Minimally Invasive Surgery Lowers Inflammation but Not Postoperative Insulin Resistance in Colorectal Cancer Patients: Study
Sweden: A study of patients undergoing colorectal cancer resection within an Enhanced Recovery After Surgery (ERAS) program has found that open surgery produced a significantly stronger postoperative inflammatory response than minimally invasive surgery (MIS). Despite this difference in inflammation, the surgical approach had no significant effect on postoperative insulin resistance, with patients in both groups showing similar metabolic responses after surgery.
These findings suggest that while MIS offers benefits in reducing surgical inflammation, it does not appear to lessen postoperative insulin resistance in colorectal cancer patients managed under ERAS protocols.
The findings were published in Clinical Nutrition ESPEN by Bayar Baban and colleagues from the Department of Surgery, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Sweden.
Postoperative insulin resistance and inflammation are key physiological responses to surgery that can affect recovery. While minimally invasive surgery (MIS) is known to reduce surgical trauma and inflammation compared with open surgery, its effect on postoperative insulin resistance remains unclear.
To investigate this, researchers conducted an exploratory study involving 17 patients undergoing elective colorectal cancer resection within a standardized Enhanced Recovery After Surgery (ERAS) program. Eight patients underwent open surgery and nine underwent MIS.
Insulin sensitivity was assessed using the hyperinsulinemic normoglycemic clamp technique, while blood samples collected before and after surgery were analyzed for glucose metabolism, hormonal changes, and inflammatory markers. Postoperative metabolic and inflammatory responses were then compared between the two surgical approaches.
The study led to the following findings:
- Postoperative insulin resistance developed to a similar extent in both the open surgery and minimally invasive surgery (MIS) groups.
- The surgical approach did not significantly affect postoperative insulin sensitivity.
- Patients undergoing MIS showed no measurable advantage over those undergoing open surgery in terms of reducing postoperative insulin resistance.
- Postoperative levels of inflammatory markers, including C-reactive protein (CRP) and interleukin-6 (IL-6), were significantly higher after open surgery than after MIS.
- Open colorectal surgery elicited a stronger systemic inflammatory response compared with minimally invasive surgery.
- Compliance with the Enhanced Recovery After Surgery (ERAS) protocol was similar in both groups.
- The observed differences in inflammatory response were likely attributable to the surgical technique rather than differences in perioperative care.
The authors concluded that while minimally invasive surgery was associated with a lower postoperative inflammatory response, it did not reduce the degree of postoperative insulin resistance compared with open surgery. The findings highlight that inflammation and insulin resistance may not always be directly linked and suggest that factors beyond surgical invasiveness contribute to postoperative metabolic changes.
Overall, the study adds to the understanding of surgical stress responses in colorectal cancer patients and indicates that the benefits of minimally invasive surgery may be more pronounced in limiting inflammation than in improving postoperative insulin sensitivity.
Reference:
Baban, B., Eklund, D., Tuerxun, K., Särndahl, E., & Ljungqvist, O. (2026). Insulin resistance and inflammation in open versus minimally invasive surgery for colorectal cancer. Clinical Nutrition ESPEN, 103424. https://doi.org/10.1016/j.clnesp.2026.103424
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