[Metabolic and nutritional management after extended radical operation for pancreatobiliary carcinoma]

The physiology after extended radical operation in patients with pancreatobiliary carcinomas and the metabolic and nutritional management were studied. Twenty-four patients who underwent pancreatoduodenectomy with extended dissection were compared with 17 patients with semi-extended dissection and 44 patients with limited or no dissection. Extended dissection meant complete dissection of the nerve plexus around the superior mesenteric artery and para-aortic node dissection. The frequency of defecation (2.7 times/day) and the blood osmolarity in the extended dissection group were significantly higher than those in the other groups during the first week after operation. The level of serum protein was significantly lower in the extended dissection group. Insulin dosage during the first 14 days after surgery was significantly greater in the extended dissection group, yet no difference was recognized in the amount of glucose administered among the 3 groups. The conclusion was as follows; frequent diarrhea, a large amount of lymph loss and increased urine volume due to an osmotic diuresis were the main causes of volume loss. So a large volume of fluid containing a high concentration of protein should be injected immediately after extended dissection to normalize serum osmotic pressure. Because of increased insulin requirement and decreased endogenous insulin production, the administration of large amount of glucose immediately after operation should be undertaken carefully.