{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:49:39Z","timestamp":1788914979539,"version":"build-2803163510"},"reference-count":35,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The International Study Group for Pancreatic Surgery has recently defined post-pancreatectomy acute pancreatitis (PPAP), stating that sustained postoperative hyperamylasemia (POH) for at least 48 h is a pivotal criterion. However, the clinical relevance of POH and PPAP following distal pancreatectomy remains uncertain. This study compares two PPAP definitions differing in POH criteria. Methods: We retrospectively analyzed all patients who consecutively underwent distal pancreatectomy at our institution (2010\u20132023). PPAP diagnosis required clinical symptoms, characteristic CT findings, and either sustained POH \u2265 48 h (standard group) or transient POH less than 48 h (modified group). Outcomes were compared between definitions. Results: Among 207 patients included, in the standard group, PPAP was diagnosed in 12 (5.8%), and in the modified group in 27 (13.0%) patients. Independent of the applied POH criteria, PPAP was associated with the occurrence of clinically relevant postoperative pancreatic fistulas (standard: 66.7% vs. 23.7%; p &lt; 0.001; modified: 44.4% vs. 23.7%; p = 0.027). Post-pancreatectomy hemorrhage and major complications (Clavien\u2013Dindo grade \u2265 III) were also significantly more frequent in patients with PPAP. This was mirrored by a significantly longer length of stay and higher costs. However, in the standard group, PPAP more often resulted in pancreas-specific and major complications compared to the modified group. Of note, in the standard group, only 50% of patients with POH progressed to PPAP, and one-third of patients suffering from PPAP did not develop harmful sequelae. Conclusions: PPAP is an uncommon, however clinically relevant complication following distal pancreatectomy that is better captured using the standard POH definition. Still, further stratification is needed to aid in the prediction of the clinical course.<\/jats:p>","DOI":"10.3390\/jcm15051803","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T10:41:02Z","timestamp":1772188862000},"page":"1803","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Analysis of Different Post-Operative Hyperamylasemia Criteria for Defining Post-Pancreatectomy Acute Pancreatitis After Distal Pancreatectomy\u2014A Retrospective Single-Center Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5767-7739","authenticated-orcid":false,"given":"Lukas Heinrich","family":"Poelsler","sequence":"first","affiliation":[{"name":"Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9451-0794","authenticated-orcid":false,"given":"Ruben","family":"Bellotti","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Pably","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5793-8417","authenticated-orcid":false,"given":"Dagmar","family":"Morell-Hofert","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5210-7358","authenticated-orcid":false,"given":"Eva","family":"Maier","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benno","family":"Cardini","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupert","family":"Oberhuber","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2774-0669","authenticated-orcid":false,"given":"Thomas","family":"Resch","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3486-7166","authenticated-orcid":false,"given":"Florian","family":"Ponholzer","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6395-490X","authenticated-orcid":false,"given":"Felix J.","family":"Krendl","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Margreiter","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2619-8639","authenticated-orcid":false,"given":"Stefan","family":"Schneeberger","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8909-8566","authenticated-orcid":false,"given":"Dietmar","family":"\u00d6fner","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1479-6129","authenticated-orcid":false,"given":"Manuel","family":"Maglione","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1016\/j.hpb.2016.05.006","article-title":"Defining post-operative pancreatitis as a new pancreatic specific complication following pancreatic resection","volume":"18","author":"Connor","year":"2016","journal-title":"HPB"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1097\/SLA.0000000000002900","article-title":"Postoperative Acute Pancreatitis Following Pancreaticoduodenectomy: A Determinant of Fistula Potentially Driven by the Intraoperative Fluid Management","volume":"268","author":"Bannone","year":"2018","journal-title":"Ann. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.pan.2023.11.004","article-title":"Post-pancreatectomy acute pancreatitis after pancreatoduodenectomy: Analysis of a clinically-relevant complication in a single-center retrospective study","volume":"24","author":"Bellotti","year":"2024","journal-title":"Pancreatology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1007\/s11605-016-3305-x","article-title":"Pancreatitis After Pancreatoduodenectomy Predicts Clinically Relevant Postoperative Pancreatic Fistula","volume":"21","author":"Samiei","year":"2017","journal-title":"J. Gastrointest. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.surg.2020.07.050","article-title":"Hyperamylasemia and acute pancreatitis after pancreatoduodenectomy: Two different entities","volume":"169","author":"Loos","year":"2021","journal-title":"Surgery"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1007\/s11605-021-05194-9","article-title":"SSAT GI Surgery Debate: Hepatobiliary and Pancreas: Is Post-Pancreatectomy Acute Pancreatitis a Relevant Clinical Entity?","volume":"26","author":"Maggino","year":"2022","journal-title":"J. Gastrointest. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/S0140-6736(14)60649-8","article-title":"Acute pancreatitis","volume":"386","author":"Lankisch","year":"2015","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.2147\/TCRM.S147594","article-title":"Predictors of acute pancreatitis with low elevation of serum amylase","volume":"13","author":"Hong","year":"2017","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1097\/SLA.0000000000005226","article-title":"Postpancreatectomy Acute Pancreatitis (PPAP): Definition and Grading From the International Study Group for Pancreatic Surgery (ISGPS)","volume":"275","author":"Marchegiani","year":"2022","journal-title":"Ann. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Bannone, E., Cattelani, A., Corvino, G., Marchetti, A., Andreasi, V., Fermi, F., Partelli, S., Pecorelli, N., Tamburrino, D., and Esposito, A. (2024). Clinical and Financial Validation of the International Study Group for Pancreatic Surgery (ISGPS) Definition of Post-Pancreatectomy Acute Pancreatitis (PPAP): International Multicenter Prospective Study. Ann. Surg.","DOI":"10.1097\/SLA.0000000000006569"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e278","DOI":"10.1097\/SLA.0000000000005605","article-title":"Postpancreatectomy Acute Pancreatitis After Pancreaticoduodenectomy: A Distinct Clinical Entity","volume":"278","author":"Chen","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1016\/j.surg.2020.06.040","article-title":"Clinical significance of postoperative acute pancreatitis after pancreatoduodenectomy and distal pancreatectomy","volume":"169","author":"Ikenaga","year":"2021","journal-title":"Surgery"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1016\/j.hpb.2021.01.004","article-title":"Postoperative acute pancreatitis is a serious but rare complication after distal pancreatectomy","volume":"23","author":"Loos","year":"2021","journal-title":"HPB"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1007\/s11605-023-05721-w","article-title":"Post-pancreatectomy Acute Pancreatitis in Distal Pancreatectomies\u2014A Rare Bird According to the New Definition","volume":"27","author":"Marcus","year":"2023","journal-title":"J. Gastrointest. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1007\/s10353-023-00825-8","article-title":"Quality assurance in surgery\u2014A moral obligation","volume":"56","year":"2024","journal-title":"Eur. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Vandenbroucke, J.P., von Elm, E., Altman, D.G., G\u00f8tzsche, P.C., Mulrow, C.D., Pocock, S.J., Poole, C., Schlesselman, J.J., and Egger, M. (2007). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and elaboration. PLoS Med., 4.","DOI":"10.1371\/journal.pmed.0040297"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"World Medical Association Declaration of Helsinki (2013). Ethical principles for medical research involving human subjects. Jama, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.surg.2016.11.014","article-title":"The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After","volume":"161","author":"Bassi","year":"2017","journal-title":"Surgery"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.surg.2007.02.001","article-title":"Postpancreatectomy hemorrhage (PPH): An International Study Group of Pancreatic Surgery (ISGPS) definition","volume":"142","author":"Wente","year":"2007","journal-title":"Surgery"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","article-title":"Classification of acute pancreatitis\u20142012: Revision of the Atlanta classification and definitions by international consensus","volume":"62","author":"Banks","year":"2013","journal-title":"Gut"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s13244-018-0595-4","article-title":"Major pancreatic resections: Normal postoperative findings and complications","volume":"9","author":"Chincarini","year":"2018","journal-title":"Insights Imaging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1152\/physrev.00003.2021","article-title":"The roles of calcium and ATP in the physiology and pathology of the exocrine pancreas","volume":"101","author":"Petersen","year":"2021","journal-title":"Physiol. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"znae039","DOI":"10.1093\/bjs\/znae039","article-title":"Standardizing definitions and terminology of left-sided pancreatic resections through an international Delphi consensus","volume":"111","author":"Boggi","year":"2024","journal-title":"Br. J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.surg.2020.09.008","article-title":"Characterization of postoperative acute pancreatitis (POAP) after distal pancreatectomy","volume":"169","author":"Andrianello","year":"2021","journal-title":"Surgery"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/j.hpb.2023.05.007","article-title":"Postoperative pancreatitis and pancreatic fistulae: A review of current evidence","volume":"25","author":"Chui","year":"2023","journal-title":"HPB"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1007\/s11605-022-05533-4","article-title":"Post-Pancreatectomy Acute Pancreatitis-The New Criteria Fail to Recognize Significant Presentations","volume":"27","author":"Holmberg","year":"2023","journal-title":"J. Gastrointest. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1016\/S0140-6736(22)00182-9","article-title":"Algorithm-based care versus usual care for the early recognition and management of complications after pancreatic resection in the Netherlands: An open-label, nationwide, stepped-wedge cluster-randomised trial","volume":"399","author":"Smits","year":"2022","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.hpb.2023.10.008","article-title":"Management and outcomes of hemorrhage after distal pancreatectomy: A multicenter study at high volume centers","volume":"26","author":"Duclos","year":"2024","journal-title":"HPB"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e230061","DOI":"10.1148\/rg.230061","article-title":"Imaging after Pancreatic Surgery: Expected Findings and Postoperative Complications","volume":"44","author":"Gaballah","year":"2024","journal-title":"Radiographics"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Wu, S., Wu, H., Xu, G., Zhao, Y., Xue, F., Dong, S., Han, L., Wang, Z., and Wu, Z. (2022). Risk Factors and Clinical Impacts of Post-Pancreatectomy Acute Pancreatitis After Pancreaticoduodenectomy: A Single-Center Retrospective Analysis of 298 Patients Based on the ISGPS Definition and Grading System. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.916486"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.surg.2020.04.062","article-title":"Postoperative hyperamylasemia (POH) and acute pancreatitis after pancreatoduodenectomy (POAP): State of the art and systematic review","volume":"169","author":"Bannone","year":"2021","journal-title":"Surgery"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1159\/000526495","article-title":"Clinical Implications of Postoperative Hyperamylasemia after Partial Pancreaticoduodenectomy","volume":"38","author":"Mintziras","year":"2022","journal-title":"Visc. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s00423-023-02814-7","article-title":"Analysis of predictors for postoperative complications after pancreatectomy\u2014What is new after establishing the definition of postpancreatectomy acute pancreatitis (PPAP)?","volume":"408","author":"Oehme","year":"2023","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/SLA.0000000000006222","article-title":"Postoperative Hyperamylasemia (POH) is an Early Predictor of Pancreatic Fistula Occurrence and Severity after Distal Pancreatectomy: Results from a European Multicentric Study","volume":"282","author":"Perri","year":"2024","journal-title":"Ann. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1803\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T11:09:56Z","timestamp":1772190596000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1803"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,27]]},"references-count":35,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15051803"],"URL":"https:\/\/doi.org\/10.3390\/jcm15051803","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,27]]}}}