Atlas of Cancer Surgery

June 1, 2001

The field of surgical oncology isgrowing rapidly. As it assumes

The field of surgical oncology isgrowing rapidly. As it assumesa 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 thecancer patient.

Among the more compelling aspects of this text is theaccumulated experience of its editors. Sadly, during final preparation of theatlas, one of its editors, Dr. Edward Beattie, died. This book will beremembered as a testament to his 50-year career of treating cancer patients andeducating cancer surgeons.

This new volume has many strengths, including the fact that allthe illustrations were done by one artist, Hugh A. Thomas, who does an excellentjob of translating complex surgical procedures into understandable yet profoundrenderings. Additionally, there are a few remarkable, almost three-dimensionalillustrations, such as a figure depicting some challenging anatomicrelationships in the lungs and thoracic inlet (which I have never before seenput together in a diagram so succinctly).

Indeed, another strength of this atlas is its emphasis on theanatomic relationships that are important to the operating surgeon for eachprocedure. In that light, many of the chapters are preceded by illustrations ofthe anatomy of the operative area. Because the surgeon must be versed in bothembryology and anatomy to fully understand the anomalies that may be confrontedduring a surgical procedure, this focus is a welcome addition.

Another strength is the use of case reports, which helps makethe information relevant to the practicing surgical oncologist. The clinicalcases are examples of the most complex situations a surgical oncologist may haveto deal with, such as a thoracic inlet desmoid tumor or a large retroperitonealsarcoma. These case illustrations underscore the point that the atlas isdirected to the practicing surgical oncologist, who may have an occasion to dealwith such surgical issues.

This volume addresses a broad cross-section of surgicaldisciplines. All types of procedures are depicted, from oncology operations ofan orthopedic nature (ie, the Tikoff-Lindberg procedure) to urologic cancer,thoracic, and general oncology operations. More than any other surgicaldiscipline, surgical oncologists often find themselves involved in proceduresthat may be considered multidisciplinary—many cancers do not respect anatomicboundaries and can involve abdominal and pelvic organs, urologic and generalabdominal organs, or thoracic and neck locations. This atlas recognizes thatfact and fills the need of the practicing surgical oncologist to be able tooperate comfortably in all these fields.

Another fine feature of this book is an abundance of surgicalpearls of wisdom, as exemplified in the chapter on parotidectomy. A niceillustration here is accompanied by a good textual description of how to findthe trunk of the seventh cranial nerve during that procedure. In fact, numerouscomplex surgical procedures—for example, pelvic exenteration (which is neatlydivided into male and female sections), forequarter amputation, andhemipelvectomy—are presented in detail.

This comprehensive atlas has 58 chapters divided into six parts:head and neck, chest, upper abdomen, lower abdomen, radical amputations, andbreast and soft-tissue tumors. Despite the large number of chapters, only sixexperienced and senior surgeons contributed to its production. Clearly, a greatdeal of work by each of them went into the development of this comprehensivebook.

Like any text, however, the Atlas of Cancer Surgery could beimproved. Some shortcomings of this volume that could be addressed in futureeditions include the lack of attention to some of the more common operationsperformed by surgical oncologists as we enter the 21st century. Specifically,there is no mention of laparoscopic approaches in cancer staging or of theoperations being performed laparoscopically by surgical oncologists, whichinclude a large portion of endocrine surgeries (specifically, adrenalectomy).

Additionally welcome would be a chapter on modified radical neckdissection, because this procedure is being performed more commonly for diseasesmandating neck dissections other than the radical procedure, which is the onlytype addressed in this volume. Another feature that clearly reflects the rapiddevelopment of this field is the lack of mention of the role and technique ofsentinel lymph node biopsy, specifically for breast cancer.

Also, some technical descriptions would be better served by atleast some editorial explanation of a procedure’s use and relevance. Forexample, the extended gastrectomy with radical lymph node dissection describedin the atlas is clearly the technique used most commonly in Japan, where thepancreas is routinely resected to enhance the lymph node dissection; in theWest, this is almost never a feature of this type of operation. In fact,randomized trials of the role of extended lymph node dissections for gastriccancer have not convincingly shown it to be beneficial. Therefore, I believethat future editions of this atlas would be enhanced by a consideration of theappropriateness 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 benefitall cancer surgeons who strive to better understand the complex surgeries theyperform.

In his lifetime, Dr. Beattie was quoted as saying, "We haveonly one standard of patient care—it’s all first class, and that in itselfis a significant landmark in American medicine." Making that statementduring his tenure as chairman of the department of surgery at MemorialSloan-Kettering Cancer Center in New York, he was referring to the absence ofany type of class system for patients in the hospital. The surgical oncologyFellows always knew him for his availability and, as Dr. Nael Martini commented,"Ed Beattie was a superb organizer and a dominant personality, and he didmuch to advance the scientific reputation of the institution." It is onlyfitting to acknowledge that in his final editorial work, Dr. Beattie has onceagain superbly organized an important text and helped to advance the practice ofthe cancer surgeon in this complex field.