Laparoscopic Surgery Improves Blood Glucose Homeostasis and Insulin Resistance Following Distal Gastrectomy for Cancer

• Published in: JPEN. Journal of parenteral and enteral nutrition 2009-11, Vol.33 (6), p.686-690
• Main Authors: Kanno, Hitoshi, Kiyama, Teruo, Fujita, Itsuo, Tani, Aya, Kato, Shunji, Tajiri, Takashi, Barbul, Adrian
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Glucose - metabolism; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Female; gastrectomy; Gastrectomy - methods; gastric cancer; Homeostasis; Humans; hyperglycemia; Insulin - blood; Insulin - metabolism; Insulin Resistance; Insulin Secretion; Intensive care medicine; laparoscopic surgery; Laparoscopy; Male; Medical sciences; Middle Aged; Postoperative Complications - surgery; Stomach Neoplasms - metabolism; Stomach Neoplasms - surgery; Transfusions. Complications. Transfusion reactions. Cell and gene therapy
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/0148607109333003

Background: Prevention of blood glucose elevation and insulin resistance could be more pronounced in patients undergoing laparoscopic rather than open gastrectomy. Methods: Fifty-seven patients underwent distal gastrectomy by either laparoscopy (n = 36) or an open approach (n = 21). Blood glucose, serum insulin, and the daily insulin secretion rate (urinary C-peptide) were measured. Insulin resistance was evaluated using an adapted homeostasis model assessment of insulin resistance (HOMA-R). Results: Blood glucose levels were lower in the laparoscopy group than in the open group on the operative day and on postoperative days (POD) 1 and 3 (P< .001, P = .001, and P = .024, respectively). Serum insulin levels were lower in the laparoscopy group than in the open group on POD 1 and 3 (P = .045 and P = .027, respectively). HOMA-R was lower in the laparoscopy group than in the open group on POD 1 and 3 (P = .024 and P = .009, respectively). Daily insulin secretion rates were lower in the laparoscopy group than in the open group on POD 1 (P = .023). Conclusions: Laparoscopic surgery prevents blood glucose elevation and improves insulin resistance compared with open surgery.