Surgical Foundations: Essentials of Thoracic Surgery
Larry R. Kaiser, Sunil Singhal
366 pp. Philadelphia, Pa: Elsevier Mosby; 2004. $79.00. ISBN 0-8151-2613-1
Kaiser and Singhal have chosen not to write an authoritative reference on the practice of thoracic surgery, but instead have produced an easily readable text that would be useful to readers such as medical students and surgical residents who wish to acquire the basic fundamentals of the practice of thoracic surgery. The beginning of each chapter contains a list of key topics that focus on the most important areas to be covered in that chapter. Key references are provided at the end of each chapter to supplement the information provided in the text.
The first 2 chapters provide an excellent review of thoracic anatomy and pulmonary physiology and are beautifully illustrated. The chapter on postoperative care discusses in great detail the parameters that are involved in assessing pulmonary function and the algorithms for determining operability. A major omission from this chapter, however, is the authors’ failure to include a discussion on screening and the management of patients with underlying ischemic heart disease before undergoing thoracotomy. Such a discussion is especially important because in current thoracic surgical practice the incidence of ischemic heart disease in patients with lung malignancies continues to rise and the morbidity and mortality of acute coronary syndromes in postoperative thoracotomy patients has increased significantly. The chapter on diagnostic procedures provides a good description of chest x-rays, CAT scans, and video-assisted thoracic surgical (VATS) techniques. Missing from this chapter is a discussion of the use of PET scans, which have become an important diagnostic tool in thoracic surgery; however, this technique is mentioned briefly in the chapter on bronchogenic cancers.
A chapter on thoracic trauma is included, which provides a detailed description of the operative and nonoperative management of major injuries to the chest. No mention is made, however, of aortic dissections or trauma to the great vessels, both of which have become more frequent indications for surgical intervention after blunt thoracic injuries. The chapter on pulmonary resections provides the reader with an excellent description of how to perform most major pulmonary resections, but I was particularly disappointed in the quality of the black and white illustrations used to supplement the chapter. Their poor quality made it difficult to adequately visualize the anatomical details that were so well described in the text.
The chapter on bronchogenic cancer provides an outstanding review of the pathophysiology and management options for the treatment of these neoplasms. Special emphasis is placed on providing the reader with an understanding of the various available adjuvant protocols and their long-term results in treating patients with stage III and IV disease. Additional chapters examine the treatment of nonbronchogenic pulmonary neoplasms; congenital lesions; chest wall disorders; mediastinal masses; and pleural, tracheal, and diaphragmatic disorders. These chapters discuss not only surgical treatment, but also provide excellent representative x-ray and CAT scan images of each disease entity. To complete the full spectrum of the newest applications of thoracic surgery, chapters on lung transplantation and the surgical treatment of emphysema are also provided.
The authors have accomplished their goal of producing a text that is easy to read yet contains detailed information on nearly every aspect of the practice of thoracic surgery. In addition to medical students and surgical residents, nurses, physicians’ assistants, medical oncologists, radiologists, pathologists, and pulmonologists who wish to learn more about the details of the practice of thoracic surgery will find this text useful. It may also serve as a useful text for practicing thoracic surgeons who may wish to use it as a quick reference.