OXFORD MEDICAL PUBLICATIONS Surgical Oncology Published and forthcoming Oxford Specialist Handbooks General Oxford Specialist Oxford Specialist Handbooks in Handbooks Paediatrics A Resuscitation Room Guide Paediatric Endocrinology and Addiction Medicine Diabetes Perioperative Medicine, Paediatric Dermatology second edition Paediatric Gastroenterology, Post-Operative Complications, Hepatology, and Nutrition second edition Paediatric Haematology and Oncology Oxford Specialist Handbooks Paediatric Nephrology in Anaesthesia Paediatric Neurology Cardiac Anaesthesia Paediatric Radiology General Thoracic Anaesthesia Paediatric Respiratory Medicine Neuroanaethesia Obstetric Anaesthesia Oxford Specialist Handbooks in Paediatric Anaesthesia Psychiatry Regional Anaesthesia, Stimulation and Child and Adolescent Psychiatry Ultrasound Techniques Old Age Psychiatry Oxford Specialist Handbooks in Oxford Specialist Handbooks in Cardiology Radiology Adult Congenital Heart Disease Interventional Radiology Cardiac Catheterization and Musculoskeletal Imaging Coronary Intervention Echocardiography Oxford Specialist Handbooks in Fetal Cardiology Surgery Heart Failure Cardiothoracic Surgery Hypertension Hand Surgery Nuclear Cardiology Hepato-pancreatobiliary Surgery Pacemakers and ICDs Oral and Maxillofacial Surgery Neurosurgery Oxford Specialist Handbooks in Operative Surgery, second edition Critical Care Otolaryngology and Head and Neck Advanced Respiratory Critical Care Surgery Paediatric Surgery Oxford Specialist Handbooks in Plastic and Reconstructive Surgery End of Life Care Surgical Oncology End of Life Care in Cardiology Urological Surgery End of Life Care in Dementia Vascular Surgery End of Life Care in Nephrology End of Life Care in Respiratory Disease End of Life in the Intensive Care Unit Oxford Specialist Handbooks in Neurology Epilepsy Parkinson’s Disease and Other Movement Disorders Stroke Medicine Oxford Specialist Handbooks in Surgery Surgical Oncology Edited by M. Asif Chaudry Specialist Registrar in Surgery, London & Surgical Research Fellow, Division of Surgery & Interventional Science, University College London, London, UK Marc C. Winslet Professor of Surgery, Head of Department & Chairman of Division of Surgery & Interventional Science, University College London, London, UK 1 1 Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offi ces in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Oxford University Press, 2009 The moral rights of the author have been asserted Database right Oxford University Press (maker) First published 2009 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging-in-Publication Data Chaudry, M. Asif. Surgical oncology / M. Asif Chaudry, Marc Winslet. p. ; cm. -- (Oxford specialist handbooks in surgery) Includes index. ISBN 978-0-19-923709-8 (alk. paper) 1. Cancer--Surgery--Handbooks, manuals, etc. I. Winslet, M. C. (Marc C.) II. Title. III. Series: Oxford specialist handbooks in oncology. [DNLM: 1. Neoplasms--surgery--Handbooks. QZ 39 C496s 2009] RD651.C43 2009 616.99’4059--dc22 2009008905 Typeset by Cepha Imaging Private Ltd., Bangalore, India Printed in China on acid-free paper through Asia Pacifi c Offset ISBN 978–0–19–923709–8 10 9 8 7 6 5 4 3 2 1 Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Some of the medication discussed in this book may not be available through normal channels and only available by special arrangements. Other examples used in research studies and recom- mended in international guidelines are unlicensed or may be subject to being used outside of their licensed dosage ranges within the UK. We suggest consulting the BNF and local prescribing guide- lines/protocols before using unfamiliar medication. v Foreword The editors and authors of this book are to be congratulated on the pro- duction of an excellent manuscript which will be of immense value both to specialist registrars in general surgery and to anyone who wants a con- temporary reference text on their bookshelf. Over the past decade especially, and in almost every sub-speciality of surgical oncology, there have been major changes in routine management as a result of improvement in technology and systemic therapies. Some of these changes have been dramatic and have taken many of us by surprise. The changes include staging techniques, neo– and adjuvant therapies and especially new surgical tools which have had a profound effect on our sur- gical practice. It is now more diffi cult then ever to keep abreast of changes in near-parallel sub-specialities which previously was not diffi cult. This book will help to overcome some of these diffi culties and will be of great value for life-long students of surgery. Throughout the book, the results of major trials which have brought about these changes are discussed and easy references provided. I have nothing but praise for this book which has been written by highly motivated members of our profession. The quality of the writing, its content, and presentation is exceptionally good and one is left with a sense of admiration for the authors and the reassurance that the future of surgery in this complex and challenging area is secure. J Meirion Thomas MS FRCP FRCS Professor of Surgical Oncology Royal Marsden Hospital and Imperial College This page intentionally left blank vii Preface How should surgeons deal with cancer patients? The cornerstone of effective treatment is a multidisciplinary collaboration between many specialties in which surgeons are not only concerned about operative accessibility and technique, but rather have a deep understanding of the fundamental biology of the malignancy they are dealing with and appre- ciate the reach of multi-modal treatment. Higher surgical trainees regularly moving to the variety of general surgical sub-specialties are required to rapidly assimilate updated clinical algorithms based on evidence-based guidelines that go beyond the basic level achieved at the MRCS. This is essential if we are to ensure that the clinical trajectory of our cancer patients is optimal. Clinical guidelines issued by national bodies usually run into hundreds of pages of dense text, as do the many textbooks of surgical oncology that often provide encyclopaedic reference material and conceptual information, but are not targeted at immediate practice. In writing this handbook, our aim has been to provide a summarized yet reliable compendium of all of those books and resources online that both our colleagues and ourselves have quickly peered into on so many occasions: after reading a pathology report or CT scan in the outpatient’s clinic; before presenting a case at a multidisciplinary team meeting at a regional cancer centre; or perhaps, before asking our seniors or colleagues for advice about surveillance for a complex case and before proceeding to the operating theatre. It is also the book that many were in search of when preparing for exams that contained the breadth of surgical oncology that had to be studied from an array of sub-specialty sources. It is an essen- tial practical handbook that draws together all the varied guidelines and source materials that form the basis of this complex subject. MAC MCW This page intentionally left blank ix Acknowledgements We acknowledge all those who have helped in producing this book at OUP namely Susan Crowhurst and Suzy Armitage. We gratefully acknowledge that many fi gures in this book have been reproduced from Operative Surgery, second edition, (2006) edited by Greg R. McLatchie and David J. Leaper (Oxford: Oxford University Press). We are deeply thankful to and acknowledge the assistance of Dr Dhiren Shah, St Thomas’s Hospital, London, who provided the radiological images used in this book. We thank Christopher Liao for his invaluable input throughout. We also thank Mr Don Menzies, ICENI Centre, Colchester, UK, for the laparoscopic images used—and Tino Solomon, ICENI Centre, Colchester, UK, for his assistance in the compilation of this book. We gratefully acknowledge Mr Daren Francis, Chase Farm Hospital, Enfi eld, for his suggestions in the anal and colorectal chapters.