Probiotics for preventing postoperative infection in colorectal cancer patients: a systematic review and meta-analysis
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Postoperative infection has seriously affected the prognosis of cancer patients, while probiotics have been increasingly used to prevent postoperative infection in clinical practice. This study aimed to evaluate the preventive effect of probiotics on infection after colorectal cancer (CRC) surgery.
Related clinical trial reports were collected from Pubmed, Embase, Cochrane Library as well as China National Knowledge Infrastructure (CNKI) databases. These reports were then strictly screened, and information as well as data were extracted. Finally, the enrolled studies were evaluated by systematic review and meta-analysis using STATA v11 and Revman v5.2.
Probiotics administration contributed to the reduction of overall infection rate after colorectal surgery, with a pooled odds ratio (OR) of 0.51 (95% CI: 0.38–0.68, P = 0.00). Meanwhile, the incidence of incision infection (pooled OR = 0.59, 95% CI 0.39–0.88, P = 0.01) and pneumonia (pooled OR = 0.56, 95% CI 0.32–0.98, P = 0.04) as well as the first flatus time (SMDs = − 0.70, 95% CI − 1.13–− 0.27, P = 0.002) were also reduced by probiotics. In addition, urinary tract infection, anastomotic leakage, and duration of postoperative pyrexia were also analyzed, which displayed no statistical differences compared with those of control.
Probiotics have potential efficacy on preventing postoperative infection and related complications in cancer patients undergoing colorectal surgery.
KeywordsMeta-analysis Probiotics Colorectal surgery Postoperative infection
Xiaojing Ouyang and Jian Wang conceived the study and planning. Xiaojing Ouyang, Qingfeng Li, Mengjing Shi, Dongsheng Niu, and Wenjing Song performed the literature search, studies selection, and data collection. Qinggong Nian and Xiangda Li performed statistical analyses and prepared figures and tables. Xiaojing Ouyang, Jian Wang, and Zhonghui Ding drafted the initial manuscript. Xianyin Ai and Zhonghui Ding gave methodological support and modify the paper.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no interest conflict.
- 2.Guo Z, Cao L, Guo F, Gong J, Li Y, Gu L, Zhu W, Li J (2017) The presence of postoperative infectious complications is associated with the risk of early postoperative clinical recurrence of Crohn’s disease. World J Surg 41(9):2371–2377. https://doi.org/10.1007/s00268-017-4026-3 CrossRefGoogle Scholar
- 6.Li D, Zhou J, Yang L, Zhou X, Wang D, Yu D (2016) A study on protection effects of stabilizing intestinal flora from postoperative complications for colorectal cancer patients. Anti Tumor Pharm 6(6):428–432. https://doi.org/10.3969/j.issn.2095-1264.2016.06.06 Google Scholar
- 7.Theodoropoulos GE, Memos NA, Peitsidou K, Karantanos T, Spyropoulos BG, Zografos G (2016) Synbiotics and gastrointestinal function-related quality of life after elective colorectal cancer resection. Ann Gastroenterol 29(1):56–62Google Scholar
- 10.Marmol I, Sanchez-de-Diego C, Pradilla Dieste A, Cerrada E, Rodriguez Yoldi MJ (2017) Colorectal carcinoma: a general overview and future perspectives in colorectal cancer. Int J Mol Sci 18(1). https://doi.org/10.3390/ijms18010197
- 12.Kotzampassi K, Stavrou G, Damoraki G, Georgitsi M, Basdanis G, Tsaousi G, Giamarellos-Bourboulis EJ (2015) A four-probiotics regimen reduces postoperative complications after colorectal surgery: a randomized, double-blind, placebo-controlled study. World J Surg 39(11):2776–2783. https://doi.org/10.1007/s00268-015-3071-z CrossRefGoogle Scholar
- 13.Li D, Zhou J (2016) Effect of intestinal microecological preparation on postoperative immune function and complications in patients with colorectal cancer. Chinese Med Guid 35:106–109+114Google Scholar
- 14.Mangell P, Thorlacius H, Syk I, Ahrne S, Molin G, Olsson C, Jeppsson B (2012) Lactobacillus plantarum 299v does not reduce enteric bacteria or bacterial translocation in patients undergoing colon resection. Dig Dis Sci 57(7):1915–1924. https://doi.org/10.1007/s10620-012-2102-y CrossRefGoogle Scholar
- 16.Yang Y, Xia Y, Chen H, Hong L, Feng J, Yang J, Yang Z, Shi C, Wu W, Gao R, Wei Q, Qin H, Ma Y (2016) The effect of perioperative probiotics treatment for colorectal cancer: short-term outcomes of a randomized controlled trial. Oncotarget 7(7):8432–8440. https://doi.org/10.18632/oncotarget.7045 Google Scholar
- 17.Consoli MLD, Silva RS, Nicoli JR, Bruna-Romero O, da Silva RG, de Vasconcelos Generoso S, Correia M (2016) Randomized clinical trial: impact of oral administration of Saccharomyces boulardii on gene expression of intestinal cytokines in patients undergoing colon resection. JPEN J Parenter Enteral Nutr 40(8):1114–1121. https://doi.org/10.1177/0148607115584387 CrossRefGoogle Scholar
- 19.Yu J (2008) Effect of preoperative enteral immune nutrition combined with probiotics on the immune function of patients with colorectal cancer. Guangxi Medical UniversityGoogle Scholar
- 20.Xia Y, Yang Z, Chen HQ, Qin HL (2010) Effect of bowel preparation with probiotics on intestinal barrier after surgery for colorectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi 13(7):528–531Google Scholar
- 22.Chen H, Xia Y, Shi C, Liang Y, Yang Y, Qin H (2014) Effects of perioperative probiotics administration on patients with colorectal cancer. Chinese J Clin Nutr 22(2):74–81. https://doi.org/10.3760/cma.j.issn.1674-635X.2014.02.002 Google Scholar
- 23.Sadahiro S, Suzuki T, Tanaka A, Okada K, Kamata H, Ozaki T, Koga Y (2014) Comparison between oral antibiotics and probiotics as bowel preparation for elective colon cancer surgery to prevent infection: prospective randomized trial. Surgery 155(3):493–503. https://doi.org/10.1016/j.surg.2013.06.002 CrossRefGoogle Scholar
- 24.Liu Z, Li C, Huang M, Tong C, Zhang X, Wang L, Peng H, Lan P, Zhang P, Huang N, Peng J, Wu X, Luo Y, Qin H, Kang L, Wang J (2015) Positive regulatory effects of perioperative probiotic treatment on postoperative liver complications after colorectal liver metastases surgery: a double-center and double-blind randomized clinical trial. BMC Gastroenterol 15:34. https://doi.org/10.1186/s12876-015-0260-z CrossRefGoogle Scholar
- 25.Goyal AK, Garg T, Rath G (2016) Probiotics in human health. Forum Immunopathol Dis Ther 7(1–2):17–31. https://doi.org/10.1615/ForumImmunDisTher.2016018570 CrossRefGoogle Scholar
- 31.Komatsu S, Sakamoto E, Norimizu S, Shingu Y, Asahara T, Nomoto K, Nagino M (2016) Efficacy of perioperative synbiotics treatment for the prevention of surgical site infection after laparoscopic colorectal surgery: a randomized controlled trial. Surg Today 46(4):479–490. https://doi.org/10.1007/s00595-015-1178-3 CrossRefGoogle Scholar
- 33.van Hooft JE, Bemelman WA, Oldenburg B, Marinelli AW, Lutke Holzik MF, Grubben MJ, Sprangers MA, Dijkgraaf MG, Fockens P (2011) Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol 12(4):344–352. https://doi.org/10.1016/S1470-2045(11)70035-3 CrossRefGoogle Scholar
- 34.Liu Z, Qin H, Yang Z, Xia Y, Liu W, Yang J, Jiang Y, Zhang H, Wang Y, Zheng Q (2011) Randomised clinical trial: the effects of perioperative probiotic treatment on barrier function and post-operative infectious complications in colorectal cancer surgery - a double-blind study. Aliment Pharmacol Ther 33(1):50–63. https://doi.org/10.1111/j.1365-2036.2010.04492.x CrossRefGoogle Scholar
- 35.Liu ZH, Huang MJ, Zhang XW, Wang L, Huang NQ, Peng H, Lan P, Peng JS, Yang Z, Xia Y, Liu WJ, Yang J, Qin HL, Wang JP (2013) The effects of perioperative probiotic treatment on serum zonulin concentration and subsequent postoperative infectious complications after colorectal cancer surgery: a double-center and double-blind randomized clinical trial. Am J Clin Nutr 97(1):117–126. https://doi.org/10.3945/ajcn.112.040949 CrossRefGoogle Scholar
- 41.Zhu D, Chen X, Wu J, Ju Y, Feng J, Lu G, Ouyang M, Ren B, Li Y (2012) Effect of perioperative intestinal probiotics on intestinal flora and immune function in patients with colorectal cancer. Nan Fang Yi Ke Da Xue Xue Bao 32(8):1190–1193Google Scholar
- 42.de Andrade Calaca PR, Bezerra RP, Albuquerque WWC, Porto ALF, Cavalcanti MTH (2017) Probiotics as a preventive strategy for surgical infection in colorectal cancer patients: a systematic review and meta-analysis of randomized trials. Transl Gastroenterol Hepatol 2:67. https://doi.org/10.21037/tgh.2017.08.01 CrossRefGoogle Scholar
- 43.He D, Wang HY, Feng JY, Zhang MM, Zhou Y, Wu XT (2013) Use of pro-/synbiotics as prophylaxis in patients undergoing colorectal resection for cancer: a meta-analysis of randomized controlled trials. Clin Res Hepatol Gastroenterol 37(4):406–415. https://doi.org/10.1016/j.clinre.2012.10.007 CrossRefGoogle Scholar
- 44.Liu PC, Yan YK, Ma YJ, Wang XW, Geng J, Wang MC, Wei FX, Zhang YW, Xu XD, Zhang YC (2017) Probiotics reduce postoperative infections in patients undergoing colorectal surgery: a systematic review and meta-analysis. Gastroenterol Res Pract 2017:6029075. https://doi.org/10.1155/2017/6029075 Google Scholar
- 47.Wang YH, Yao N, Wei KK, Jiang L, Hanif S, Wang ZX, Pei CX (2016) The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer: a systematic review and meta-analysis. Eur J Clin Nutr 70(11):1246–1253. https://doi.org/10.1038/ejcn.2016.102 CrossRefGoogle Scholar