Of all the therapeutic approaches, there is little doubt that surgery, when indicated is the oldest and still the most curative approach in early stages of the disease. Despite rapid progress in chemoradiotherapy, surgery still remains steadfast as a major therapeutic approach for the cure and control of cancer. It is, therefore, necessary and imperative that surgeons dealing with cancer know the finer nuances of the surgical approach like indications, contraindications and techniques in given clinical settings. The surgeon also needs to be adept in foreseeing complications, its early diagnosis and appropriate management; indeed, most complications can be and should be prevented at the time of surgical procedure by precise and appropriate surgical techniques.

I sincerely hope and I am sure that this important, significant and brief surgical atlas will be extremely useful and helpful to many of our non-oncology and general surgeons who carry and manage a significant load of surgical oncology beyond the confines of large oncology centers and general hospitals. Even the postgraduate students will find this “Atlas” useful for their qualifying examinations.

I wish to congratulate the editors and their colleagues at Tata Memorial Centre, for this seminal effort and wish this compilation will receive a wide acceptance.

Cancer demographics vary among countries but correlates with level of economic development. Cancers of the breast, lung, colorectum, and prostate account for half the overall cancer burden in regions of the highest Human Development Index (HDI), while cancers of the esophagus, stomach, and liver are relatively more common in medium HDI regions. Cervical cancer was more common than both breast and liver cancer in low HDI regions back in 1990, but those trends are shifting as cervical cancer prevention is improving while breast cancer rates continue to rise. Overall, the rapid societal and economic transition in many countries means that any reductions in infection-related cancers (cervical, liver, stomach) are offset by an increasing number of new cases that are more associated with reproductive, dietary, and hormonal factors (breast, colorectal, prostate) all of which require multidisciplinary treatment if curative outcomes are intended.

Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases needed surgery, some several times. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This deficit is multifactorial, but a significant obstacle is the lack of education about cancer surgery in limited resource settings, where cancer presentations differ from high-income countries and where healthcare system constraints require adapted approaches that are resource-appropriate.

The internationally recognized surgical oncology faculty from the Tata Memorial Hospital, Mumbai, Maharashtra, India, is well positioned to teach us about the unique cancer surgical needs of a lower-middle income environment like India. These accomplished surgeons previously proved that deficits of surgical education can lead to detrimental surgical outcomes. For example, of 424 patients who underwent therapeutic breast cancer surgery between 2000 and 2003, 191 (45%) had received incomplete surgery at outside non-specialty centers. Almost half of those patients who underwent incomplete surgery had surgically excisable residual disease. Of 148 patients who underwent completion revision surgery, 123 (83%) patients had residual lymph nodes in the axilla including 64 who had metastatic lymph nodes left behind in the axillary bed.

The Tata Memorial surgical experts have also shown that approaches commonly considered essential in high-income countries may not be needed in limited resource settings where patients most commonly present with clinically advanced disease. For example, in high-income countries where the majority of breast cancers are identified by mammographic screening prior to the development of clinical signs and symptoms, diagnostic mammography is considered an essential diagnostic study for patients undergoing breast conservation surgery to determine the actual extent of disease for proper surgical planning. By contrast, the Tata Memorial team showed us that in their setting where essentially all patients present with well-established clinically palpable disease, diagnostic mammography had limited value, making no difference in the decision making among 95% of the 735 breast conservation patients treated at their institution. Educational materials are clearly needed to be properly contextualized to the environment in which they are going to be applied.

This Atlas of Operative Surgical Oncology from Tata Memorial's surgical oncology faculty is a valuable contribution to the surgical management of cancer. The well-written text is brief but poignant. Key issues in diagnosis and operative preparation are discussed. The bullet point explanations of the surgical procedure provide a clear description of the operative steps, especially helpful for surgeons who may be experienced in surgery but may not have had the benefit of complete surgical training in cancer surgery. The operative photographs and diagrams are clear, well selected and highly informative. Indications, contraindications and cautions are nicely presented, providing crystal clarity of the key issues that thoughtful surgeons need to properly manage their cancer patients. The value of this document goes beyond its technical scope to touch on key issues in cancer control. The authors and collaborators should be congratulated for this important achievement.

This atlas will not only be helpful for those who are at the beginning of their surgical oncology training but also for the experienced surgeons to enhance their surgical techniques, as this atlas highlights fine nuances developed by the masters in their respective specialties.

I had the privilege and the honor to perform one of the first Veronesi quadrantectomies at Tata Memorial in Mumbai in 1985 and I still remember the interest and the curiosity of the colleagues who were around in the theatre. A lot of time has passed and Tata is now a world leader of conservative breast surgery, supported by outstanding biological and molecular research.

Thank you for having given me the wonderful opportunity of sharing with you the pioneering work of Umberto Veronesi and our surgery group in Milan. Hope that this atlas becomes a guide for surgeons not only in Asia but across the globe.

Best wishes!

We have avoided describing the disease process, but concentrated on the operative techniques. Every chapter in the book not only informs the surgeon on how best to select patients for each procedure but also when surgery is contraindicated. A brief description of the preoperative evaluation of the patient for the procedure, type of anesthesia commonly employed and the positioning of the patient is also included. This is accompanied by a step-by-step description of the procedure and a list of common complications. Variations in surgical steps, tips to avoid surgical mishaps and techniques to improve oncological outcomes and surgical safety have been addressed. Minimally invasive procedures have been mentioned wherever appropriate. Every chapter ends with key points, which include the do's and don'ts for surgery of that organ. Operative photographs, illustrations and tables are the highlights of this atlas, and make the understanding of the operative field, the technique and steps involved easier to grasp.

Complex and less common surgical oncology procedures which require a high degree of specialization have not been included in this atlas, as the focus remains on the common cancers. Even though this book has been written keeping the general surgical oncologists and general surgeons in mind, it provides enough information for the specialists. This atlas aims to serve as a ready reference for a practicing surgical oncologist, a guide for the trainees and fellows and will be useful for the undergraduates preparing for their examinations to understand the techniques in surgical oncology.

The contributors to the book are the esteemed faculty from the surgical oncology department at Tata Memorial Centre, an institution committed to service, research and education. We are extremely grateful to all the contributors who took the time to put this atlas together, summarizing their expert views on the surgical procedures that they have mastered.

Lastly, we must not forget our patients, whose trust in us is an everyday reminder of how sincerely we need to try to do our best for them.

We also want to thank the medical artist department at Tata Memorial Hospital, especially Mr Nilesh Ganthade and Mr Kamlesh, who have helped us in editing the operative photographs and illustrations, and this effort would be incomplete without them.

Finally, this book would not have been published in time without the support of Shri Jitendar P Vij (Group Chairman) and Mr Ankit Vij (Group President) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India. The team assigned to this atlas, especially Mr Sabarish Menon, Mr Joaquim Marques, Mr Rajesh Sharma and Mr Laxmidhar Padhiary have worked round the clock to ensure the successful publication of this title.