Postoperative pancreatitis as a specific complication after pancreatoduodenectomy: A single-center retrospective cohort study

Background. Post-pancreatectomy acute pancreatitis is a serious, procedure-specific complication that occurs after pancreatoduodenectomy. However, only in 2022 did the International Study Group of Pancreatic Surgery formulate a clear definition and diagnostic criteria for post-pancreatectomy pancreatitis.

Objective. To determine the incidence of post-pancreatectomy acute pancreatitis according to the current ISGPS definition and classification, to assess risk factors for this complication, and to evaluate its association with other procedure-specific postoperative complications following pancreatoduodenectomy.

Methods. A single-center retrospective cohort study was conducted based on review of medical record of 451 patients who underwent pancreatic resections at the Department of Abdominal Surgery of the National Medical Research Center of Surgery named after A.V. Vishnevsky between January 2021 and May 2025. A total of 147 patients who underwent pancreatoduodenectomy were included in the analysis. All patients were divided into two groups: those who developed post-pancreatectomy acute pancreatitis (per ISGPS criteria) and those without this complication. Primary endpoints included: incidence and severity score of post-pancreatectomy acute pancreatitis; its impact on overall postoperative morbidity; overall frequency of procedure-specific postoperative complications and each complication separately (pancreatic fistula, postoperative hemorrhage, delayed gastric emptying); frequency of reoperations; postoperative length of stay; length of stay in the intensive care unit; and in-hospital mortality. Potential risk factors for post-pancreatectomy acute pancreatitis were assessed.

Results. Persistent elevation of serum amylase for at least the first two postoperative days occurred in 29/147 patients (19.7%). According to ISGPS criteria, 7/147 patients (4.8%) were classified as having postoperative hyperamylasemia rather than a complication. Post-pancreatectomy acute pancreatitis developed in 22/147 patients (14.9%): grade B in 14 cases (9.5%) and grade C in 8 cases (5.4%). Post-pancreatectomy acute pancreatitis had a significant impact on postoperative course. These patients had a significantly longer postoperative hospital stay (p < 0.001), longer ICU stay (p < 0.001), a higher overall rate of postoperative complications (p < 0.001), and a higher rate of severe complications (Clavien–Dindo ≥ 3) (p = 0.002), including procedure-specific complications (p < 0.001). Clinically relevant pancreatic fistulas (p < 0.001), postoperative hemorrhage (p = 0.003), and delayed gastric emptying (p = 0.016) occurred more frequently; reoperations were more common (p = 0.001); and mortality was significantly higher (18.2% vs. 3.2%; p = 0.018). Comparative analysis showed that post-pancreatectomy acute pancreatitis developed significantly more often in patients with diagnoses other than pancreatic ductal adenocarcinoma or chronic pancreatitis (p = 0.011), in those with a “soft” pancreatic texture (p = 0.008), a narrow main pancreatic duct (p = 0.007), and with a high abundance of acinar structures in the pancreatic section (p = 0.001). Multivariate analysis demonstrated statistical significance only for the high proportion of acinar structures in the pancreatic specimen and intraoperative blood loss.

Conclusion. Post-pancreatectomy acute pancreatitis now has a well-established definition and clear diagnostic criteria, including severity score. It substantially affects the postoperative course, often necessitating additional conservative or interventional treatment and, at times, reoperation. Accounting for risk factors for post-pancreatectomy acute pancreatitis may help improve short-term outcomes following pancreatoduodenectomy.

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