of the second edition remain the same as those for the first edition: this book is not meant to be a full review of small animal oncology. We wanted to concentrate on the surgical procedures, such as those that are not well covered in other textbooks, and importantly to assist with decision making by providing information such as complications, prognoses, and adjuvant or alternative therapies. The reader is expected to have a basic knowledge of general surgical principles and surgical techniques.
Without the excellent contribution and collaboration by the chapter authors, all of whom are leaders in the field of surgical oncology, the second edition of this textbook would not have been possible. We are indebted to our colleagues who have tirelessly reviewed the first edition and any feedback from readers to correct any shortfalls in their chapters, as well as to add newer and pertinent information. We also want to thank Justinia Wood, Catriona Cooper, Teri Jensen, Erica Judisch, Jayadivya Saiprasad, and particularly Merryl Le Roux and Susan Engelken, from Wiley‐Blackwell, for their assistance, guidance, and patience during the process of updating the first edition. We also want to thank Molly Borman and Kip Carter for creating new illustrations, Maddi Funk for photography and technical assistance with new figures. Finally, and most importantly, we want to thank our families who have again lived through the creation of the second edition, which has encompassed trying times in world health, and we sincerely appreciate their resilience and support. We are confident that Veterinary Surgical Oncology will remain the textbook of choice for students, interns, residents, and veterinary surgeons with interest in surgical oncology.
Simon T. Kudnig and Bernard Séguin
Foreword
It is my honor to write a foreword for the second edition of Veterinary Surgical Oncology. Having spent most of my career in this discipline, it is rewarding to see an evidence‐based approach to surgical oncology being emphasized.
It should go without saying that surgical oncology could not have developed to the specialty it is today without the parallel growth of advanced imaging, anesthesia, analgesia, blood products, pathology, critical care, and hemostatic/stapling equipment. Close integration with medical and radiation oncology has been crucial to optimizing patient care.
Surgery probably cures more patients than any other discipline but must be tempered with acceptable cosmesis and function. The old adage of “to cut is to cure” should not dominate decisions and outcomes. More radical procedures in the chest, abdomen, and brain are being slowly supplemented with skilled minimally invasive procedures in select instances.
Surgical judgment may be the wild card. Determining when, how, and why to operate remains the art of the discipline. The establishment of ACVS fellowship training in surgical oncology has established minimal training guidelines.
On a personal note, I have been involved with the training of 22 of the 32 authors of this text. I couldn’t be prouder of their efforts to optimize Veterinary Surgical Oncology and congratulate the editors: Dr. Bernard Séguin and Dr. Simon Kudnig.
Stephen J. Withrow, DVM, diplomate ACVS, ACVS
Founding Fellow, Surgical Oncology
University Distinguished Professor
Stuart Chair in Oncology – Emeritus
Founding Director, Flint Animal Cancer Center
Colorado State University
Fort Collins, CO
About the Companion Website
The companion website for this book is at
www.wiley.com/go/kudnig/veterinary
The website contains –
Figures
Video Clips
1 Principles of Surgical Oncology
William T.N. Culp and Nicole Ehrhart
Cancer treatment is a rapidly changing and evolving area involving multiple diagnostic and therapeutic modalities to achieve the most optimal outcome. Surgical intervention remains a pivotal aspect of the treatment of cancer. Surgery cures more solid cancers than any other single modality. Nonetheless, the optimal treatment pathway for any given animal patient with cancer most often involves several adjuvant treatment modalities. Adjuvant treatments significantly affect the success of surgery, and likewise, surgery affects the outcome of adjuvant treatments. It is widely recognized in human cancer centers that patient outcome is greatly improved when surgery is performed by a surgeon with specialized training in oncologic procedures. Surgeons trained in these programs have expertise in the selection of surgical treatment options in combination with other forms of cancer treatment, as well as knowledge of the benefits and risks associated with a multidisciplinary approach beyond what can be mastered within a three‐year surgery residency training program. This level of expertise requires an understanding of the fundamental biology of cancer, clinical pharmacology, tumor immunology, and endocrinology, as well as a thorough understanding of potential complications of multimodality therapy. Veterinary training programs in surgical oncology have been in existence for almost 20 years. With the development of novel treatments, the role of the surgical oncologist is constantly evolving and changing (O’Reilly et al. 1997; Drixler et al. 2000).
Therapeutic goals (e.g. curative‐intent, cytoreduction, or palliation) for each case should be established with owners before surgery is initiated. The efficacy of surgical therapy in any patient with cancer is heavily dependent upon the surgeon’s global understanding of the patient’s general health status, lifestyle and activity level, type and stage of cancer, adjuvant therapies available, alternatives to surgery, and expected prognosis. To maximize effectiveness, the optimal treatment pathway for each case should be strategically assessed prior to initiating treatment. This planning should always include a frank and thorough discussion with the owner regarding preoperative diagnostic tests, stage of cancer, palliative options, surgical options, adjuvant treatments likely to be needed, costs, postoperative care and expected function, cosmesis, and prognosis including risks of complications. The goal of this discussion is to provide the owner with enough information to help them make an informed choice regarding the best treatment pathway for their companion. Highly individualized initial planning will allow for the best overall outcome for each patient.
Preoperative Considerations
Signalment
The patient’s age, gender, breed, and weight are important factors in the determination of appropriate recommendations. Advanced age is not necessarily a negative prognostic factor. Comorbidities common to geriatric veterinary patients such as renal insufficiency, hepatic disease, or osteoarthritis may limit or change specific treatment recommendations; however, the age of the patient alone should not.
Certain neoplastic diseases are common in a particular gender or breed. The surgical oncologist should always bear in mind
