Department of Surgery and Cancer, South Kensington Campus, Imperial College London, London SW7 2AZ, UK.
Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy.
Nutrients. 2021 Apr 25;13(5):1451. doi: 10.3390/nu13051451.
The perioperative care of colorectal cancer (CRC) patients includes antibiotics. Although antibiotics do provide a certain protection against infections, they do not eliminate them completely, and they do carry risks of microbial resistance and disruption of the microbiome. Probiotics can maintain the microbiome's balance postoperatively by maintaining intestinal mucosal integrity and reducing bacterial translocation (BT). This review aims to assess the role of probiotics in the perioperative management of CRC patients. The outcomes were categorised into: postoperative infectious and non-infectious complications, BT rate analysis, and intestinal permeability assessment. Fifteen randomised controlled trials (RCTs) were included. There was a trend towards lower rates of postoperative infectious and non-infectious complications with probiotics versus placebo. Probiotics reduced BT, maintained intestinal mucosal permeability, and provided a better balance of beneficial to pathogenic microorganisms. Heterogeneity among RCTs was high. Factors that influence the effect of probiotics include the species used, using a combination vs. single species, the duration of administration, and the location of the bowel resection. Although this review provided evidence for how probiotics possibly operate and reported notable evidence that probiotics can lower rates of infections, heterogeneity was observed. In order to corroborate the findings, future RCTs should keep the aforementioned factors constant.
结直肠癌（CRC）患者的围手术期护理包括使用抗生素。虽然抗生素确实可以提供一定的抗感染保护，但并不能完全消除感染，而且还存在微生物耐药性和微生物组破坏的风险。益生菌可以通过维持肠黏膜完整性和减少细菌易位（BT）来维持术后微生物组的平衡。本综述旨在评估益生菌在 CRC 患者围手术期管理中的作用。结果分为：术后感染和非感染性并发症、BT 率分析和肠通透性评估。共纳入 15 项随机对照试验（RCT）。与安慰剂相比，益生菌组术后感染和非感染性并发症的发生率呈下降趋势。益生菌可减少 BT、维持肠黏膜通透性，并更好地平衡有益和致病微生物。RCT 之间存在高度异质性。影响益生菌作用的因素包括使用的菌种、联合使用与单一菌种、给药时间和肠切除部位。虽然本综述提供了益生菌可能作用的证据，并报告了益生菌可降低感染率的显著证据，但观察到了异质性。为了证实这些发现，未来的 RCT 应保持上述因素不变。
