Duodeno-jejunal or gastro-enteric leakage after pancreatic resection: a case-control study

Duodeno-jejunal (DJ) and gastro-jejunal (GJ) anastomosis leakage represents a rare but life-threatening complication after pancreaticoduodenectomy or total pancreatectomy. The aim of this study was to assess its incidence, clinical presentation, and outcomes, and to identify perioperative risk factors for DJ/GJ leak. Prospectively collected perioperative data were reviewed, and a case-control study was performed. Patients who presented with a DJ/GJ leak (cases) were matched in a 1:5 ratio with patients who did not develop it. Match criteria included age, diagnosis, type of surgery, and anastomosis. Perioperative factors and outcomes were compared between groups. From January 2008 to present, 13 cases were observed and compared to 60 controls. Concerning pre-operative variables, cases showed lower pre-operative serum hemoglobin (p = 0.021) and increased pre-operative radiotherapy (p = 0.037). Cases experienced more severe post-operative complications than Controls, according to the CD classification (p < 0.001), with a higher mortality rate (23% vs. 2%; p < 0.016). They also experienced a more demanding intra-operative course including an increased estimated blood loss (median 600 vs. 400 mL; p = 0.002), a higher rate of blood transfusion (n4 31% vs. n5 8%; p = 0.047) with also a longer operative time (median 360 vs. 318 min; p = 0.038). Moreover, the occurrence of a DJ/GJ leak was significantly associated with other post-operative complications: clinically relevant pancreatic fistula (p = 0.006), bile leak (p = 0.021), and bleeding (p = 0.001). In addition, another post-operative finding significantly related to the DJ/GJ occurrence was sepsis (p < 0.001) The DJ/GJ fistula required a surgical treatment in the majority of cases (92.3%), while, in only one patient, a conservative management was accomplished. Length of hospital stay and mortality at 90 days were higher in the DJ/GJ leak group (p = 0.001). DJ/GJ leakage is a severe complication following pancreatic resection. A higher index of suspicion for DJ/GJ fistula should be maintained in case of concomitant relevant pancreatic fistula and post-operative hemorrhage.