Extended Appleby's operation for pancreatic cancer involving celiac axis

Abstract

Background: In Appleby's operation, the adequate flow of proper hepatic artery (PHA) from pancreaticoduodenal arcades was considered to be important in the previous reported pancreatic cancer cases. Insufficient blood flow of PHA was considered as the contraindication for Appleby's operation.

Methods: We herein reported a 20 cm in diameter pancreatic sarcomatoid carcinoma involving celiac axis (CA), which was treated by extended Appleby's operation without proper hepatic arterial flow. The extended Appleby's operation for pancreatic cancer involving CA and/or common hepatic artery (CHA) was firstly applied to the current case according to the 43 previous reported cases in English literature from a Medline search. In the extended Appleby's operation, the resection scope included total pancreas, total stomach, spleen, and CA; the anterior and posterior pancreaticoduodenal arcades were removed in whipple's procedure, which was previously thought to be the contraindication for Applyby's operation.

Results: Proper hepatic arterial flow from superior mesenteric artery (SMA) was totally lost; No liver failure happened postoperatively.

Conclusions: 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.