Application Of Modified Appleby In The Surgical Treatment Of Body And Tail Of Pancreas

Objective:To explore the effect of modified Appleby operation in the treatment of locally advanced carcinoma of the body and tail of the pancreas.In order to demonstrate and evaluate the efficacy and safety of modified Appleby operation in the treatment of malignant pancreatic body and tail tumors,and to explore the safety and feasibility of modified Appleby operation in clinical.Methods:Twenty patients with pancreatic body and tail cancer diagnosed and treated in the Department of Hepatobiliary and Pancreatic surgery of the First People’s Hospital of Yunnan Province.Among them,10 patients with pancreatic body and tail cancer who met the surgical indications and underwent modified Appleby operation,remainder were treated with distal pancreatomy.The preoperative data of the patients included:basic information,location and degree of pain,physical condition,preoperative auxiliary examination data,intraoperative condition:operation method,operation time,combined vascular revascularization,intraoperative blood loss,pathological conditions of resected specimens including pathological classification,nerve infiltration and lymph node metastasis.Postoperative condition:postoperative complications,postoperative pain relief,postoperative hospital stay,postoperative liver function and operative mortality.Results:The operation time of modified Appleby operation was long,some patients had the increase of aspartate transaminase and alanine aminotransferase after operation,and there were transient manifestations of liver function insufficiency（but returned to normal after symptomatic liver protection treatment,no serious hepatic ischemic complications such as liver failure）,no gastric ischemia/necrosis occurred,the negative margin rate was increased,and the postoperative pain was significantly relieved.GIQLI score showed that the quality of life was improved,sleep and diet were significantly improved,and the difference was statistically significant at 28 days after operation.There was no significant difference in postoperative diarrhea and pancreatic leakage between the two groups.There was no significant difference in postoperative pancreatic leakage,no increase in operative mortality,no significant prolongation of hospital stay,and no operation-related death.Conclusion:Through a retrospective study,this study confirmed that the modified Appleby operation is safe and effective in the treatment of locally advanced malignant tumors of the body and tail of the pancreas,bringing surgical opportunities for patients with pancreatic cancer invading the celiac trunk without increasing operative mortality.However,due to the lack of evidence-based medicine related to the long-term follow-up results of a large number of cases,the long-term survival benefits of the modified Appleby surgery need to be further studied.