Modified Appleby procedure for locally advanced pancreatic cancer

Locally advanced pancreas cancer (LAPC) involving the celiac axis is typically considered unresectable and carries a poor prognosis. We present a case of a patient with LAPC who underwent a modified Appleby procedure for tumor clearance following neoadjuvant therapy. Technical aspects include diagno...

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Bibliographic Details
Published in:The American journal of surgery 2018-05, Vol.215 (5), p.853-855
Main Authors: Deal, Shanley, Nathan, Derek, Rocha, Flavio G.
Format: Article
Language:English
Subjects:
Cancer
Cancer therapies
Chemotherapy
Diagnostic systems
Hepatic artery
Laparoscopy
Lymphatic system
Metastases
Pancreas
Pancreatic cancer
Patients
Preservation
Spleen
Surgery
Veins & arteries
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Summary:Locally advanced pancreas cancer (LAPC) involving the celiac axis is typically considered unresectable and carries a poor prognosis. We present a case of a patient with LAPC who underwent a modified Appleby procedure for tumor clearance following neoadjuvant therapy. Technical aspects include diagnostic laparoscopy to exclude occult metastatic disease followed by complete mobilization of the pancreas and spleen, preservation of the left gastric artery, and resection and reconstruction of the common hepatic artery. With proper patient selection and preparation, LAPC with celiac axis involvement can be safely resected with favorable outcomes. •Modified Appleby procedure for locally advanced pancreatic cancer.•Careful patient selection is required.•Tumor Non-progression during neoadjuvant therapy is imperative.•Resection and reconstruction of the hepatic artery may be needed.•Preservation of the left gastric artery is preferred.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2018.01.004