettering Cancer Center in New York, he was referring to the absence of
any type of class system for patients in the hospital. The surgical oncology
Fellows always knew him for his availability and, as Dr. Nael Martini commented,
"Ed Beattie was a superb organizer and a dominant personality, and he did
much to advance the scientific reputation of the institution." It is only
fitting to acknowledge that in his final editorial work, Dr. Beattie has once
again superbly organized an important text and helped to advance the practice of
the cancer surgeon in this complex field.