NUTRITIONAL SUPPORT FOR PANCREATIC SURGERY

Actuality. According to the recom- mendations of RUSCO (2017), surgery of resectable pancreatic cancer (PCa) is performed without preopera- tive chemo- and/ or radiation therapy (CT, RT). The main method of treatment of metastatic cancer of the pancreas and relapse after surgical treatment in accordance with these recommendations is CT. It is also known that nutri- tional support (NS) favorably affects the outcome of sur- gical treatment and recovery processes after chemothera- py or radiation therapy. However, until now the role of the nutritional specialist is not sufficiently taken into account in the interdisciplinary approach to the treatment of such patients. The aim is to evaluate the role of the nutritionist in the interdisciplinary approach to the treatment of pa- tients with non-metastatic and metastatic pancreatic head, showing the effectiveness of adjuvant nutritional support in the structure of the combined treatment. Material and methods. 35 patients were ex- amibed with ductal adenocarcinoma (5 people with T1N0M0, 7 patients - with T2N0M0, 14 non-metastatic prostate cancer T3N0M1, 3 person - with T4N1M1 and 6 persons - with unverified on cancer stage). Adjuvant CT was started within 3 months after operation. The NRI scale, quality of life by SF-36 and ECOG, body composi- tion by bioimpedance technique, assessed nutritional risk (NR). Results. When studying the mechanisms of mus- cle catabolism, basal metabolism parameters and phase angle it has been observed that patients with high NR decreased as a skinny (SMB) and the body fat mass at an elevated content of extracellular fluid. After adjuvant CT patients with T1N0M0, T2N0M0 T4N0M1 and even able to maintain SMBdurable within fitness standard, which was accompanied by positive dynamics of biochemical parameters, decrease of basal metabolism, a tendency to normalization of the phase angle. However, even with hyperalimentation, patients with T3N1M1 and T4N0M1 retained an increased content of extracellular water, which covered the actual loss of muscle mass. The quality of life in the NS in all patients was higher, and NR was lower. Bioimpedance assessment of body composition is a quick and informative method of tracking the dynamics of metabolism in this category of patients, and confirmed that the NS - one of the main components of the com- bined treatment of patients at all stages of the pancreatic cancer. Conclusions. 1) Quality of life is provided not only by basic operative treatment, but also by timely relief of metabolic (including nutritional) complications of the tumor pro- cess. 2) If only the combined treatment and surgical operated cancer of the pancreas head, nutritionist surgeon role within an interdisciplinary approach (with joint chemotherapist, surgeons and oncologists et al.) is im- portant because in the course of adjuvant CT and after it NS (detoxification nutritionincluding) is effective. 3) Bioimpedance evaluation of body composition is a fast and an informative method for monitoring the dynamics of metabolism in this category of patients.