[Importance of nutritional management for the treatment of carcinoma of the pancreas].

Because the majority of patients with carcinoma of the pancreas are already in a state of malnutrition on admission, various complications can easily occur after surgery and adjuvant therapy such as radiation and chemotherapy. Therefore, the importance of nutritional management in the treatment of pancreatic carcinoma was examined in our department and the following results were obtained: 1) Preoperative nutritional assessment The nutritional state was evaluated using the Prognostic Nutritional Index for Surgery: PNI-S = -0.147 X (ratio of weight loss) + 0.046 X (weight for height) + 0.010 X (% triceps skin fold thickness) + 0.051 X (hepaplastin test), which was calculated from our results. In patients with the PNI-S of over 8, total pancreatectomy was performed safely, and when the PNI-S was more than 6, pancreaticoduodenectomy was done successfully. When the PNI-S was more than 5, it was possible to perform distal pancreatectomy or bypass operation. Depending on the nutritional assessment before surgery, the appropriate operative method could be selected, and the operative results could be improved by preoperative nutritional support. 2) Postoperative nutritional management Administration of a high-calorie by both parenteral and enteral nutrition during the early postoperative period produces good operative results, accompanied by a reduction of postoperative complications, such as fatty liver and so on. This approach also reduces the adverse effects of adjuvant therapy, such as radiation and chemotherapy, with an improvement of prognosis. Thus, it was revealed that nutritional assessment and management was very important for improving the therapeutic results in cases of carcinoma of the pancreas.