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Modern Management of Cancer of the Rectum
  1. R J Heald

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This is a remarkable little book. A brief review of contributors will whet the appetite: a quick read of the first chapter by Drs Shelton and Goldberg will soon confirm your decision to buy. This initial chapter is an engaging review of the key writings of the leaders of surgical thought over the centuries and provides a rare insight into how we have arrived where we are today. The book continues with the rich but often all too brief reviews of the many components of the colorectal cancer scene. This is the most important of all of the human cancers as we already know enough to cure more people of bowel cancer than all of the other internal cancers put together. Nevertheless, even those involved in the disease have areas where knowledge may be incomplete: this book will provide a brief summary of what the surgeon must know about P53 or the medical oncologist about TME. The obvious and the necessary are mercifully omitted while the uncommon is usually well covered. Rare tumours, for example, are splendidly complete and the book provides valuable detail and formidable lists of references.

For any book the scene is moving too rapidly to be completely up to date. Details of the potential of magnetic resonance imaging (MRI) for example and the currently confused state of knowledge about who should have which type of radiotherapy. Nevertheless, even in these difficult areas, the writers have a constant sense of direction which will seldom be felt, even by an expert, to be off target. Seen through the eyes of a somewhat reactionary reviewer, the importance of laparoscopic surgery in the management of colorectal cancer seems a little overplayed. The “may be” of this still emerging modality seems to be pointing a way that not all doctors will agree with. We have after all still to hear even the most ardent supporters of laparoscopic surgery claim that they can cure more people, perform less colostomies, or save more nerves. In most hospitals around the world open surgery remains both the norm and the probable future for rectal cancer at least. It could have been given more space in the book.

The histopathology chapter is exceptionally good and has much practical content. An area that will not commend itself to most European readers in the multimodality postoperative chemo radio therapeutic onslaught that characterises modern American thought and is unequivocally recommended in this book. I would have liked to have read some questioning of the enormous amounts of money expended on chemotherapy and radiotherapy given postoperatively. Many serious oncologists, well aware of the strength of the argument for chemotherapy after colon cancer resections, nevertheless seriously doubt its value for rectal cancer. Minsky et al in an otherwise superb review of chemotherapy dismiss on grounds which I consider spurious the argument that better surgery may make some patients better managed without chemotherapy. I would personally prefer to read about honest controversy and to see current American dogma questioned rather than reinforced.

These few criticisms are offered as a surgeon's affectionate commentary on an essentially splendid little book with something worthwhile for all serious doctors in the field of rectal cancer.

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