Division of Abdominal Imaging, Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.
Harvard Medical School, Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Abdom Radiol (NY). 2018 Feb;43(2):467-475. doi: 10.1007/s00261-017-1344-8.
Despite advances in medical and surgical care, pancreatic ductal adenocarcinoma remains one of the most locally aggressive neoplastic processes in the abdomen. Unfortunately, most pancreatic adenocarcinomas present late and are unresectable at time of diagnosis. The modified Appleby procedure is a surgical option in patients with locally advanced pancreatic neoplasms of the body and tail with vascular invasion of the celiac trunk. To our knowledge, no radiologic journal has previously reported on the pre-operative evaluation or postoperative imaging findings of such patients.
We report herein three patients who underwent the modified Appleby procedure, each with a unique complication, in an attempt to illustrate common pitfalls of interpretation in these advanced cases.
Our case series emphasizes the importance of pre-operative radiologic assessment of variant arterial anatomy, knowledge of pre- and intraoperative procedures and appearances, and familiarity with potential postoperative complications.
Thorough understanding of the important aspects of the pre-surgical anatomy, as well as possible post-surgical complications, is the key to the radiologist being a useful participant in the clinical care of these patients.
尽管在医学和外科治疗方面取得了进展，但胰腺导管腺癌仍然是腹部最具侵袭性的肿瘤之一。不幸的是，大多数胰腺腺癌在晚期出现，且在诊断时无法切除。改良的 Appleby 手术是一种针对体尾部局部进展性胰腺肿瘤且腹腔干血管受侵犯患者的手术选择。据我们所知，以前没有放射学杂志报道过此类患者的术前评估或术后影像学发现。
我们在此报告了三例接受改良 Appleby 手术的患者，每位患者都有独特的并发症，旨在说明在这些晚期病例中解释常见陷阱的重要性。
我们的病例系列强调了术前评估变异动脉解剖、了解术前和术中的程序和表现以及熟悉潜在术后并发症的重要性。
彻底了解术前解剖的重要方面以及可能的术后并发症是放射科医生在这些患者的临床治疗中发挥有益作用的关键。
