Insulin resistance and inflammation in open versus minimally invasive surgery for colorectal cancer.

BACKGROUND & AIMS: To investigate the role of surgical technique - OPEN or minimally invasive surgery (MIS) - on the development of postoperative insulin resistance and inflammatory response in elective colorectal resections for cancer.

METHODS

Clinical exploratory study of patients with colorectal cancer planned for elective colorectal resections by either OPEN (n = 8) or MIS (n = 9) approach within a controlled Enhanced Recovery After Surgery (ERAS) program. Insulin sensitivity was determined using the hyperinsulinemic normoglycemic clamp and blood samples were collected before and after surgery for analysis of glucose, hormones and inflammatory markers in both the OPEN and MIS group, as well as comparing the two groups to each other.

RESULTS

Patients undergoing surgery, OPEN or MIS, exhibited postoperative insulin resistance to a similar degree regardless of surgical approach. Postoperative plasma levels of the inflammatory markers CRP and IL-6 were significantly (p < 0.05) higher following open surgery. Perioperative compliance to the ERAS protocol was similar in both the OPEN and MIS groups.

CONCLUSION

While open colorectal surgery did elicit a significantly higher inflammatory response compared to MIS, the surgical approach did not influence the degree of postoperative insulin resistance in patients undergoing colorectal resections for cancer in ERAS.