To evaluate the selection and safety of surgical approach of laparoscopic distal pancreatectomy.

Clinical data of 39 patients with pancreatic tumors who underwent laparoscopic distal pancreatectomy in Foshan First People's Hospital from February 2012 to November 2019 were retrospectively analyzed. Among them, 10 patients were male and 29 female, aged from 19 to 75 years, with a median age of 49 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Five-port laparoscopic distal pancreatectomy was performed via antegrade approach (Kimura, Warshaw method), pancreatic caudal first approach or antegrade combined with retrograde approach. Perioperative conditions and incidence of complications of all patients were observed.

37 cases successfully underwent laparoscopic distal pancreatectomy, while 2 cases were converted to open surgery due to adhesion caused by chronic pancreatitis. Laparoscopic spleen-preserving distal pancreatectomy was performed in 21 cases, of whom 9 cases used Kimura method and 4 cases used Warshaw method, 7 cases via pancreatic caudal first approach and 1 case via antegrade combined with retrograde approach. Laparoscopic distal pancreatectomy combined with splenectomy was performed in 16 cases. The average operation time was (272±91) min. The median intraoperative blood loss was 200(50-1 200) ml. 1 case received blood transfusion during the operation. The length of postoperative hospital stay was (10±4) d. Postoperatively, 24 cases developed biochemical leakage, 5 cases developed pancreatic fistula of grade B and 8 cases without pancreatic fistula. Postoperative intra-abdominal hemorrhage occurred in 2 cases, chylous leakage in 1 case and acute deep venous thrombosis of lower limb in 1 case. Postoperative pathological examination result showed 14 cases with serous cystadenoma, 8 cases with mucinous cystadenoma, 7 cases with pancreatic neuroendocrine tumors, 3 cases with solid pseudopapillary tumors, 2 cases with chronic pancreatitis and 5 cases with other complications.

Laparoscopic distal pancreatectomy is a safe surgery. Different surgical approach can be adopted according to the size, location of tumors and its relationship with splenic artery and vein, which helps to reduce the intraoperative blood loss and improve the success rate of operation and spleen-preserving rate.