Management of complications occurring after pancreatic surgery

Summary Background Pancreatic resections remain high-risk surgeries with high morbidity and nonnegligible mortality. Prevention and optimized management of complications are therefore foremost goals of clinical research. While interdisciplinary rescue strategies including radiologic and endoscopic approaches have made relevant advances in the successful management of life-threatening situations, effective preventive measures for complications such as postoperative pancreatic fistula (POPF) and the associated morbidity are lacking. In recent years, ideal outcomes and benchmarks have been defined to better compare surgical results and facilitate quality assurance in pancreatic surgery. Methods This work comprises a narrative review. Results and conclusion This review gives an update on the current evidence for preventive strategies and perioperative management of the most relevant complications, including POPF, postpancreatectomy hemorrhage (PPH), postpancreatectomy acute pancreatitis (PPAP), delayed gastric emptying (DGE), chyle leak, and diarrhea after extended resections. Risk stratification tools and standardized algorithm-based postoperative care help to guide risk-adapted surgical procedures and optimize perioperative management, especially in terms of drain policy and diagnostic approaches to detecting complications early and managing them, aiming to reduce severe morbidity and prevent surgery-related deaths.