Probiotics administration as a prevention for postoperative infectious complications in colorectal cancer patients: A literature review

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Angela Dalimarta
Wiji Lestari


Background Colorectal cancer is the third leading cause of death from cancer in adults in the United States, with increasing prevalence in other countries. Radical resection is the gold standard of treatment in most cases of colorectal cancer, with a high rate of postoperative complications. Perioperative probiotics can improve the immune response and the postoperative intestinal microbiota environment. Although several studies have shown the benefits of probiotics in preventing postoperative complications of infection, the administration of perioperative probiotics in colorectal cancer patients is still controversial.
Objective. The purpose of this critical appraisal is to know the effectiveness of administering probiotics to prevent infectious complications in colorectal cancer patients.
Methods. Literature research using Pubmed, Cochrane, and EBSCOhost was carried out and 2 articles were obtained in the form of meta-analysis using STATA v11 and Revman v5.2 that was critically examined using the FAITH method. A comprehensive search for all studies was done to find all relevant studies using both MeSH terms and text words. The article should describe the assessment of quality and criteria used in method section, also provide information on the quality of individual studies in result section to minimize bias. The result section should state whether heterogeneity exists and mention possible reasons.
Results. Based on 2 meta-analyses that have been critically examined, which each consisting of 13 and 7 studies, giving probiotics can reduce the overall infection rate after colorectal cancer surgery. One meta-analysis showed an odds ratio (OR) of 0.51 (95% CI: 0.38 – 0.68, p = 0.00). Probiotics, such as Lactobacillus acidophilus and Bifidobacterium longum can also reduce the incidence of surgical site infections (OR = 0.59, 95% CI 0.39 – 0.88, p = 0.01) and pneumonia (OR = 0.56, 95% CI 0.32 – 0.98, p = 0.04). Probiotics did not provide statistically significant benefits in preventing urinary tract infections, leakage of anastomosis, and duration of postoperative pyrexia compared to the control group. Seven articles analyzed in the second meta-analysis showed probiotics to be useful in preventing postoperative infections with OR 0.5388 (95% CI, 0.4058-0.7154, P <0.0001).
Conclusions. Combination of more than one strain of probiotics such as Lactobacillus and Bifidobacterium is promising for the prevention of infections in patients undergoing colorectal cancer surgery.


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Author Biographies

Angela Dalimarta, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia

Department of Nutrition

Wiji Lestari, Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia

Department of Nutrition


Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019;69:7-34.

Li M, Gu J. Changing patterns of colorectal cancer in China over a period of 20 years. World J Gastroenterol 2005;11: 4685-8.

Kementerian Kesehatan Republik Indonesia. Riset Kesehatan Dasar 2018.

Kotzampassi K, Stavrou G, Damoraki G, Georgitsi M, Basdanis G, Tsaousi G, et al. A Four-Probiotics Regimen Reduces Postoperative Complications After Colorectal Surgery: A Randomized, Double-Blind, Placebo-Controlled Study. World J Surg 2015;39:2776-83.

Sadahiro S, Suzuki T, Tanaka A, Okada K, Kamata H, Ozaki T, et al. Comparison between oral antibiotics and probiotics as bowel preparation for elective colon cancer surgery to prevent infection: prospective randomized trial. Surgery 2014;155:493-503.

Rawlinson A, Kang P, Evans J, Khanna A. A systematic review of enhanced recovery protocols in colorectal surgery. Ann R Coll Surg Engl 2011;93:583-8.

Zhang JW, Du P, Gao J, Yang BR, Fang WJ, Ying CM. Preoperative probiotics decrease postoperative infectious complications of colorectal cancer. Am J Med Sci 2012;343:199-205.

Yang Y, Xia Y, Chen H, Hong L, Feng J, Yang J, et al. The effect of perioperative probiotics treatment for colorectal cancer short-term outcomes of a randomized controlled trial. Oncotarget 2016;7;8432-40.

Aisu N, Tanimura S, Yamashita Y, Yamashita K, Maki K, Yoshida Y, et al. Impact of perioperative probiotic treatment for surgical site infections in patients with colorectal cancer. Exp Ther Med 2015;10:966-72.

Kinross J, von Roon AC, Penney N, Holmes E, Silk D, Nicholson JK. The Gut Microbiota as a Target for Improved Surgical Outcome. Current Pharmaceutical Design 2009; 15:1537-45.

Fooks LJ, Gibson GR. Probiotics as modulators of the gut flora. Br J Nutr 2002;88 Suppl 1:S39-49.

Reddy BS, Macfie J, Gatt M, Larsen CN, Jensen SS, Leser TD. Randomized clinical trial of effect of synbiotics, neomycin and mechanical bowel preparation on intestinal barrier function in patients undergoing colectomy. Br J Surg 2007;94:546-54.

Anderson ADG, McNaught CE, Jain PK, MacFie J. Randomised clinical trial of synbiotic therapy in elective surgical patients. Gut 2004; 53:241–5.

Consoli ML, da Silva RS, Nicoli JR, Bruna-Romero O, da Silva RG, de Vasconcelos Generoso S, et al. 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 2016;40:1114-21.

Gianotti L, Morelli L, Galbiati F, Rocchetti S, Coppola S, Beneduce A, et al. A randomized double-blind trial on perioperative administration of probiotics in colorectal cancer patients. World J Gastroenterol 2010;16:167-75.
16. Glasziou P. Can I have FAITH in this Review? Centre for Research in Evidence Based Practice Bond University.

Ouyang X, Li Q, Shi M, Niu D, Song W, Nian Q, et al. Probiotics for preventing postoperative infection in colorectal cancer patients: a systematic review and meta-analysis. Int J Colorectal Dis 2019;34:459-69.

de Andrade Calaca PR, Bezerra RP, Albuquerque WWC, Porto ALF, Cavalcanti MTH. Probiotics as a preventive strategy for surgical infection in colorectal cancer patients: a systematic review and meta-analysis of randomized trials. Transl Gastroenterol Hepatol 2017;2:67.

Liu Z, Li C, Huang M, Tong C, Zhang X, Wang L, et al. 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 2015;15:34.