• Giampaolo Perri, Elisa Romandini, Giovanni Marchegiani, Poya Ghorbani, Musheg Sahakyan, Marcus Holmberg, Alice Cattelani, Åsmund Fretland, Roberto Montorsi, Isabella D Rodrigues, Dyre Kleive, Elisa Bannone, Bjørn Edwin, Stefan Gilg, Knut Labori, Ernesto Sparrelid, and Roberto Salvia.
• Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy).
• Ann. Surg. 2024 Feb 2.

ObjectivesThe aim of this international multicentric study is to characterize postoperative hyperamylasemia (POH) after distal pancreatectomy (DP), with particular focus on its relationship with postoperative pancreatic fistula (POPF) occurrence and severity.BackgroundThe clinical relevance of POH after DP and its relationship with the occurrence and severity of POPF have not been explored yet.MethodsAll patients undergoing DP for any indication between 2015 and 2021 at three European referral Centers for pancreatic surgery were retrospectively analyzed. Drain fluid amylase (DFA), C-reactive protein (C-RP), and serum amylase were examined from postoperative-day (POD) 1 to 3. Biochemical leak (BL), POPF, POH, and post-pancreatectomy hemorrhage (PPH) were defined and graded according to ISGPS definitions.ResultsIn total 1192 patients were included. Overall rates of POH and POPF were 18% (n= 210) and 29% (n= 344), respectively. The presence of DFA ≥2000 U/L on POD 1 (OR=2.11, 95% CI 1.68-2.86), C-RP ≥200 mg/L on POD 3 (OR=2.19, 95% CI 1.68-2.86), and POH (OR=1.58, 95% CI 1.14-2.19) were all independent early predictors of POPF (all P< 0.01). The presence of POH almost doubled the rate of POPF (43% vs. 26%, P<0.001), and higher POPF severity presented also higher POH rates (no POPF= 12%; BL= 19%; B POPF= 24%; C POPF= 52%). Among patients developing POPF, patients with POH had higher rates of PPH (22% vs 9%, P= 0.001), sepsis (24% vs 13%; P=0.011), re-operation (21% vs 8%; P< 0.01), and mortality (3% vs 0.3%; P= 0.025).ConclusionsThe occurrence of POH is an early predictor of POPF and its severity after DP. The diagnosis of POH might define patients at higher risk for a complicated course, targeting them for prevention / mitigation strategies against pancreas specific complications.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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