Modified Appleby Procedure with Arterial Reconstruction for Locally Advanced Pancreatic Adenocarcinoma: A Literature Review and Report of Three Unusual Cases

Systematic review of outcomes after distal pancreatectomy with coeliac axis resection for locally advanced pancreatic cancer

“…A recent study of distal pancreatectomy with coeliac axis resection in 16 American College of Surgeons National Surgical Quality Improvement Program® centres reported a 10 per cent mortality rate (2 of 20 patients) in centres that performed between one and three procedures over a 14‐month period. Additionally, two small studies identified after completion of this review had comparable rates of major morbidity, 90‐day mortality, radical resection and overall survival.…”

Modified Appleby Procedure for Pancreatic Adenocarcinoma: Does Improved Neoadjuvant Therapy Warrant Such an Aggressive Approach?

“…However, both patients who required arterial reconstruction of the HA experienced a complicated postoperative course (DGE and POPF). This finding is also partially reflected in a case series and literature review by Latona et al 16 where one of three patients with arterial resection and reconstruction had a complicated postoperative course. Although we have insufficient data to support this claim, we do believe that combined arterial and venous reconstructions in an already complex DP-CAR adds further risk of postoperative complications, which further highlights the importance of appropriate patient selection.…”

“…15 Despite test clamping and Doppler ultrasonography, the major concern is the risk of ischemic complications after DP-CAR: insufficient flow in Data are expressed as n (%) unless otherwise specified DP-CAR distal pancreatectomy with en bloc splenectomy and celiac axis resection, DP distal pancreatectomy, ICU intensive care unit, EBL estimated blood loss, NA not available, POD postoperative day, ALAT alanine transaminase, ASAT aspartate transaminase, AJCC American Joint Committee on Cancer the PHA is a potential catastrophic complication. 16 Therefore, patients need to be carefully selected and evaluated for the feasibility of performing DP-CAR. Emphasis is given to maintaining collateral flow to the liver via the GDA.…”

Neoadjuvant Chemotherapy and Appleby Procedure for Pancreatic Acinar Cell Carcinoma: A Case Report

“…5 Tumors in the pancreatic body and tail are often diagnosed with involvement of the nearby celiac artery, and such tumors have generally been deemed unresectable. 10 However, in certain circumstances, the modified Appleby procedure, which consists of distal pancreatectomy with en bloc splenectomy and celiac artery resection, can be performed to achieve negative resection margins in patients with such tumors. 10 This procedure requires adequate collateral circulation between the superior mesenteric artery and the proper hepatic artery (PHA) through the gastroduodenal artery (GDA) to prevent catastrophic hepatic ischemia after resection of the celiac artery and associated common hepatic artery (CHA).…”