Preoperative Nutritional Support in Malnutritional Cancer Patients

Inclusion Criteria:

1. Subjects in anticipating major surgery of hepatobiliary pancreatic cancer
2. Patients diagnosed with malnutrition (at least more than one)

   1. PG-SGA B or C
   2. Weight loss \>10% within 6 month
   3. BMI \<18.5
   4. Serum Albumin \<3.0
3. Age less than 80 years old over 20 years old
4. Performance status (ECOG scale): 0-1
5. Adequate organ functions

   1. Hb ≥7.0 g/dl
   2. ANC ≥1,500/mm3
   3. PLT ≥80,000/mm3
   4. Liver function: AST/ALT ≤5×upper limit of normal
   5. Creatinine ≤2.0 ULN

Exclusion Criteria:

1. Biopsy, drainage tube insertion, and other minor surgery
2. palliative surgery
3. Serious illness or medical conditions, as follows;

   1. congestive heart failure (NYHA class III or IV)
   2. unstable angina or myocardial infarction within the past 6 months,
   3. significant arrhythmias requiring medication and conduction abnormality such as over 2nd degree AV block
   4. uncontrolled hypertension
   5. hepatic cirrhosis( ≥ Child class B)
   6. interstitial pneumonia, pulmonary adenomatosis
   7. psychiatric disorder that may interfere with and/or protocol compliance
   8. unstable diabetes mellitus
   9. uncontrolled ascites or pleural effusion
   10. active infection
4. Pregnancy
5. Any patients judged by the investigator to be unfit to participate in the study