Appleby technique: review of the state of the art

Introduction
Adenocarcinomas of the distal part of the pancreas frequently present as advanced stage tumours due to the presence of metastases, peritoneal carcinosis, or as locally advanced tumours invading the celiac axis. This finding leads to the non-resectability of the neoplasm, resulting in an average patient survival of about 6–11 months. To improve the prognosis, surgery has moved to advanced demolition procedures such as distal en bloc pancreatectomy with celiac axis resection (DP-CAR). However, the long-term results of disease-free survival and overall survival are still not clear and noticeable.

Aim
To carry out a retrospective review of the cases of DP-CAR present in the literature to highlight the survival benefits.

Material and methods
To identify results from retrospectives research, the authors analysed studies from the PubMed, Embase, and Cochrane databases by applying various combinations of the subject-related terms. The search terms identified with the medical subject heading (MeSH) were “distal pancreatectomy (DP), distal pancreatectomy celiac axis resection (DP-CAR), median survival rates”.

Results
Eleven studies were analysed with a total of 221 DP-CARs. The analysis demonstrated that DP-CAR had a longer operative time, higher blood transfusion rates, more delayed gastric emptying, and fewer R0 resections obtained compared to classic distal pancreatectomy (DP), which demonstrated a better prognosis and a median survival of 27 months compared to 17 months with DP-CAR.

Conclusions
This study demonstrates that DP-CAR does not improve survival compared to DP, exposing the patient to even greater complications; however, in cases of distal pancreatic adenocarcinoma with celiac tripod invasion, DP-CAR appears to be a valid option to increase the average patient survival to 17 months.