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World J Gastrointest Surg. Mar 27, 2013; 5(3): 51-61
Published online Mar 27, 2013. doi: 10.4240/wjgs.v5.i3.51
Published online Mar 27, 2013. doi: 10.4240/wjgs.v5.i3.51
Liver blood supply after a modified Appleby procedure in classical and aberrant arterial anatomy
Vyacheslav I Egorov, Ostroumov 14th City Hospital, Department of Surgical Oncology, Sechenov First State Medical University, 117997 Moscow, Russia
Roman V Petrov, Department of General Surgery, Russian National Research Medical University, 117997 Moscow, Russia
Michail V Lozhkin, Department of Abdominal Surgery, Herzen Institute of Oncology, 117997 Moscow, Russia
Olga A Maynovskaya, Department of Pathology, Herzen Institute of Oncology, 117997, Moscow, Russia
Natalia S Starostina, Department of Radiological, Herzen Institute of Oncology, 117997 Moscow, Russia
Natalia R Chernaya, Department of Interventional Radiology, Sklifosovsky Emergency Institute, 117997 Moscow, Russia
Ekaterina M Filippova, Department of Pathology, Vishnevsky Institute of Surgery, 117997 Moscow, Russia
Author contributions: Egorov VI made contributions to the conception and designed the case report; Egorov VI, Lozhkin MV and Petrov RV made contributions to the primary surgery; Starostina NS and Chernaya NR provided the imaging; Maynovskaya OA and Filippova EM carried out the pathology analysis; all authors contributed to data acquisition and interpretation, literature research, drafting the manuscript, revision and final version approval.
Correspondence to: Dr. Vyacheslav I Egorov, Ostroumov 14th City Hospital, Department of Surgical Oncology, Sechenov First State Medical University, 117997 Moscow, Russia. v.egorov61@gmail.com
Telephone: +7-495-4335467 Fax: +7-499-2366130
Received: August 14, 2012
Revised: November 2, 2012
Accepted: December 20, 2012
Published online: March 27, 2013
Revised: November 2, 2012
Accepted: December 20, 2012
Published online: March 27, 2013
Abstract
Reported here are two cases of a modified Appleby operation for borderline resectable ductal adenocarcinoma of the pancreatic body, in one of which a R0 distal resection was attended to by excision, not only of the celiac axis, but also of the common and left hepatic arteries in the presence of arterial anatomic variation Michels, type VIIIb. The possibility and avenues of the maintenance of the blood supply to the left hepatic lobe after surgical aggression of this kind are demonstrated employing computed tomography (CT) and 3-D CT angiography. Furthermore, both cases highlight all important worrisome aspects of pancreatic cancer resectability prediction.
Keywords: Cancer; Pancreas; Management; Pancreatectomy; Distal pancreatectomy; Vascular invasion; Computed tomography; Blood supply