Laparoscopic surgery improves blood glucose homeostasis and insulin resistance following distal gastrectomy for cancer.
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.
Kanno
Hitoshi
H
Department of Surgery, Nippon Medical School, Tokyo, Japan.
Kiyama
Teruo
T
Fujita
Itsuo
I
Tani
Aya
A
Kato
Shunji
S
Tajiri
Takashi
T
Barbul
Adrian
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000097:blood / Q000378:metabolism*; D007333:Insulin Resistance; D000078790:Insulin Secretion; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D013274:Stomach Neoplasms / Q000378:metabolism / Q000601:surgery*
D001786:Blood Glucose; D007328:Insulin