Appleby Operation for Pancreatic Body-Tail Carcinoma: Report of Three Cases

Abstract

The clinical course of patients with carcinoma of the pancreas, especially of the body-tail, remains dismal despite recent advances in diagnostic and therapeutic procedures. We present three case reports to evaluate the role of the Appleby operation in the treatment of pancreatic body-tail cancer. Care 1 was a 55-year-old Japanese woman who underwent the Appleby operation for mucinous cystadenocarcinoma of the body and tail of the pancreas invading the stomach, celiac axis, superior mesenteric and splenic arteries, and the splenic, superior mesenteric, and portal veins. Local recurrence and peritoneal dissemination with malignant ascites were found 7 months later and she died 10 months after the operation. Case 2 was a 61-year-old Japanese man who underwent the Appleby operation with 20 Gy radiation therapy for invasive ductal carcinoma of the body of the pancreas involving the celiac axis, common hepatic, splenic, and left gastric arteries, and the splenic vein. Peritoneal dissemination with malignant ascites was evident 5 months later and he died 14 months after the operation. Case 3 was a 50-year-old Japanese man who underwent the Appleby operation with 20 Gy radiation therapy for invasive ductal carcinoma of the body of the pancreas invading the stomach, splenic artery, celiac axis, and splenic vein. Multiple hepatic metastases were found 2 months later and the patient died 8 months after the operation. Based on our experience of these three cases, we conclude that the indications for the Appleby operation to treat locally advanced pancreatic body carcinoma are still limited because it does not improve quality of life or clinical outcome.

Distal Pancreatectomy for Body-Tail Pancreatic Cancer: Is There a Role for Celiac Axis Resection?

“…We performed a tangential resection of the portal vein in one of our 5 patients, as in 31/78 patients (39.7%) reported in the literature [7,8,9,10,11,12,13,14,15,16,18,19,20,21,22,24,25,26,28]. The mortality rate after combined CA and portal vein resection was 2/31 patients (6.5%), while it was 0/47 patients after CA resection alone; thus, associating portal vein resection with DP-CAR increases the related mortality rate.…”

“…After the first DP-CAR for body-tail pancreatic cancer performed by Nimura et al [7] in 1976, only 90 patients emerged from a careful literature review [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28] (table 2). Since there are no large series of DP-CAR for pancreatic cancer, we pooled our own findings with published reports in an attempt to draw some conclusions about the related surgical risk and long-term results.…”

“…Nimura et al [7] performed the first DP-CAR in a patient with body-tail pancreatic cancer in 1976. To date, DP-CAR for the surgical treatment of body-tail pancreatic cancer has been reported in a limited number of patients, mainly by Far Eastern authors [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22], while experience with this operation in Western countries is limited and more recent [23,24,25,26,27,28]. The indication for DP-CAR was recently extended to patients without any direct invasion of the CA to increase the radical resection (R0) rate for advanced body-tail pancreatic cancer [18].…”

Transposition of the hepatic artery as a salvage procedure for an aortic pseudoaneurysm after liver transplantation

“…In 1953, Appleby 6 described the resection of the celiac axis in the context of radical gastrectomy for gastric cancer. In 1976, Nimura et al 7 adopted this operative method for patients with carcinoma of the body and tail of the pancreas and infiltration of the celiac axis. 7 The anatomic basis for arterial perfusion of the liver after the occlusion or resection of the CT is the collateral blood circulation from the superior mesenteric artery (SMA) via the pancreaticoduodenal arcade and the GDA.…”

“…In 1976, Nimura et al 7 adopted this operative method for patients with carcinoma of the body and tail of the pancreas and infiltration of the celiac axis. 7 The anatomic basis for arterial perfusion of the liver after the occlusion or resection of the CT is the collateral blood circulation from the superior mesenteric artery (SMA) via the pancreaticoduodenal arcade and the GDA. 8 To make retrograde arterial perfusion possible in analogy to the Appleby operation, we transposed the donor's HA to the recipient's GDA.…”