Distinguishing between parenchymal and anastomotic leakage at duct-to-mucosa pancreatic reconstruction in pancreaticoduodenectomy

Table 1 Clinical parameters of the three groups of patients who had duct-to-mucosa PJ reconstruction after resection of the pancreatic head

	Normal	Parenchymal leak	Anastomotic leak
n	48	8	12
Age (yr1)	67.5 (29-81)	56.0 (51-79)	65.5 (51-82)
Diagnosis
Ductal adenocarcinoma	28	1	4
Duodenal adenomas	3	0	1
Neuroendocrine	2	2	1
FAP	0	1	0
Cystadenoma	2	0	1
Benign stricture	2	0	0
Chronic pancreatitis	4	1	1
IPMN	0	2	3
Others	7	1	1
RBC transfused (U1)	2 (0-39)	2 (0-18)	2.5 (0-88)
OR time (h1)	5.94 (4.18-11.04)	5.55 (3.40-14.55)	5.04 (4.93-10.65)
Biliary leak	1	0	0
Gastric leak	2	0	0
Intraabdominal abscess	0	0	1

The normal group had no evidence of any pancreatic leakage. Parenchymal leak indicates no extravasation at the duct-to-mucosa anastomosis in the presence of elevated amylase levels in the peripancreatic drain. Anastomotic leak indicates active contrast extravasation at the PJ reconstruction during pancreatography in the postoperative period after pancreaticoduodenectomy. FAP: Familial adenomatous polyposis; IPMN: Intraductal papillary mucinous neoplasm. Other diagnoses included pseudoinflammatory tumor, hereditary pancreatitis, metastatic renal cell carcinoma, solid pseudopapillary tumor, cystic lymphangioma, microcystic adenoma, recurrent duodenal perforation s/p liver transplant; GIST: Gastric efferent stricture with GJ efferent stricture.

¹Age, RBC transfused, and OR time are expressed as median (range).

Table 2 Outcome patterns of PJ anastomosis after pancreaticoduodenectomy based on pancreatography findings and amylase levels in peripancreatic drain fluid

	Normal	Anastomotic leakage	Parenchymal leakage
Pancreatography	No extravasation	Extravasation present	Normal
Peripancreatic drain	Normal	Elevated	Elevated
Occurrence, n (%)	48 (72.7)	8 (12.1)	12 (18.2)