Serum amylase elevation following pancreatoduodenectomy with pancreatogastrostomy is strongly associated with major complications

Background Recent reports suggest that, following pancreatic resection, serum amylase elevation (SAE) may be a surrogate indicator of post‐operative acute pancreatitis (PAP) and predict post‐operative pancreatic fistula (POPF). However, POPF may not account for the majority of complications when pancreatoenteric continuity is restored by pancreatogastrostomy. We aimed to evaluate, among patients undergoing pancreatoduodenectomy with pancreatogastrostomy, the correlation between SAE, radiological changes consistent with PAP and types of post‐operative complications overall and specific for pancreatic surgery. Methods Perioperative data from 102 patients who underwent pancreatoduodenectomy with pancreatogastrostomy at two Italian hospitals (January 2015–January 2017) were retrospectively analysed. SAE was defined as serum amylase more than three times the normal concentration at post‐operative day 1. Post‐operative abdominal computed tomography scan was routinely performed and retrospectively and blindly re‐assessed for findings consistent with PAP. Results Among 102 study patients, overall and major complications and mortality occurred in 68% and 24% and 3% of cases, respectively. POPF and post‐pancreatectomy haemorrhage (PPH) occurred in 12% and 21%, respectively. In 75% of patients developing PPH, it occurred in the absence of POPF. SAE occurred in 36 patients who, compared to 66 non‐SAE patients, more frequently showed computed tomography scan findings consistent with pancreatic stump inflammation (P = 0.002), confirming association between SAE and PAP. SAE was independently associated with the occurrence of major complications, POPF and PPH (hazard ratio (HR) 3.27, P = 0.032; HR 3.94, P = 0.012; HR 12.26, P = 0.002). Conclusion SAE can be considered a valid surrogate of PAP and is strongly associated with a higher rate of post‐operative major complications, both overall and specific for pancreatic resection. Serum amylase elevation (SAE) may be a surrogate indicator of post‐operative acute pancreatitis (PAP) and predict clinically relevant post‐operative pancreatic fistula. SAE was defined as serum amylase more than three times the normal concentration at post‐operative day 1. Post‐operative abdominal computed tomography scan was routinely performed and retrospectively and blindly re‐assessed for findings consistent with PAP. SAE can be considered a valid surrogate of PAP and is strongly associated with a higher rate of post‐operative major complication