Malignant liver tumors: current and emerging therapies 3rd edition, Pierre-Alain Clavien, editor
As the editors note on several occasions in Malignant Liver Tumors, Current and Emerging Therapies (Wiley-Blackwell, January 2010, ISBN: 978-1-4051-7976-8. http://www.wiley.com/WileyCDA/WileyTitle/productCd-1405179767.html), the treatment of hepatic malignancies requires a multidisciplinary approach. Herein lies the value of this book – it enables clinicians from various disciplines to gain a more nuanced understanding of their colleagues’ treatment strategies for these complex diseases. This text is the latest offering from Clavien et al. in the series, and the newest edition has been carefully revised and updated from previous versions. Included are a new introduction, and notably, a section on treatment guidelines for primary and metastatic liver tumors. The former includes important historical context for the treatment of hepatic malignancy including the advent and development of transplantation while the latter describes mostly consensus-based interventions. The work is edited and presented by a wide array of international experts in the field of hepatic malignancy. This diverse group of chapter authors lends welcome perspective to a complex set of topics.
This book is divided into 7 sections of 5-9 chapters each. The sections are grouped into an introduction, epidemiology/diagnosis, systemic/regional therapies, resection and transplantation, guidelines, emerging therapies, and special considerations. The latter addresses a veritable gab-bag of topics such as endocrine tumors, pediatric tumors, regional variations in tumor incidence and treatment, and anesthesia considerations. Chapters are typically on the shorter side, rarely exceeding 15 pages. Nice glossy color photos are included in most chapters and the imaging and diagrams add emphasis to the text throughout while keeping the text from becoming overbearing or stale. At the end of each chapter is a short multiple-choice quiz, a complete reference list, and finally the quiz answers. While the quiz might be unnecessary for some readers, it does enable the use of the book for teaching and self-assessment.
Several chapters are worth highlighting. The second chapter, “Hepatic Anatomy and Terminology,” by Steven Strasberg is a must read for any surgical resident or fellow. It includes an exceptional discussion of anatomic nomenclature and clearly describes the rationale for anatomic-based resection. Similarly, the third chapter, “Histology and Pathology of Normal and Diseased Liver,” by Paradis and Weber concisely describes histopathology and fibrosis grading systems with excellent color photos and diagrams. For those clinicians who may frequently refer patients for radiation or interventional therapies but do not have a strong understanding of the logistics and technical aspects of these particular therapies, Chapters 11-13 expound on external beam radiation, internal radiation and trans-arterial chemoembolization in such a fashion as to make them quickly and readily comprehensible. In the Emerging Therapies section, Chapter 31, “Signaling Pathways and Rationale for Molecular Therapies in Hepatocellular Carcinoma,” clearly describes important cellular mechanisms in the development of HCC and the concordant targets for molecular therapy.
One notable criticism is a slight over emphasis on primary hepatobiliary malignancy and less emphasis on metastatic liver lesions. For instance, in the section on treatment guidelines, the chapter on colorectal cancer (CRC) liver metastases barely covers 4 pages, while those on HCC, cholangiocarcinoma, and gallbladder cancer nearly twice as many. In the setting of more extensive research and dramatic improvement in outcomes with neo- and adjuvant therapy for CRC as well as considerable controversy, this is an area for expanded discussion in future editions. What may underlie this deficiency is a surgical bias to the text, which precludes a more developed discussion of systemic therapies.
What does this book need? Digital media. An accompanying web-based version or digital copy on cd of the highlights and key concepts in this text would be a most welcome addition. Also, I find that a short list of the key references on a topic preceding the full references section is one of the more enlightening mechanisms for directing future study, enabling the reader to get to the critical or seminal papers on the chapter’s subject matter and to highlight the critical concepts the author is trying to impart.
If I were to choose a single text to read for a hepatobiliary surgery, oncology or hepatology fellowship, this would not be the text. For that purpose one requires a broader text, and this is a very focused book. Nonetheless, if I were to design the perfect book to cover this particular subject matter in just the right amount of detail while maintaining a conciseness that prevents the work from being obtuse, this would be the book. In fact, this may be the ideal book for those clinicians whose practice is focused on the treatment of patients with hepatic malignancies.
Acknowledgements
Disclosure: The author declares no conflict of interest.
