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Hepatobiliary malignancy: Its multidisciplinary management
GASTROENTEROLOGY 1 9 9 5 ; 1 0 9 : 3 2 9 - 3 3 0
BOOK REVIEWS Jonathan E. Clain, M.D. Book Review Editor Mayo Foundation 200 First Street S.W. Rochester, Minnesota 55905
Hepatobilia U Malignancy: Its Multidisciplina U Management. Edited by John Terblanche. 672 pp. $175.00 Edward Arnold, London, England, 1994. ISBN 0-340-588985. In the future, academic medical centers are likely to have numerous multidisciplinary centers focused on the care of patients with organ-specific disease processes. These centers wili facilitate multidisciplinary care of patients with complex diseases in a timely, cost-effective, and efficacious manner. This revolution is now rapidly taking place in the care of patients with heparobiliary disease, which currently requires the expertise of surgeons, hepatologists, therapeutic endoscopists, interventional radiologists, and pathologists. In recognition of the team approach required for the care of patients with neoplastic diseases of the liver and biliary system, Professor Terblanche has edited the first edition of Hepatobiliary Malignancy: Its Multidisciplinary Management. The aims of this book are to provide up-to-date and balanced information for practicing specialists who deal with the problems presented by patients with hepatobiliary neoplasia as well as to recognize the educational needs of postgraduate trainees. The book is organized into five sections dealing with hepatic malignancy, biliary tract malignancy, surgical techniques, liver transplantation for malignancy, and palliative care in hepatobiliary malignancy. A unique feature of the book is the inclusion of an editorial overview by Professor Terblanche after each section. The strengths of the textbook include the depth and breadth of the subject matter, the international expertise of the authors, the multidisciplinary approach, and the high quality of the reproductions. This book is a valuable addition to the literature because the majority of textbooks focusing on diseases of the hepatobiliary system apportion little space to malignancy. Moreover, the publisher is to be congratulated for rapidly producing a book to keep it current. Overall, this is a first-rate textbook. I particularly enjoyed the chapter on "dystychomas," lesions identified by chance as a result of the wide use of abdominal imaging modalities. I agree with the algorithms provided in this chapter for the evaluation of these lesions, especially the lack of emphasis on fine needle aspirations, which are often not diagnostic and can lead to complications. In addition, the section on bile duct carcinoma represents the best compilation of information to date on this difficult problem in one easy reference source. The section on palliative and terminal care of patients with hepatobiliary malignancy is unique and a valuable addition to the book. As with all multiauthored textbooks, there is considerable overlap. On selected subjects, such as on the presentation and management of hepatocellular carcinoma, Professor Terbtanche has encouraged overlap to provide viewpoints from experts
throughout the world. However, the overlap makes obtaining information on some subjects difficult and apparently precluded the editor from commissioning chapters on other subjects. Identifiable chapters with an objective review of the relevant literature regarding chemoembolization of malignant liver masses, percutaneous ethanol ablation of small hepatocellular carcinomas, cryosurgery, and the pros and cons of screening for hepatocellular carcinoma in cirrhotics with a cost-benefit analysis would have been desirable. Currently, the information on these subjects is spread in multiple chapters and is often antedotal. The index is substandard. For example, staging of malignant mass lesions using internationally accepted criteria (TNM staging) has become important in interpreting results from center to center, and the staging systems are appropriately reviewed in the book. However, the staging systems will never be located if one relies on the index! Finally, chapters on the current concepts regarding the molecular mechanisms responsible for hepatobiliary neoplasia and on new and potential innovative strategies for the treatment of these lesions would have been useful additions. Although heavily weighted towards the surgeon (e.g., a whole section is devoted to surgical technique), the book contains information relevant to all disciplines involved in the care of patients with hepatobiliary malignancy and provides a unique resource. Overall, the book does an excellent job of accomplishing its goal and will be of value to all specialists involved in the care of patients with hepatobiliary malignancy. I recommend this book for all medical libraries, for libraries of all liver units, and for specialists with a practice focused on the care of patients with these difficult problems.
GREGORY J. GORES, M.D. Centerfor Basic Research in Digestive Diseases Division of Gastroenterology and Internal Medicine Mayo Clinic and Mayo Foundation Rochester, Minnesota
Constipation. Edited by Michael A. Kamm and John E. Lennard-Jones. Taylor & Francis, Bristol, Pennsylvania, 1994. ISBN 0-871816-24-6. The principal aim of this multiauthored text, edited by two of the foremost figures in the field, is to introduce the subject of constipation to practicing physicians. The text aims to explain constipation to practitioners from the physiological and pragmatic perspective. A text on this subject is sorely needed because primary-care physicians, gastroenterologists, and general
BOOK REVIEWS Jonathan E. Clain, M.D. Book Review Editor Mayo Foundation 200 First Street S.W. Rochester, Minnesota 55905
Hepatobilia U Malignancy: Its Multidisciplina U Management. Edited by John Terblanche. 672 pp. $175.00 Edward Arnold, London, England, 1994. ISBN 0-340-588985. In the future, academic medical centers are likely to have numerous multidisciplinary centers focused on the care of patients with organ-specific disease processes. These centers wili facilitate multidisciplinary care of patients with complex diseases in a timely, cost-effective, and efficacious manner. This revolution is now rapidly taking place in the care of patients with heparobiliary disease, which currently requires the expertise of surgeons, hepatologists, therapeutic endoscopists, interventional radiologists, and pathologists. In recognition of the team approach required for the care of patients with neoplastic diseases of the liver and biliary system, Professor Terblanche has edited the first edition of Hepatobiliary Malignancy: Its Multidisciplinary Management. The aims of this book are to provide up-to-date and balanced information for practicing specialists who deal with the problems presented by patients with hepatobiliary neoplasia as well as to recognize the educational needs of postgraduate trainees. The book is organized into five sections dealing with hepatic malignancy, biliary tract malignancy, surgical techniques, liver transplantation for malignancy, and palliative care in hepatobiliary malignancy. A unique feature of the book is the inclusion of an editorial overview by Professor Terblanche after each section. The strengths of the textbook include the depth and breadth of the subject matter, the international expertise of the authors, the multidisciplinary approach, and the high quality of the reproductions. This book is a valuable addition to the literature because the majority of textbooks focusing on diseases of the hepatobiliary system apportion little space to malignancy. Moreover, the publisher is to be congratulated for rapidly producing a book to keep it current. Overall, this is a first-rate textbook. I particularly enjoyed the chapter on "dystychomas," lesions identified by chance as a result of the wide use of abdominal imaging modalities. I agree with the algorithms provided in this chapter for the evaluation of these lesions, especially the lack of emphasis on fine needle aspirations, which are often not diagnostic and can lead to complications. In addition, the section on bile duct carcinoma represents the best compilation of information to date on this difficult problem in one easy reference source. The section on palliative and terminal care of patients with hepatobiliary malignancy is unique and a valuable addition to the book. As with all multiauthored textbooks, there is considerable overlap. On selected subjects, such as on the presentation and management of hepatocellular carcinoma, Professor Terbtanche has encouraged overlap to provide viewpoints from experts
throughout the world. However, the overlap makes obtaining information on some subjects difficult and apparently precluded the editor from commissioning chapters on other subjects. Identifiable chapters with an objective review of the relevant literature regarding chemoembolization of malignant liver masses, percutaneous ethanol ablation of small hepatocellular carcinomas, cryosurgery, and the pros and cons of screening for hepatocellular carcinoma in cirrhotics with a cost-benefit analysis would have been desirable. Currently, the information on these subjects is spread in multiple chapters and is often antedotal. The index is substandard. For example, staging of malignant mass lesions using internationally accepted criteria (TNM staging) has become important in interpreting results from center to center, and the staging systems are appropriately reviewed in the book. However, the staging systems will never be located if one relies on the index! Finally, chapters on the current concepts regarding the molecular mechanisms responsible for hepatobiliary neoplasia and on new and potential innovative strategies for the treatment of these lesions would have been useful additions. Although heavily weighted towards the surgeon (e.g., a whole section is devoted to surgical technique), the book contains information relevant to all disciplines involved in the care of patients with hepatobiliary malignancy and provides a unique resource. Overall, the book does an excellent job of accomplishing its goal and will be of value to all specialists involved in the care of patients with hepatobiliary malignancy. I recommend this book for all medical libraries, for libraries of all liver units, and for specialists with a practice focused on the care of patients with these difficult problems.
GREGORY J. GORES, M.D. Centerfor Basic Research in Digestive Diseases Division of Gastroenterology and Internal Medicine Mayo Clinic and Mayo Foundation Rochester, Minnesota
Constipation. Edited by Michael A. Kamm and John E. Lennard-Jones. Taylor & Francis, Bristol, Pennsylvania, 1994. ISBN 0-871816-24-6. The principal aim of this multiauthored text, edited by two of the foremost figures in the field, is to introduce the subject of constipation to practicing physicians. The text aims to explain constipation to practitioners from the physiological and pragmatic perspective. A text on this subject is sorely needed because primary-care physicians, gastroenterologists, and general