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

Abstract

BackgroundColorectal liver metastases (CLM) occur frequently and postoperative intestinal infection is a common complication. Our previous study showed that probiotics could decrease the rate of infectious complications after colectomy for colorectal cancer. To determine the effects of the perioperative administration of probiotics on serum zonulin levels which is a marker of intestinal permeability and the subsequent impact on postoperative infectious complications in patients with CLM.Methods150 patients with CLM were randomly divided into control group (n = 68) and probiotics group (n = 66). Probiotics and placebo were given orally for 6 days preoperatively and 10 days postoperatively to control group and probiotics group respectively. We used the local resection for metastatic tumor ,while for large tumor, the segmental hepatectomy. Postoperative outcome were recorded. Furthermore, complications in patients with normal intestinal barrier function and the relation with serum zonulin were analyzed to evaluate the impact on the liver barrier dysfunction.ResultsThe incidence of infectious complications in the probiotics group was lower than control group. Analysis of CLM patients with normal postoperative intestinal barrier function paralleled with the serum zonulin level. And probiotics could also reduce the concentration of serum zonulin (P = 0.004) and plasma endotoxin (P < 0.001).ConclusionPerioperative probiotics treatment could reduce the serum zonulin level, the rate of postoperative septicemia and maintain the liver barrier in patients undergoing CLM surgery. we propose a new model about the regulation of probiotics to liver barrier via clinical regulatory pathway. We recommend the preoperative oral intake of probiotics combined with postoperative continued probiotics treatment in patients who undergo CLM surgery.Trial registrationChiCTR-TRC-12002841. 2012/12/21Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-015-0260-z) contains supplementary material, which is available to authorized users.

Probiotics as a preventive strategy for surgical infection in colorectal cancer patients: a systematic review and meta-analysis of randomized trials

“…A total of 4 of 6 articles evaluated showed a positive response of the probiotic use (4,5,9,18), while 2 of them showed a placebo response (2,19).…”

“…CRC is ranked as the second leading cause of death from tumors, which are primarily originate from the gastrointestinal tract (GIT), particularly the colon and rectum, and have the liver as the most common site of metastases (2). Surgical resection remains the mainstay for treatment of CRC, with the extent of surgery and the need for chemotherapy and radiation depending on the stage and disease presentation (3).…”

Uso De Pré, Pró E Simbióticos Como Coadjuvantes No Tratamento Do Câncer Colorretal

“…O uso de probióticos e prebióticos diminui o risco de complicações pós-operatórias, como septicemia 22,28 , ventilação mecânica, infecções, pneumonia e vazamento da anastomose 25,26 , além de trazer benefícios clínicos em curto prazo através da recuperação mais rápida da função intestinal, com menor incidência de diarreia e alta hospitalar mais rápida 26,30 . Além disso, o uso de probióticos e prebióticos auxilia na manutenção da resistência à colonização microbiana por microrganismos indesejáveis e restringe a translocação bacteriana no intestino.…”

“…Um dos mecanismos propostos é o aumento do nível sérico das citocinas interleucina 6 (IL-6) e fator de necrose tumoral (TNF) em pacientes com câncer, o que estimularia o fígado a sintetizar a PCR. Desse modo, a PCR pode ser utilizada como um índice da função imune intestinal para o prognóstico de pacientes com CCR 28 . Os níveis de IL-6 estão sempre relacionados aos estudos com pacientes oncológicos, pois a IL-6 é uma potente citocina que possui ação imunológica, mobilizando a produção de granulócitos e macrófagos no organismo 31 .…”

“…Por outro lado, Gao et al 5 mostraram que a utilização de probióticos no pré-operatório aumentou o número de microrganismos benéficos, proporcionando uma maior diversidade da microbiota intestinal, além de inibir potenciais agentes patogênicos. Da mesma forma, Liu et al 28 relataram que o tratamento com probióticos no pré-operatório poderia reduzir a taxa de septicemia pós-operatória e manter a barreira hepática em pacientes submetidos à cirurgia de tratamento e CCR. Recomendaram, portanto, a ingestão oral pré-operatória de probióticos, combinada com o tratamento pós-operatório em pacientes submetidos à cirurgia de ressecção de metástases hepáticas colorretais.…”