• C M Kühlbrey, N Samiei, O Sick, F Makowiec, U T Hopt, and U A Wittel.
• Clinic for General and Visceral Surgery, Department of Surgery, University of Freiburg, Freiburg, Germany.
• J. Gastrointest. Surg. 2017 Feb 1; 21 (2): 330-338.

BackgroundMorbidity after pancreas resection is still high with postoperative pancreatic fistulas (POPF) being the most frequent complication. However, exocrine insufficiency seems to protect from POPF. In clinical practice, patients showing increased postoperative systemic amylase concentrations appear to frequently develop POPF. We therefore retrospectively examined the occurrence of systemic amylase increase after pancreas resections and its association with the clinical course.Patients And MethodsPerioperative data from 739 consecutive pancreas resections were assessed in a prospectively maintained SPSS database. Serum and drain amylase concentrations were determined by routine clinical chemistry. POPFs were graded into A-C according to ISGPF definitions.ResultsIn patients with reduced serum amylase (n = 89) on day 1 after pancreatoduodenectomy, clinically relevant POPFs were not observed. In patients with normal serum amylase concentrations, clinically relevant POPFs occurred in 9 %, while in 39 % of the patients with more than three times elevated amylase concentrations, a clinically relevant postoperative fistula was observed (p < 0.001). Systemic hyperamylasemia detected on postoperative day 1 after pancreatoduodenectomy was further a good predictor for clinically relevant POPFs (AUROC = 0.797, p < 0.001).ConclusionPatients with a high risk for developing clinically relevant POPFs can be identified on the first postoperative day by determining serum amylase.

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