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

From the ¹ Department of Surgery, Nippon Medical School, Tokyo, Japan; and ² Department of Surgery, Sinai Hospital of Baltimore and the Johns Hopkins University, Baltimore, Maryland.

Address correspondence to: Teruo Kiyama, MD, PhD, Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo, 113-8603 Japan; e-mail: kiyama{at}nms.ac.jp.

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.

Key Words: hyperglycemia • insulin resistance • laparoscopic surgery • gastrectomy • gastric cancer

This version was published on November 1, 2009

Journal of Parenteral and Enteral Nutrition, Vol. 33, No. 6, 686-690 (2009)
DOI: 10.1177/0148607109333003


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