Insulin/insulin-like growth factor-1 receptors mediate acquired resistance to anti-EGFR therapy in human cholangiocarcinoma cells by regulating an epithelial to mesenchymal transition/cancer stem cell axis

Surgical trauma produces metabolic and hormonal responses, which are characterized by insulin resistance. Due to extension of the preoperative fasting period, which increases the magnitude of postoperative insulin resistance, preoperative oral carbohydrates (POC) have been developed.This prospective, randomized, controlled study was performed on 43 ASA I–II patients undergoing elective microsurgical lumbar discectomy. The intervention group received oral carbohydrate solution 800 mL the night before and 400 mL 2 h prior to operation. The other group fasted for 8 h prior to operation. Blood samples were obtained the day before the operation, before induction of anesthesia, after skin incision, 1 h, 2 h, 6 h and 24 h following skin incision. Blood glucose, plasma insulin, cortisol and interleukin-6 (IL-6) levels were determined. The primary endpoint was to assess the effect of POC treatment on insulin resistance and surgical stress response following lumbar disc surgery. The secondary endpoint was to assess POC’s effects on postoperative nausea and vomiting.The serum insulin levels were higher before induction of anesthesia in the study group and returned to fasted group levels by 2 h after skin incision. The plasma IL-6 levels were higher in the intervention group at 6 h after the skin incision. There were no differences between the two groups with respect to blood glucose, plasma cortisol levels and the incidence of nausea and vomiting.This study suggests that use of POC treatment does not attenuate development of insulin resistance in patients undergoing lumbar disc surgery.