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

Chen, Y; Qi, Aiying; Teng, Da; Li, S; Yan, Yuhan; Hu, Shaojun; Du, Xiaohui

doi:10.1007/s10151-022-02585-1

Cited by 28 publications

(29 citation statements)

References 37 publications

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“…This is counter-intuitive, especially as we can expect that prebiotics and probiotics (defining synbiotics) produce synergistic effects. A further meta-analysis published by Chen et al [ 45 ] after the completion of our own meta-analysis included fewer ( n = 14) trials than our meta-analysis and showed quite similar results. One meta-analysis [ 46 ] showed similar outcomes whatever the treatment used with an apparent effect of synbiotics.…”

Section: Discussionsupporting

confidence: 79%

Probiotics/Synbiotics to Reduce Infectious Complications after Colorectal Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

et al. 2022

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Aim: The aims of this systematic review and meta-analysis were to assess to what extent probiotics/synbiotics reduce infectious complications after colorectal surgery and whether probiotics or synbiotics should be considered as perioperative measures preventing or reducing infectious complications after CRS and should be included in enhanced recovery programmes (ERP). Secondary aims were to answer practical questions precisely on the best formulation and the type and timing of probiotics or synbiotics in CRS. Method: This systematic review and quantitative meta-analysis were conducted in accordance with PRISMA 2020 guidelines. Inclusion criteria were randomised trials comparing perioperative probiotics/synbiotics with a placebo or standard care in elective colorectal surgery. Exclusion criteria were non-randomised trials. Overall infectious complications and surgical site infections (SSIs including both deep abdominal infections and wound (skin or under the skin) infections) were the primary outcomes. Secondary outcomes were pulmonary and urinary infections, wound infections, and anastomotic leaks. The databases consulted were Medline, Cochrane Database of Systematic Reviews, Scopus, and Clinical Trials Register. Risk of bias was assessed according to the GRADE approach. The analysis calculated the random effects estimates risk ratio (RR) for each outcome. Results: 21 trials were included; 15 evaluated probiotics, and 6 evaluated synbiotics. There were significantly fewer infectious complications (risk ratio (RR) 0.59 [0.47–0.75], I2 = 15%) and fewer SSI (RR 0.70 [0.52–0.95], I2 = 0%) in the probiotic or synbiotic group. There were also significantly fewer pulmonary infections (RR 0.35 [0.20–0.63]) and urinary infections RR 0.41 [0.19–0.87]) as opposed to anastomotic leaks (RR 0.83 [0.47–1.48]) and wound infections (RR 0.74 [0.53–1.03]). Sensitivity analyses showed no significant difference between probiotics and synbiotics in reducing postoperative infections (RR 0.55 [0.42–0.73] versus RR 0.69 [0.42–1.13], p = 0.46). Conclusions: Based on the finding of this study, probiotics/synbiotics reduce infectious complications after colorectal surgery. The effect size was more pronounced for pulmonary and urinary infections. From a practical aspect, some of the questions related to formulations and duration of probiotics or synbiotics need to be answered before including them definitively in enhanced recovery after colorectal surgery programmes.

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Section: Discussionsupporting

confidence: 79%

Probiotics/Synbiotics to Reduce Infectious Complications after Colorectal Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

et al. 2022

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“…CRC is a common malignant tumor of the digestive tract. Preoperative treatment, surgery, and postoperative adjuvant therapy are important treatment strategies for a variety of malignant tumors (10)(11)(12). Individualized treatment of CRC needs to be based on detailed preoperative assessment.…”

Section: Discussionmentioning

confidence: 99%

Apparent diffusion coefficient is a good marker in predicting the prognosis in colorectal cancer liver metastases: a diagnostic study

Zheng¹,

Lu²,

Zhang³

et al. 2022

J Gastrointest Oncol

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Background: Colorectal cancer (CRC) is one of the most common malignant tumors. Up to 10% CRC patients can have liver metastases at the first diagnosis. At present, clinical diagnosis of CRC liver metastasis (CRCLM) is mostly based on imaging, and there is a certain false-positive rate and false-negative rate.Improving the diagnostic accuracy of imaging for CRCLM is highly significant. Apparent diffusion coefficients showed high predicting value in other cancers. The aim of the present study was to explore the diagnostic value of apparent diffusion coefficients based on magnetic resonance diffusion weighted imaging for CRCLM.Methods: Fifty patients with CRCLM admitted to Hebei Yanda Hospital from January 2018 to December 2018 were retrospectively collected, and the data of 50 patients with benign liver nodules were collected at the same time. The diagnostic value of apparent diffusion coefficients on liver metastatic cancer was analyzed using receiver operating characteristic curve. The correlation between apparent diffusion coefficients and clinical pathological features of patients with CRCLM was also analyzed. The diagnosis of liver metastatic cancer was based on pathological biopsy. Three-year follow up after surgery was conducted in clinic or via phone.Results: Compared with the benign liver nodule group, the apparent diffusion coefficients of patients in the CRCLM group were significantly decreased [(1.14±0.26 vs. 2.06±0.57)×10−3 mm 2 /s, P<0.001]. The apparent diffusion coefficient was of high value in differentiating between benign liver nodules and liver metastatic cancer. The area under the curve was 0.927 [95% confidence interval (CI): 0.879-0.975, P<0.001]. Compared with patients with highly differentiated tumors, the apparent diffusion coefficients of patients with moderately and poorly differentiated tumors were significantly reduced [(1.08±0.26 vs. 1.29±0.22)×10−3 mm 2 /s, P=0.010]. Compared with patients who survived 3 years after operation, the apparent diffusion coefficients of patients who died were significantly lower [(1.05±0.26 vs. 1.23±0.23)×10−3 mm 2 /s, P=0.011]. The apparent diffusion coefficients of liver nodules in patients with CRCLM is a good marker in predicting postoperative 3-year survival, and the area under the curve was 0.728 (95% CI: 0.580-0.876, P=0.006). Conclusions:The apparent diffusion coefficient can sever as a marker in diagnosing CRCLM and predicting prognosis.

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“…Clinical studies found that perioperative administration of probiotics/synbiotics in patients with CRC surgery had a lower incidence of infection (odds ratio [OR] = 0.34, p < .001), and was associated with six different types of postoperative infectious complications (sepsis, wound infection, central line infection, pneumonia infection, urinary tract infection, and diarrhea) were significantly lower by 37% (relative risk (RR) = 0.63, 95% confidence interval (CI) 0.54–0.74, p < .001). In addition, patients had a lower incidence of diarrhea (OR = 0.38, p < .001), faster return to normal bowel function (mean difference [MD] −0.66 days, p < .001), shorter postoperative antibiotic use (MD −0.64 days, p < .001), lower incidence of sepsis (OR = 0.31, p < .001), and shorter hospital stay (MD −0.41 days, p = .110) (Amitay et al, 2020; Chen et al, 2022). Preoperative administration of a synbiotic preparation including fructooligosaccharides, Lactobacillus acidophilus NCFM, L. rhamnosus HN001, L. casei LPC‐37, and Bififidobacterium lactis HN019 for 7 days in colorectal cancer patients could reduce the incidence of infectious or non‐infectious complications, hospitalization time and the duration of antibiotic use (Polakowski et al, 2019).…”

Section: Application Of Prebiotics Probiotics and Synbiotics In Adjuv...mentioning

confidence: 99%

The potential role of prebiotics, probiotics, and synbiotics in adjuvant cancer therapy especially colorectal cancer

Alam

Shang

Effat

et al. 2022

Journal of Food Biochemistry

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Cancer is a global health issue that is rising swiftly with younger people and an increased number of patients. The role of human microbiota in the pathophysiology of tumors has been paid more and more attention. Microecologics including prebiotics, probiotics, and synbiotics are among the best validated/proven resources for the application of microbiological prophylaxis and therapy. There is strong evidence that microecologics have anti-cancer activity and their potential association with cancer is significant. In this review, we will focus on the role of prebiotics, probiotics, and synbiotics in tumor suppression in maintaining the colon barrier, metabolism, immune regulation, inhibition of host tumor cell proliferation, and epidemiologicalbased recommendations. Besides, other signs illuminate the role of microecological agents to adjunct the cancer treatment and counter the toxic side effects of cancer drugs. In addition, we will explore their role in chemotherapy, where these probiotics can be used as an adjunct to chemotherapy, counteracting the toxic side effects of chemotherapy drugs to minimize or optimize the therapeutic effect. In the treatment of cancer, we can see the role of prebiotics, probiotics, synbiotics, and their application in cancer patients, and the effectiveness effect can be considered as a clinical benefit. Practical applicationsA large number of studies have shown that microecologics including prebiotics, probiotics, and synbiotics play an important role in regulating intestinal microecology and contribute to the prevention and treatment of cancer, indicating that prebiotics, probiotics, and synbiotics have the potential to be used as microecological modulators in the adjuvant therapy of cancer. However, it is not clear what is the anti-tumor mechanism of these microecologics and how they antagonize the side effects of cancer chemotherapy and protect normal cells. This paper reviews the role of prebiotics, probiotics, and synbiotics in tumor suppression in maintaining the colon barrier, metabolism, immune regulation, and prevention of rapid growth of host cells, as well as their potential role in cancer chemotherapy. This review helps to better understand the relationship between prebiotics, probiotics, and synbiotics with immune regulation, intestinal microecology, metabolic regulation, and cell proliferation and provides strong evidence for their potential application as microecologics in cancer adjuvant therapy.

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

Cited by 28 publications

References 37 publications

Probiotics/Synbiotics to Reduce Infectious Complications after Colorectal Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Probiotics/Synbiotics to Reduce Infectious Complications after Colorectal Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Apparent diffusion coefficient is a good marker in predicting the prognosis in colorectal cancer liver metastases: a diagnostic study

The potential role of prebiotics, probiotics, and synbiotics in adjuvant cancer therapy especially colorectal cancer

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