Effects Of Preoperative Oral Carbohydrate On Postoperative Insulin Resistance And Immunity In Cervical Cancer Patients With Neoadjuvant Chemotherapy

Objective: To evaluate the effects of preoperative oral carbohydrate on postoperative insulin resistance and tumor immunity in cervical cancer patients with neoadjuvant chemotherapy.Methods:Fifty-one patients undergoing neoadjuvant chemotherapy and radical hysterectomy with bilateral pelvic lymph node dissection were randomized to receive 300 m L of an oral carbohydrate liquid supplement 2 hour before surgery(CHO group)or to fast on standard hospital protocol(8 hour fasting for solid and 4 hour fasting for clear liquid)(FAST group).According to inclusion and exclusion standards,twenty-six patients undergoing the same surgery and standard fasting were selected as control group.Baseline and postoperative measurements of insulin sensitivity were assessed in term of fasting plasma glucose(FPG),fastingainsulin(FINS),HOMA-insulinaresistance(HOMA-IR),HOM A-insulin secretion function index(HOMA-IX),HOMA-beta cell function index(HOMA-?),serum C-peptide and glucagon.Baseline and postoperative measurements of tumor immunity were evaluated using NK cell and T-cell dynamics.VAS score was introduced to assess preoperative comfort.Results:The condition of insulin resistance was significantly improved in CHO group(The level of FPG,FINS,HOMA-IR,fasting serum C-peptide and glucagon in CHO group were higher than those in FAST group and control group and the level of HOMA-IS in CHO group was lower than those in FAST group and control group,p<0.05).Postoperative tumor immunity was significantly boosted in CHO group compared to FAST group and control group.(The percentage of CD3+ and CD4+,the ratio of CD8+ to CD4+ and number of NK cells in CHO group were higher than those in FAST group and control group,p<0.05) Preoperative oral carbohydrate increase preoperative comfort significantly(The VAS scores assessing preoperative thirst,hunger,fatigue and weakness in CHO group were lower than those in FAST group and control group,p<0.05).Conclusions:Preoperative oral carbohydrate may reduce postoperative insulin resistance,enhance immunity and increase preoperative comfort in cervical cancer patients with neoadjuvant chemotherapy scheduled to undergo radical hysterectomy with bilateral pelvic lymph node dissection.