Is there a Role for the Appleby Procedure in 2020? Results from a Matched-Pair-Analysis

Locally advanced pancreatic cancer (LAPC) of the pancreatic body involving the celiac axis requires specialized treatment, including a subtotal distal pancreatectomy (SDP) with resection of the celiac axis (Appleby procedure). This study aimed to examine the value of the Appleby procedure, in current individualized treatment approaches, and to define its possible therapeutic impact for patients with LAPC.

20 consecutive patients who underwent SDP with resection of the celiac axis between January 2005 and December 2018 were identified from a prospectively collected database and were matched with 20 patients experiencing SDP without resection of the celiac axis. Both perioperative parameters, as well as the overall postoperative course, were evaluated.

The rate of perioperative complications in both groups was comparable (p=0.744). The rate of severe type C postoperative pancreatic haemorrhages (PPH) was significantly lower in patients with resection of the celiac axis compared to those without (p=0.035).

The Appleby procedure may be considered as a safe and feasible treatment option with favorably fewer postoperative severe bleeding complications. Besides surgical expertise, such procedures, however, require an experienced interventional radiologist and should thus only be performed in high-volume centers.