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International Journal of Colorectal Disease

, Volume 34, Issue 3, pp 459–469 | Cite as

Probiotics for preventing postoperative infection in colorectal cancer patients: a systematic review and meta-analysis

  • Xiaojing Ouyang
  • Qingfeng Li
  • Mengjing Shi
  • Dongsheng Niu
  • Wenjing Song
  • Qinggong Nian
  • Xiangda Li
  • Zhonghui Ding
  • Xianyin Ai
  • Jian WangEmail author
Original Article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

Probiotics have potential efficacy on preventing postoperative infection and related complications in cancer patients undergoing colorectal surgery.

Keywords

Meta-analysis Probiotics Colorectal surgery Postoperative infection 

Notes

Author contributions

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.

Supplementary material

384_2018_3214_MOESM1_ESM.doc (64 kb)
ESM 1 (DOC 64 kb)

References

  1. 1.
    Kikuchi M, Kameyama K, Yasuda M, Yokoi S, Deguchi T, Miwa K (2016) Postoperative infectious complications in patients undergoing holmium laser enucleation of the prostate: risk factors and microbiological analysis. Int J Urol 23(9):791–796.  https://doi.org/10.1111/iju.13139 CrossRefGoogle Scholar
  2. 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
  3. 3.
    Gianotti L, Morelli L, Galbiati F, Rocchetti S, Coppola S, Beneduce A, Gilardini C, Zonenschain D, Nespoli A, Braga M (2010) A randomized double-blind trial on perioperative administration of probiotics in colorectal cancer patients. World J Gastroenterol 16(2):167–175CrossRefGoogle Scholar
  4. 4.
    Bhatt AP, Redinbo MR, Bultman SJ (2017) The role of the microbiome in cancer development and therapy. CA Cancer J Clin 67(4):326–344.  https://doi.org/10.3322/caac.21398 CrossRefGoogle Scholar
  5. 5.
    Sharma M, Devi M (2014) Probiotics: a comprehensive approach toward health foods. Crit Rev Food Sci Nutr 54(4):537–552.  https://doi.org/10.1080/10408398.2011.594185 CrossRefGoogle Scholar
  6. 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. 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
  8. 8.
    Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F (2017) Global patterns and trends in colorectal cancer incidence and mortality. Gut 66(4):683–691.  https://doi.org/10.1136/gutjnl-2015-310912 CrossRefGoogle Scholar
  9. 9.
    dos Reis SA, da Conceição LL, Siqueira NP, Rosa DD, da Silva LL, Peluzio MDCG (2017) Review of the mechanisms of probiotic actions in the prevention of colorectal cancer. Nutr Res 37:1–19.  https://doi.org/10.1016/j.nutres.2016.11.009 CrossRefGoogle Scholar
  10. 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
  11. 11.
    Aisu N, Tanimura S, Yamashita Y, Yamashita K, Maki K, Yoshida Y, Sasaki T, Takeno S, Hoshino S (2015) Impact of perioperative probiotic treatment for surgical site infections in patients with colorectal cancer. Exp Ther Med 10(3):966–972.  https://doi.org/10.3892/etm.2015.2640 CrossRefGoogle Scholar
  12. 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. 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. 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
  15. 15.
    Zhang JW, Du P, Gao J, Yang BR, Fang WJ, Ying CM (2012) Preoperative probiotics decrease postoperative infectious complications of colorectal cancer. Am J Med Sci 343(3):199–205.  https://doi.org/10.1097/MAJ.0b013e31823aace6 CrossRefGoogle Scholar
  16. 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. 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
  18. 18.
    Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928.  https://doi.org/10.1136/bmj.d5928 CrossRefGoogle Scholar
  19. 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. 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
  21. 21.
    Ding HD, Su Q, Yin HZ (2013) Use of immune microecological nutrition as an alternative to traditional bowel preparation in minimally invasive treatment of colorectal cancer. World Chinese J Digestol 21(10):940–944.  https://doi.org/10.11569/wcjd.v21.i10.940 CrossRefGoogle Scholar
  22. 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. 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. 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. 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
  26. 26.
    Misra S, Sabui TK, Pal NK (2009) A randomized controlled trial to evaluate the efficacy of lactobacillus GG in infantile diarrhea. J Pediatr 155(1):129–132.  https://doi.org/10.1016/j.jpeds.2009.01.060 CrossRefGoogle Scholar
  27. 27.
    Underwood MA (2017) Impact of probiotics on necrotizing enterocolitis. Semin Perinatol 41(1):41–51.  https://doi.org/10.1053/j.semperi.2016.09.017 CrossRefGoogle Scholar
  28. 28.
    Lau CS, Ward A, Chamberlain RS (2016) Probiotics improve the efficacy of standard triple therapy in the eradication of Helicobacter pylori: a meta-analysis. Infect Drug Resist 9:275–289.  https://doi.org/10.2147/IDR.S117886 CrossRefGoogle Scholar
  29. 29.
    Celiberto LS, Bedani R, Rossi EA, Cavallini DC (2017) Probiotics: the scientific evidence in the context of inflammatory bowel disease. Crit Rev Food Sci Nutr 57(9):1759–1768.  https://doi.org/10.1080/10408398.2014.941457 Google Scholar
  30. 30.
    Ramalho R, Couto N, Cabral S, Magalhaes B, Alves P (2012) Pro- and symbiotics in oncology: a systematic review. Clin Nutr Supplement 7(1):79.  https://doi.org/10.1016/s1744-1161(12)70186-2 Google Scholar
  31. 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
  32. 32.
    Chalas R, Janczarek M, Bachanek T, Mazur E, Cieszko-Buk M, Szymanska J (2016) Characteristics of oral probiotics - a review. Curr Issues Pharm Med Sci 29(1):8–10.  https://doi.org/10.1515/cipms-2016-0002 CrossRefGoogle Scholar
  33. 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. 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. 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
  36. 36.
    MacFie J, Reddy BS, Gatt M, Jain PK, Sowdi R, Mitchell CJ (2006) Bacterial translocation studied in 927 patients over 13 years. Br J Surg 93(1):87–93.  https://doi.org/10.1002/bjs.5184 CrossRefGoogle Scholar
  37. 37.
    Correia MI, Liboredo JC, Consoli ML (2012) The role of probiotics in gastrointestinal surgery. Nutrition 28(3):230–234.  https://doi.org/10.1016/j.nut.2011.10.013 CrossRefGoogle Scholar
  38. 38.
    Resta-Lenert S, Barrett KE (2003) Live probiotics protect intestinal epithelial cells from the effects of infection with enteroinvasive Escherichia coli (EIEC). Gut 52(7):988–997CrossRefGoogle Scholar
  39. 39.
    Takeda K, Suzuki T, Shimada SI, Shida K, Nanno M, Okumura K (2006) Interleukin-12 is involved in the enhancement of human natural killer cell activity by Lactobacillus casei Shirota. Clin Exp Immunol 146(1):109–115.  https://doi.org/10.1111/j.1365-2249.2006.03165.x CrossRefGoogle Scholar
  40. 40.
    Tien MT, Girardin SE, Regnault B, Le Bourhis L, Dillies MA, Coppee JY, Bourdet-Sicard R, Sansonetti PJ, Pedron T (2006) Anti-inflammatory effect of Lactobacillus casei on Shigella-infected human intestinal epithelial cells. J Immunol 176(2):1228–1237CrossRefGoogle Scholar
  41. 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. 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. 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. 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
  45. 45.
    Yang Z, Wu Q, Liu Y, Fan D (2017) Effect of perioperative probiotics and synbiotics on postoperative infections after gastrointestinal surgery: a systematic review with meta-analysis. JPEN J Parenter Enteral Nutr 41(6):1051–1062.  https://doi.org/10.1177/0148607116629670 CrossRefGoogle Scholar
  46. 46.
    Yang H, Tang S, Huang H, Zhao X, Ning Z, Fu X, Zhang C (2016) Probiotics reduce psychological stress in patients before laryngeal cancer surgery. Asia Pac J Clin Oncol 12(1):e92–e96.  https://doi.org/10.1111/ajco.12120 CrossRefGoogle Scholar
  47. 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

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Xiaojing Ouyang
    • 1
  • Qingfeng Li
    • 2
  • Mengjing Shi
    • 2
  • Dongsheng Niu
    • 3
  • Wenjing Song
    • 2
  • Qinggong Nian
    • 2
  • Xiangda Li
    • 2
  • Zhonghui Ding
    • 2
  • Xianyin Ai
    • 4
  • Jian Wang
    • 2
    Email author
  1. 1.Department of GastroenterologyThe Third Hospital Affiliated to Beijing University of Chinese MedicineBeijingChina
  2. 2.Center for Disease Prevention and Control of Beijing Military RegionBeijingChina
  3. 3.Beijing Prevention and Treatment Hospital of Occupational Disease for Chemical IndustryBeijingChina
  4. 4.Medical Company of 32143 ForceXinyangChina

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