Malignant tumors of the body and tail of the pancreas account for about 20% of all malignant tumors of the pancreas. The early clinical symptoms of the tumors are mainly abdominal and back pain and weight loss. The symptoms and signs are not obvious or specific. At the time of consultation, the tumors often metastasize and invade the main peripancreatic vessels, which mainly include the abdominal trunk, the common hepatic artery, and the splenic artery and vein, etc. The resectability rate of these tumors is low. The 2-year survival rate was only 10%, the median survival time was 9.8 months, and the prognosis was very poor . In the past, it was considered that the tumors invaded the abdominal trunk could not be resected. But with the advancement of pancreatic surgery technology, the modified Appleby operation was applied to the treatment of pancreatic body and tail malignant tumors invading the common hepatic artery and abdominal trunk, which provided patients with the opportunity of operation, improved the resection rate of R0, effectively prolonged the survival time of patients, and improved the quality of life of patients.
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Yamamoto Y, Sakamoto Y, Ban D, et al. Is celiac axis resection justified for T4 pancreatic body cancer? Surgery. 2012;151:61–9.CrossRefGoogle Scholar
Appleby LH. The coeliac axis in the expansion of the operation for gastric carcinoma. Cancer. 1953;6(4):704–7.CrossRefGoogle Scholar
Hishinuma S, Ogata Y, Tomikawa M, et al. Stomach-preserving distal pancreatectomy with combined resection of the celiac artery: radical procedure for locally advanced cancer of the pancreatic body. J Gastrointest Surg. 2007;11(6):743–9.CrossRefGoogle Scholar
Hirano S, Kondo S, Hara T, et al. Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer: long-term results. Ann Surg. 2007;246(1):46–51.CrossRefGoogle Scholar
Greer J, Zureikat AH. Robotic distal pancreatectomy combined with celiac axis resection. J Vis Surg. 2017;3:145.CrossRefGoogle Scholar
Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 2017;15(8):1028–61.CrossRefGoogle Scholar
Wolfgang CL, Herman JM, Laheru DA, et al. Recent progress in pancreatic cancer. CA Cancer J Clin. 2013;63(5):318–48.CrossRefGoogle Scholar
Nakamura T, Hirano S, Noji T, et al. Distal Pancreatectomy with en bloc celiac Axis resection (modified Appleby procedure) for locally advanced pancreatic body cancer: a single center review of 80 consecutive patients. Ann Surg Oncol. 2016;23:969–75.CrossRefGoogle Scholar
De Rooij T, Tol JA, van Eijck CH, et al. Outcomes of distal pancreatectomy for pancreatic ductal adenocarcinoma in the Netherlands: a nationwide retrospective analysis. Ann Surg Oncol. 2016;23(2):585–91.CrossRefGoogle Scholar
Cesaretti M, Abdel-Rehim M, Sauvanet A. Modified Appleby procedure for borderline resectable/locally advanced distal pancreatic adenocarcinoma: a major procedure for selected patients. J Visc Surg. 2016;153:173–81.CrossRefGoogle Scholar