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The Pancreas.
  1. A N KINGSNORTH

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The Pancreas. Volumes 1 and 2. Edited by Beger HG, Warshaw AL, Buchler MW, Carr-Locke DL, Neoptolemos JP, Russell C, Sarr MG. (Pp 1509; illustrated; £295.00.) UK: Blackwell Science Ltd, 1998. ISBN 0 86542 420 9.

Imagine the task: seven editors coordinating manuscripts from 222 contributors, two thirds of whom are surgeons and most are professors. They have synthesised a landmark reference book of 1509 pages which seems destined to become the bible of the pancreas.

I chose a 12 hour return rail journey to attend the Pancreatic Society to review this monumental book. I was well rewarded and even though I had listened to the delivery of many papers at the cutting edge of pancreatic research at the scientific meeting, The Pancreas was well up to date probably because the editors had asked for an update just prior to publication. It would be fruitless to list the contents of this book because all aspects of pancreatic disease, physiology and anatomy are covered in very great detail.

The one obvious hallmark of this book is the evidence base with which the authors have been encouraged to back-up their contribution. Most chapters incorporate a battery of several hundred citations from the literature and many include well reasoned debate on difficult areas of management of pancreatic disease. Inevitably this results in some overlap between chapters but this enriches the debate in difficult areas. For instance utilisation of different imaging modalities is controversial. Thus the reader will find different opinions regarding use of computed tomography (CT) (chapter 15), spiral CT angiography (chapter 19), endoscopic ultrasound (chapter 102), and laparoscopy (chapter 107). Laparoscopic ultrasound has not been discussed and perhaps this is an omission which will undoubtedly find its way into the next edition. Similarly the surgeon will find a magnificent array of information, diagrams and pictures regarding surgical management with extensive coverage of the Japanese staging classification with pictures of the primary lymph node groups and detailed descriptions of the techniques used for resection, ranging from simple enucleation techniques to the complex duodenum preserving operations for chronic pancreatitis. The publishers have played no small part in this clarity because they have provided uniform illustrations throughout the text which are beautifully clear and understandable cartoon images in black and white.

The pearls from this book include the extensive and balanced account of biliary acute pancreatitis, a thoroughly realistic account of endoscopic treatment of chronic pancreatitis, an exhaustive coverage of tumour markers, and a chapter which should be read by all physicians on indications for surgical resection.

The only difficulty I have with this book is struggling with my conscience to retain it in my personal library rather than give it to our medical library as a reference book which is where it belongs. Space prevents me from telling you where it will ultimately reside!

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