Distal Pancreatectomy with Celiac Axis Resection—with Posterior Ramps Approach—for Locally Advanced Pancreatic Adenocarcinoma with Celiac Trunk Infiltration (Modified Appleby Procedure) (with Video)

With the advent of FOLFIRINOX and neoadjuvant radiotherapy, the surgical indications for adenocarcinoma have expanded. Locally advanced pancreatic adenocarcinomas of the body/tail with infiltration of the celiac trunk which have a good clinical, biological, and radiological response to neoadjuvant treatment may therefore be eligible for caudal pancreatectomy with resection of the celiac trunk (modified Appleby procedure). In addition to rigorous patient selection and surgical expertise, this procedure also requires experience in interventional radiology.