Extended Appleby's operation for pancreatic cancer involving celiac axis

Abstract

The extended Appleby's procedure without blood flow of PHA might be feasible and offered a new approach to resection of pancreatic cancer involving CA and/or CHA; the involvement of pancreatic head might not be the contraindication for Appleby's operation.

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.…”

“…Konishi et al [11] reported several complications, such as liver necrosis, liver abscess, gallbladder necrosis and cholecystitis with DP-CAR. Several authors [11,16,18,19,20,24] reported a transient, moderate elevation of hepatic enzymes, with no signs of clinically significant hepatic ischemia. In our experience, as in the more recently published series, carefully evaluating the pulsatility of the proper hepatic artery after occluding the CA and the CHA proximal to the gastroduodenal artery prevented any severe complications.…”

“…In our experience, one of the main achievements of DP-CAR was the control of severe pain in all 5 patients. Unfortunately, many authors do not report on their patients’ pain [7,8,9,11,12,15,16,17,20,22,23,24,26], while complete, or near-complete pain relief was achieved in 24 of 25 patients (96%) mentioned in reports dealing with this aspect [10,13,14,18,19,21,25,27,28] (table 2). …”

“…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].…”