title: Extended pancreatectomy with resection of the celiac axis: the modified Appleby operation.
abstract: BACKGROUND
  Celiac axis invasion by central and distal pancreatic cancers has been considered a contraindication to resection. Appleby first described en-bloc celiac axis resection with total gastrectomy for locally advanced gastric cancer. We present our experience with a modification of this procedure in central pancreatic cancers involving the celiac trunk.
  
  
  METHODS
  Three patients with central pancreatic cancers invading the celiac axis are reviewed. All patients underwent extended pancreatectomy with en-bloc resection of the celiac axis.
  
  
  RESULTS
  Margins were grossly clear of tumor in all patients. The mean length of stay was 8.3+/-1.1 days. There was no evidence of clinically significant gastric or hepatic ischemia. All 3 patients remain disease free at 34, 14, and 14 months from surgery, respectively.
  
  
  CONCLUSIONS
  Extended pancreatectomy with celiac axis resection can result in prolonged survival and should be considered in central and distal pancreatic cancers invading the celiac trunk.
authors.affiliation: Division of Hepatobiliary/Pancreatic Surgery and Transplant Surgery, University of Southern California University Hospital, 1510 San Pablo St., HCC1 Suite 200, Los Angeles, CA 90033, USA.
authors.forename: Singh
authors.initials: S
authors.lastname: Gagandeep
authors.forename: Avo
authors.initials: A
authors.lastname: Artinyan
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jabbour
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Mateo
authors.forename: Lea
authors.initials: L
authors.lastname: Matsuoka
authors.forename: Linda
authors.initials: L
authors.lastname: Sher
authors.forename: Yuri
authors.initials: Y
authors.lastname: Genyk
authors.forename: Rick
authors.initials: R
authors.lastname: Selby
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D002445:Celiac Artery / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome