Elevated Liver Enzymes Can Predict Complications Early After Pancreatic Resection

Background/Objectives: Pancreatic surgery has always been associated with a variety of complications. In the current study, we analyzed more than 800 consecutive pancreatic resections and tried to find clinically relevant routine parameters that could predict adverse outcomes at an early stage. We focused on hepato-pancreato-biliary routine parameters, especially on liver enzymes, because so far there are no studies showing any correlation between postoperatively elevated liver enzymes and postoperative complications. Methods: All pancreatic resections of a tertiary care center from 2003 until 2025 were documented prospectively and analyzed retrospectively. Data analysis comprised descriptive as well as inferential statistical analyses. Results: Laboratory values from 808 consecutive resections were analyzed for the first week after surgery. Elevated aspartate aminotransferase (AST) was associated with postoperative hemorrhage on POD 1, pulmonary insufficiency on POD 1 to 4, other complications on POD 1 to 5, MODS on POD 2 to 4, and development of pneumonia on POD 3 to 5. Elevated alanine aminotransferase (ALT) was associated with pulmonary insufficiency on POD 1 to 4 and POD 6, pneumonia, and other complications on POD 3. It was also associated with MODS on POD 1 to 6. Bilirubin elevated preoperatively and on POD 1 could not really predict any complication. In this study, we can also confirm that elevated amylase and lipase can predict complications. Conclusions: This is the first study that shows a correlation between postoperatively elevated AST and ALT and the development of postpancreatectomy complications. Elevated AST and ALT, especially in combination with postoperative pancreatitis or at least elevated pancreatic enzymes, can identify patients at risk for life-threatening conditions and might be useful to decrease failure-to-rescue patients.