Modified Appleby Procedure for Resection of Tumors of the Pancreatic Body and Tail with Celiac Axis Involvement

Involvement of the celiac axis by pancreatic tumors of the body and tail is no longer considered an absolute contraindication to resection. In highly selected patients, resection is possible, relying on collateral circulation through the gastroduodenal artery to maintain liver perfusion. Our approach to intraoperative assessment and resection is described herein.