What are the components of contemporary surgical care for the
patient burdened by cancer? The answer to this question is to be found in the
discipline of surgical oncology, which is arguably more of a cognitive than a
technical surgical specialty. Other than several surgical procedures that are
only infrequently performed outside of cancer centers (such as trisegmentectomy,
hemipelvec-tomy, and regional pancreatectomy), the specialty of surgical
oncology focuses on integrating surgery with other modalities of cancer
treatment such as radiation oncology and systemic chemotherapy approaches. This
integration is achieved via the crucible of prospective clinical trials that
have emerged as the hallmark of clinical scientific research in oncology. To be
effective, the surgical oncologist must understand the natural biology of solid
tumors including their inception, proliferation, and dissemination. Such an
understanding also implies a more than passing awareness of the underlying basic
and translational science that is currently pushing the frontiers of our
understanding in oncology further and further.
In addition to knowledge about the natural biology of tumors, the
surgical oncologist must be intimately aware of the diagnostic options in the
initial evaluation of the tumor and the staging systems by which a given tumor
can be described, prognosis ascertained, and therapeutic algorithms accessed.
The applicable treatments and their indications, risks, and benefits are
critically important as part of this cognitive armamentarium. Moreover, in this
era of managed care and cost containment, outcomes and research-defined
surveillance strategies are also a part of the knowledge base of the practicing
surgical oncologist.
The targeted audience of, The M. D. Anderson
Surgical Oncology Handbook, now in its fourth edition, includes
surgeons-in-training as well as surgeons of all specialties who are in practice.
Other healthcare professionals will no doubt find this concise manual to be of
use as a ready reference as well, in much the same manner as the first and
second editions of this book has been utilized by the oncology community at
large. The credit for this current handbook belongs to the present and former
surgical oncology fellows at The University of Texas M. D. Anderson Cancer
Center. These efforts, coupled with your own interest, will help ensure that the
solid tumor oncology patient receives the best possible multimodality care
available. We hope that you find this handbook useful in this critical
effort.
Raphael E. Pollock M.D., Ph.D.
Head, Division of Surgery, Professor and Chairman, Department of
Surgical Oncology, M. D. Anderson Cancer Center, Houston,
Texas