췌장원위부선암에서 변형적 Appleby씨 수술법 시행 1 예 보고

다국어 초록 (Multilingual Abstract)

The prognosis of distal pancreatic cancer is even poorer than that of pancreatic head cancer because
of its late symptom onset and tendency of aggressive retroperitoneal invasion at diagnosis. Since the
first Appleby’s operation in 1952, it has been performed in stomach cancer by several surgeons. But
the survival benefit is still controversial. Appleby’s operation includes total gastrectomy, splenectomy,
distal pancreatectomy, celiac trunk division with ligation of common hepatic artery(CHA) and retroperitoneal
lymph node dissection. In 1976, Nimura first adopted this method for distal pancreatic cancer.
We report a case of modified Appleby’s operation for distal pancreatic cancer. The patient was 44-
year old female. Her chief complaint was epigastric pain for 2 weeks. Preoperative liver function test
was within normal range and CA19-9 was elevated to 200 U/ml. Preoperative CT angiography showed
4.5×3cm sized, pancreatic mass in body and tail area invading splenic artery and celiac trunk from its
left side. In operation, splenectomy and distal pancreatectomy was initially performed. After ligation of
CHA, we confirmed intact proper hepatic artery(PHA) flow by doppler and then divided CHA. After
confirmation of intact gastric blood flow, left gastric artery(LGA) was divided. Celiac axis(CA) was
divided near its origin. Then we dissected retroperitoneal lymph nodes. There was minor pancreatic
leakage controlled by conservative management. CA19-9 was normalized to 33 U/ml on the 16th postoperative
day. She was discharged on the 28th postoperative day and underwent adjuvant chemotherapy
and radiotherapy.
There is no evidence of recurrence for 15 months of follow-up. We suggest that modified Appleby’s
operation should be considered for radical resection of distal pancreatic cancer which is invading CA or
major CA branch but not involving PHA and superior mesenteric artery(SMA), if the CA root is
resectable and PHA flow is intact from SMA after ligation of CHA.

다국어 초록 (Multilingual Abstract)

The prognosis of distal pancreatic cancer is even poorer than that of pancreatic head cancer because
of its late symptom onset and tendency of aggressive retroperitoneal invasion at diagnosis. Since the
first Appleby’s operation in 1952, it has been performed in stomach cancer by several surgeons. But
the survival benefit is still controversial. Appleby’s operation includes total gastrectomy, splenectomy,
distal pancreatectomy, celiac trunk division with ligation of common hepatic artery(CHA) and retroperitoneal
lymph node dissection. In 1976, Nimura first adopted this method for distal pancreatic cancer.
We report a case of modified Appleby’s operation for distal pancreatic cancer. The patient was 44-
year old female. Her chief complaint was epigastric pain for 2 weeks. Preoperative liver function test
was within normal range and CA19-9 was elevated to 200 U/ml. Preoperative CT angiography showed
4.5×3cm sized, pancreatic mass in body and tail area invading splenic artery and celiac trunk from its
left side. In operation, splenectomy and distal pancreatectomy was initially performed. After ligation of
CHA, we confirmed intact proper hepatic artery(PHA) flow by doppler and then divided CHA. After
confirmation of intact gastric blood flow, left gastric artery(LGA) was divided. Celiac axis(CA) was
divided near its origin. Then we dissected retroperitoneal lymph nodes. There was minor pancreatic
leakage controlled by conservative management. CA19-9 was normalized to 33 U/ml on the 16th postoperative
day. She was discharged on the 28th postoperative day and underwent adjuvant chemotherapy
and radiotherapy.
There is no evidence of recurrence for 15 months of follow-up. We suggest that modified Appleby’s
operation should be considered for radical resection of distal pancreatic cancer which is invading CA or
major CA branch but not involving PHA and superior mesenteric artery(SMA), if the CA root is
resectable and PHA flow is intact from SMA after ligation of CHA.