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Charles J. Yeo - One of the best experts on this subject based on the ideXlab platform.

  • Enhanced Vascular Collateralization Through the Pancreaticoduodenal Arcade Secondary to Median Arcuate Ligament Compression of the Celiac Axis in the Setting of Pancreatic Body Adenocarcinoma: The Ideal Scenario for the Modified Appleby Procedure.
    Journal of pancreatic cancer, 2017
    Co-Authors: Kathleen A. Holoyda, Warren R. Maley, Charles J. Yeo
    Abstract:

    Background: A modified Appleby procedure for pancreatic body tumors relies upon collateral vessels maintaining blood flow to the proper hepatic artery (PHA) through the pancreaticoduodenal arcade (PDA) off of the superior mesenteric artery (SMA). Compression of the celiac axis by the median arcuate ligament (MAL) promotes the expansion of collateral vessels without preoperative intervention. Case Presentation: A 51-year-old male with asymptomatic compression of the celiac artery presented with new onset insulin-dependent diabetes mellitus. He underwent imaging that demonstrated a locally advanced pancreatic body tumor that encased the superior mesenteric vein and portal vein confluence and involved the common hepatic artery. He had an adequate response to neoadjuvant FOLFIRINOX chemotherapy and underwent an uncomplicated modified Appleby procedure with a margin negative resection. Hepatic blood flow was adequate through the PHA as a result of collateralization of blood flow through the PDA off the SMA. The enhanced collateralization appeared to have occurred secondary to compression of the celiac axis by the MAL. Conclusions: Herein we present a unique case in which improved collateral blood flow through the PDA and the gastroduodenal artery to the PHA occurred due to celiac artery compression by the MAL. This vascular anomaly fortuitously improved the ability to achieve an R0 resection of a locally advanced pancreatic adenocarcinoma of the body of the pancreas by a modified Appleby procedure.

  • A Brief Overview of the Life and Work of Lyon Henry Appleby, M.D. (1895-1970).
    The American surgeon, 2016
    Co-Authors: Jon Harrison, Michael J. Pucci, Scott W. Cowan, Charles J. Yeo
    Abstract:

    The life and work of Dr. Lyon Henry Appleby, M.D., portrays the essence of a devoted clinician committed to scholarly excellence. Born in Deseronto, Ontario, in 1895 and passing in 1970, Dr. Appleby influenced all areas of general surgery, most notably popularizing a procedure that bears his name today. After a tour in World War I, he quickly proved himself to be a dedicated clinician with roots in academia, which translated into excellence within the Department of Surgery at St. Paul's Hospital in Vancouver, Canada. He served in various leadership roles including Chair of the Department of Surgery, President of the International College of Surgeons, and Fellow of the Royal College of Physicians and Surgeons. The Appleby procedure, or en bloc removal of the celiac axis, at the time of gastrectomy, is the technical focus of this paper, although reference is made to Appleby's extensive contributions to historical medicine.

  • Modified Appleby Procedure with Arterial Reconstruction for Locally Advanced Pancreatic Adenocarcinoma: A Literature Review and Report of Three Unusual Cases.
    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2015
    Co-Authors: Jessica A. Latona, Michael J. Pucci, Warren R. Maley, Kathleen M. Lamb, Charles J. Yeo
    Abstract:

    Background Pancreatic body and tail ductal adenocarcinomas are often diagnosed with local vascular invasion of the celiac axis (CA) and its various branches. With such involvement, these tumors have traditionally been considered unresectable. The modified Appleby procedure allows for margin negative resection of some such locally advanced tumors. This procedure involves distal pancreatectomy with en bloc splenectomy and CA resection and relies on the presence of collateral arterial circulation via an intact pancreaticoduodenal arcade and the gastroduodenal artery to maintain prograde hepatic arterial perfusion. When the resultant collateral circulation is inadequate to provide sufficient hepatic and gastric arterial inflow, arterial reconstruction (AR) is necessary to “supercharge” the inflow. Herein, we review all reported cases of AR with modified Appleby procedures that we have identified in the literature, and we report our experience of three recent cases with arterial reconstruction including two cases with arterial bypasses not requiring interposition grafting.

  • Mo1662 Modified Appleby Procedure With Arterial Reconstruction: A Literature Review and Report of 3 Unusual Cases
    Gastroenterology, 2015
    Co-Authors: Jessica A. Latona, Warren R. Maley, Kathleen M. Lamb, Daniel Relles, Charles J. Yeo
    Abstract:

    BACKGROUND Pancreatic body and tail carcinomas are often diagnosed with local vascular invasion of the celiac axis (CA) and its branches. With such involvement, these tumors have traditionally been considered unresectable. The modified Appleby procedure allows margin negative resection of such locally advanced tumors. This procedure involves distal pancreatectomy with en bloc splenectomy and CA resection and relies on the presence of collateral arterial circulation via an intact pancreaticoduodenal arcade and gastroduodenal artery (GDA). When the resultant collateral circulation is inadequate to provide sufficient hepatic and gastric arterial inflow, arterial reconstruction (AR) is necessary to "supercharge" the inflow. Herein, we review all reported cases of AR with modified Appleby procedures and report our experience of 3 recent cases with arterial reconstruction including 2 cases with arterial bypasses not requiring interposition grafting. METHODS A PubMed search was systematically completed of studies relating to distal pancreatectomy with CA resection and subsequent AR. RESULTS Eleven reports involving 27 patients were identified of distal and total pancreatectomy with AR after CA resection (Table 1). The most common AR, performed in 11 patients, was a bypass from the aorta to the common hepatic artery (CHA) using a variety of interposition conduits. In our experience, patient #1 had a primary side to end aorto-CHA bypass, patient #2 had a primary end to end bypass of the distal CHA to the left gastric artery (LGA) in the setting a replaced left hepatic artery (rLHA), and patient #3 required an aortic to proper hepatic artery bypass with saphenous vein graft and venous reconstruction. Patient #1 received adjuvant chemo-radiation therapy. Patient #2 received neoadjuvant chemotherapy and proton therapy with a near complete tumor response. Patient #3 received neoadjuvant chemo-radiation therapy with a near complete tumor response. All patients recovered well and they are currently 6, 5 and 2 months post-op, respectively. CONCLUSIONS Criteria for resectablilty in patients with locally advanced pancreatic body and tail neoplasms are expanding due to increasing experience with AR in the setting of the modified Appleby procedure. When performing AR, primary anastomosis may be considered preferable to interposition grafting as it decreases the potential for the infectious and thrombotic complications associated with conduits and it reduces the number of vascular anastomoses from two to one. Consideration must also be given to normal variant anatomy of the hepatic circulation (as seen in patient #2) during operative planning as the LGA is resected with the CA. The modified Appleby with AR, when used in appropriately selected patients, offers the potential for safe, margin negative resection of locally advanced tumors.

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