Advanced pancreatic ductal adenocarcinoma represents one of the most challenging oncologic diseases nowadays for many reasons: it is burdened by one of the poorest prognoses, it is often diagnosed when in an advanced stage and it demands a multimodal approach which is necessary to assign the proper patient-specific treatment. When feasible, surgical resection combined with systemic treatment is still the best curative choice and can require complex vascular resections and reconstructions to obtain R0 margins. In these cases, a detailed preoperative assessment made of blood tests, thoracoabdominal imaging and histological definition of the tumor is fundamental. Unfortunately, the current imaging techniques are not completely reliable in defining the extension of the contact between the neoplasm and the surrounding arteries and veins, especially when considering borderline and locally advanced diseases. The use of 3D reconstructions can improve the perception of crucial anatomical details for the diagnostic evaluation and the surgical procedure.
Distal pancreatectomy with coeliac axis resection (Appleby procedure)
