Intervention d'Appleby : place et technique en cas d'envahissement tumoral du tronc cœliaque et de ses branches

Cancerous invasion of the celiac trunk is usually considered a contraindication to attempts at curative resection. Appleby was the first to propose an en bloc resection of the celiac trunk along with the celiac nervous plexus and lymph nodes for advanced gastric cancer. We describe a « modified Appleby technique » without gastrectomy for locally advanced cancer of the body of the pancreas. It accomplishes radical tumor resection, relieves pain, and improves the quality of life and overall prognosis. The principal complications are pancreatic fistula and gastric ischemia. Preoperative embolization of the common hepatic artery helps to develop favorable collateral blood flow and to avoid ischemia of the hepatobiliary system. A stomach-preserving « Appleby resection » may be appropriate treatment for selected nonaggressive cancers of the midpancreas; preoperative embolization of the common hepatic artery is an important adjunct of this technique.