Surgical Procedures Used in the Treatment of Postoperative Acute Pancreatitis Grade C After Pancreatoduodenectomy-A Narrative Review.

Postpancreatectomy acute pancreatitis grade C (PPAP-C) is the most severe grade of this complication, associated with the highest mortality rate after pancreatoduodenectomy (PD). Most PPAP-C cases require surgical intervention. However, no treatment guidelines for PPAP-C have been established. Literature reports are largely based on the coexistence of postoperative pancreatic fistula grade C (POPF-C) and PPAP-C, with similar surgical treatment methods. However, in PPAP-C, the evolution of inflammation can vary in course and severity: from necrosis limited to the anastomotic line to extensive necrosis involving the entire pancreatic parenchyma. In this narrative review, we summarize the surgical techniques proposed for PPAP-C treatment and attempt to create a decision-making algorithm for optimizing the choice of surgical treatment for PPAP-C depending on the extent of pancreatic necrosis and the patient's general condition after PD. Our retrospective review is largely based on retrospective evidence and contains an inevitable selection bias. According to the cited literature, in cases of limited necrosis, parenchyma-sparing methods show an advantage over completion pancreatectomy. However, the complete pancreatic removal is usually performed in the initially more advanced cases or as a second choice when the pancreas-preserving methods fail. Therefore, the superiority of any approach cannot be clearly determined. More studies and uniform guidelines for optimal PPAP-C treatment are needed.