Changes in Serum Amylase Level following Hepatic Resection

Abstract

Hyperamylasemia may follow hepatic resection; Akagi reports 15(62.5%) of his 24 patients with hepatic resection experienced hyperamylasemia, and almost none of those patients had clinical symptoms or complications. The mechanism of postoperative hyperamylasemia is not clear yet, but Makuuchi states that the cause of hyperamylasemia is pancreatic congestion due to vascular occlusion methods used during hepatic resection. The frequency of hyperamylasemia, occurrence of pancreatitis, and factors likely to cause hyperamylasemia following hepatic resection were studied by the authors. The subjects consisted of 31 patients without history of pancreatitis or DM who underwent hepatic resection. In all of the cases, serum amylase levels were measured on the preoperative day, operative day, and postoperative days 1, 3, 5 and 7. Total serum amylase level was found to be significantly elevated postoperatively in 14(42.5%) of 31 patients undergoing hepatic resection. These patients did not have pancreatitis nor fatal complications. The serum amylase was at its lowest level(153+/-79U/L) immediately after operation, and highest(321+/-176U/L) on postoperative day 1, and eventually returned to preoperative level. When the difference in serum amylase level based on the patient’s preoperative state was considered, patient’s in the liver cirrhosis group(n=17) had significantly elevated postoperative serum amylase level on postoperative days 3, 5 and 7 in comparison with the group of patients without liver cirrhosis (p<0.05). The differences in the level of serum amylase based on ICG R15 retention rate, extent of hepatic resection, age and vascular occlusion time used during hepatic resection did not show any statistical signifcance. Since postoperative hyperamylasemia was not related to vascular occlusion time used during hepatic resection, and the level of serum amylase was higher in the liver cirrhosis group than in the normal liver group, the cause of hyperamylasemia following hepatic resection cannot be explained by pancreatic congestion due to vascular occlusion time used during hepatic resection.