Analysis of the frequency and risk indicators of developing acute pancreatitis after gastrectomy

INTRODUCTION. Surgical intervention remains the only effective treatment for gastric cancer. Despite advances in surgical techniques, tissue dissection and coagulation methods, and the quality of postoperative intensive care, the incidence of early complications remains considerably high. One of the most serious postoperative complications is acute pancreatitis, which significantly prolongs hospital stay and may lead to unsatisfactory treatment outcomes.

The OBJECTIVE was to determine the incidence and risk factors for the development of acute pancreatitis following gastrectomy.

METHODS AND MATERIALS. From 01.01.2018 to 31.10.2023, a total of 198 patients with stage I–III gastric cancer underwent gastrectomy at the Ulyanovsk Regional Oncology Center (Database State Registration Certificate no. 2024622328). Statistically significant factors influencing the development of acute pancreatitis after gastrectomy were identified.

RESULTS. The incidence of acute pancreatitis (AP) was 8 % (16 out of 198). Among the 16 patients with AP, 5 developed a grade B external pancreatic fistula. Statistical analysis revealed a significant difference in the incidence of acute pancreatitis depending on the T category. Intraoperative blood loss volume also had a significant impact on the development of acute pancreatitis. Risk indicators for AP included the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (nLR). The threshold value for PLR was 215.6, and for nLR – 15.5. Exceeding these values predicted the development of AP in the postoperative period.

CONCLUSION. Significant risk factors for the development of AP are the tumor size and depth of invasion (T category) and intraoperative blood loss exceeding 500 ml. Elevated serum amylase, PLR, and nLR levels on the first postoperative day, in the absence of other inflammatory signs, should be considered potential indicators of AP. 

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