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Some reflexions on the modified Appleby procedure.

Francisco José Morera-Ocon¹, Inmaculada Cárcel-Cárcel, Javier Ballestín Vicente

¹Department of Surgery, Hospital General de Requena, 46340 Valencia, Spain. fmoreraocon@aecirujanos.es

JOP : Journal of the Pancreas

|November 6, 2009

Summary

The modified Appleby procedure can successfully resect pancreatic cancer involving major arteries. Careful surgical technique and adjunctive cholecystectomy are crucial for favorable outcomes in advanced pancreatic cancer.

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Area of Science:

Surgical Oncology
Gastroenterology
Vascular Surgery

Background:

Pancreatic cancer resection with vascular invasion, particularly of the celiac axis, remains controversial.
The modified Appleby procedure offers a solution for managing celiac trunk encasement in pancreatic cancer.

Observation:

Two cases of locally advanced pancreatic cancer with celiac trunk and hepatic artery involvement were reviewed.
One patient underwent extended pancreatectomy with en-bloc resection; the other had arterial trunk liberation.
Neoadjuvant chemoradiation was administered to one patient.

Findings:

Microscopically clear margins (R0) were achieved in both patients.
One patient experienced fatal cholecystitis due to arterial insufficiency post-procedure.

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CT findings of vascular encasement do not always confirm actual tumor invasion.

Implications:

Surgical and anesthesiological advancements enable vascular resections with reduced morbidity.
A prophylactic cholecystectomy is recommended when performing the modified Appleby procedure.
This case series highlights the feasibility and potential complications of advanced pancreatic cancer resection techniques.