Post-Pancreatectomy Acute Pancreatitis in Pancreatic Cancer: A Single-Center Experience

Background and Objectives: In 2022, the International Study Group of Pancreatic Surgery (ISGPS) introduced a definition of postoperative acute pancreatitis (PPAP). This study aimed to assess the perioperative factors associated with clinically relevant PPAP (CR-PPAP) after pancreatoduodenectomy (PD) due to pancreatic ductal adenocarcinoma (PDAC) and to present the real-world treatment strategies for this complication. Materials and Methods: We performed a retrospective single-center analysis of 282 patients who underwent pancreatoduodenectomy for PDAC between 2010 and 2023. Results: CR-PPAP was diagnosed in 13.1% of patients. This group had significantly higher CRP (219 vs. 42 mg/L) and more frequently elevated drain amylase activity (97.3% vs. 18%). CR-PPAP was associated with significantly higher rates of reoperation (37.8% vs. 3.3%), delayed gastric emptying (73% vs. 16.3%), hemorrhage (21.6% vs. 0.8%) and pancreatic fistula (97.3% vs. 0.8%), as well as longer hospitalization (15 vs. 13 days). Antibiotics were administered significantly more often in the CR-PPAP group (86.5% vs. 6.5%), while somatostatin was used in all CR-PPAP patients and octreotide in 62.2%. Thirty-day mortality did not differ significantly between groups. In multivariate analysis, a small main pancreatic duct was the only independent factor associated with CR-PPAP. Conclusions: PPAP, as defined by the ISGPS 2022 criteria, is a relatively common complication following PD for malignancy, with a small pancreatic duct being a major risk factor. PPAP is strongly associated with other major postoperative complications and prolonged hospitalization, but not with increased mortality. Despite the frequent use of antibiotics, octreotide, and somatostatin in clinical practice, evidence-based treatment recommendations for CR-PPAP remain lacking, highlighting the need for management guidelines.