Association Between Combined Preoperative Alkaline Phosphatase-Lactate Dehydrogenase Status and Postoperative Outcomes After Pancreaticoduodenectomy for Periampullary Carcinoma

Background: Periampullary carcinoma is a heterogeneous group of tumours arising within 2 cm of the papilla of Vater, including pancreatic, ampullary and biliary cancers, and is most commonly treated with pancreaticoduodenectomy (PD), a complex procedure associated with substantial postoperative morbidity. The combination of alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) provides more information than either marker individually regarding hepatobiliary tumour burden and tumour metabolic activity, respectively. This study aimed to examine the association between combined ALP-LDH status and the postoperative outcome of patients with periampullary carcinoma after PD. Methods: This was a prospective, observational study in the Department of Hepatobiliary, Pancreatic and Liver Transplantation Surgery, Bangladesh Medical University, Dhaka, from December 2024 till November 2025. Thirty periampullary carcinoma patients admitted for PD were enrolled consecutively. Patients were divided into three groups: Group 1 (ALP and LDH below their respective cut-off values, n=2); Group 2 (either ALP or LDH was elevated, n=10); and Group 3 (ALP and LDH both elevated, n=18). One-way ANOVA/Kruskal-Wallis and chi-square/Fisher-Freeman-Halton exact tests were used with effect sizes to compare groups with respect to the following variables: demographic, clinical, laboratory, tumour-related, operative, and postoperative variables. Complications after surgery were classified according to the Clavien-Dindo system. Results: The mean age was 51.70 ± 11.03 years, and baseline demographic and clinical features were similar for the three groups. Of all the pre-operative laboratory parameters, only carbohydrate antigen 19-9 (CA 19-9) was significantly different: median 26.48 U/mL in Group 1, 212.40 U/mL in Group 2 and 569.40 U/mL in Group 3 (epsilon squared = 0.208, P = 0.022); the other laboratory parameters did not show a significant difference. The sizes of the tumour, nodal status, operative time, blood loss and pancreatic fistulas were not significantly correlated with ALP-LDH status. The major complications (Clavien-Dindo grade ≥III) were increasing, but not statistically significantly, from 0% to 30.0% and 66.7% in Group 2 and Group 3, respectively. With regard to the postoperative outcomes, wound infection was the only one that was statistically significantly associated with combined ALP-LDH status (Cramer's V=0.601, P=0.004), with a rate of 0% in Group 1, 30.0% in Group 2 and 83.3% in Group 3. Conclusion: In this small, exploratory cohort, preoperative ALP and LDH status were associated with the preoperative CA 19-9 level and postoperative wound infection, with a non-significant trend toward increased major complications; there was no significant association with most other postoperative outcomes such as pancreatic fistula, delayed gastric emptying, and 30-day mortality. Given the limited and unevenly distributed sample, these findings should be regarded as hypothesis-generating and require validation in larger, multicentre cohorts before any clinical application.