Atlas of Cancer Surgery

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 cancer patient.

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 multidisciplinary—many 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 procedures—for example, pelvic exenteration (which is neatly divided into male and female sections), forequarter amputation, and hemipelvectomy—are 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 book.

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 perform.

In his lifetime, Dr. Beattie was quoted as saying, "We have only one standard of patient care—it’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.