Modified Appleby Procedure, Distal Splenopancreatectomy with Celiac Axis Resection

Area of Science:

• Surgical Oncology
• Gastroenterology
• Oncology

Background:

• Locally advanced body pancreatic ductal adenocarcinoma (PDAC) involving the celiac axis presents a surgical challenge.
• Neoadjuvant treatment has improved outcomes, enabling more aggressive surgical approaches.

Observation:

• A 38-year-old woman with PDAC involving the celiac trunk and common hepatic artery received neoadjuvant FOLFIRINOX and chemoradiotherapy.
• Preoperative embolization of the common hepatic artery was performed to mitigate ischemia risks.
• Tumor markers normalized, and imaging showed stable disease after neoadjuvant treatment.

Findings:

• A modified Appleby procedure with en bloc celiac axis resection and portal vein resection was successfully performed.
• Pathologic evaluation confirmed a 2.5-cm PDAC with negative resection margins.
• The patient experienced acute ischemic cholecystitis but completed adjuvant chemotherapy and remained disease-free at 6 months post-surgery.

Implications:

• The modified Appleby procedure is increasingly utilized for selected advanced PDAC cases due to enhanced treatment responses.
• Aggressive surgical resection following neoadjuvant therapy can achieve favorable outcomes in locally advanced PDAC.
• This approach highlights the importance of multidisciplinary management in complex pancreatic cancer cases.