The Modified Appleby Procedure For Locally Advanced Pancreatic Body/Tail Cancer: How I Do It
Published 2018 · Medicine
Tumors of the body and tail account for approximately one-third of pancreatic cancers, and up to three-quarters of body and tail tumors are deemed unresectable on presentation. Unresectability is a result of liver metastases, carcinomatosis, or local invasion of major vascular structures. Although pancreatectomy in the presence of metastatic disease has not proven beneficial, resection of locally advanced pancreatic cancer to negative margins may improve survival. Treatment of locally advanced pancreatic adenocarcinoma with arterial involvement remains controversial; however, 30% of patients with locally advanced, Stage III pancreatic cancer will die without evidence of metastatic spread. As such, this group of patients is most likely to benefit from an aggressive surgical approach. Neoadjuvant therapy has allowed for more careful selection of patients that may benefit from pancreatectomy with arterial resection. In this chapter, we discuss how we perform the modified Appleby procedure and review the literature.