Efficacy and safety of lateral approach laparoscopic spleen-preserving distal pancreatectomy: a multicenter retrospective cohort study.

This study compared the lateral approach laparoscopic spleen-preserving distal pancreatectomy (LA LSPDP) with the conventional approach to LSPDP (CA LSPDP) for benign to borderline malignant tumors in the pancreatic tail. A multicenter retrospective cohort of patients undergoing LA LSPDP or CA LSPDP for pancreatic tail tumors with a tumor center located beyond the left lateral border of the aorta was analyzed. A 1:1 propensity score matching (PSM) yielded 56 patients per group. A total of 172 patients were planned for LSPDP. After PSM, the tumor sizes were comparable (3.1 cm vs 3.3 cm, p = 0.549). However, resected specimens were longer in the CA LSPDP group (8.4 cm vs. 7.7 cm, p < 0.001). Rates of conversion to open surgery, the use of Warshaw's technique, and the need for combined splenectomy were not significantly different between the two groups. However, the LA LSPDP group had a shorter operation time (127.1 min vs. 161.1 min, p = 0.002) and less blood loss (106.2 cc vs. 291.4 cc, p = 0.001). The postoperative complication rates were similar (35.7% vs. 27.3%, p = 0.339). LA LSPDP is a safe and effective technique that reduces operative time and blood loss in pancreatic tail tumors; however, larger prospective studies are needed to confirm this finding.