Effects on nutrition of surgery of the liver, pancreas, and genitourinary tract.

Carcinoma of the pancreas is increasing in the United States and has a grave progonosis. Surgical treatment has moved from subtotal pancreatectomy to total pancreatectomy and now to en bloc resection and vascular replacement. Pancreatic exocrine and endocrine insufficiency following resection add to the nutritional problems presented by this major surgery and its high complication rate. Recognition of these problems and adequate treatment decrease morbidity and mortality. Major hepatic resection imposes metabolic problems in the immediate postoperative period that are minimized by improving preoperative nutritional status and by providing adequate postoperative support with albumin and carbohydrate. Urinary tract diversion for pelvic cancer involving the ureters and/or bladder has progressed from ureterosigmoidostomy with its high incidence of disturbances of electrolyte and acid-base balance to ureteroileostomy with its appreciably lower rate of complications.