Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
Hôpital Charles-Nicolle (Rouen), 37 Boulevard Gambetta, 76038, Rouen Cedex, France.
World J Surg. 2022 Mar;46(3):656-665. doi: 10.1007/s00268-021-06388-7. Epub 2021 Nov 26.
By inhibiting the growth of pathogenic bacteria and modulating the local intestinal immune system, probiotics may reduce bacterial translocation and systemic endotoxaemia, factors partially responsible for post-operative complications following liver resection for hepatocellular carcinoma in patients with cirrhosis.
Patients with resectable hepatocellular carcinoma developed in the setting of chronic liver disease were prospectively divided into two equal-sized groups: one receiving probiotic treatment 14 days prior to surgery and the other receiving placebo. The primary endpoint was the level of circulating endotoxins after hepatectomy. Secondary endpoints were systemic inflammation (inflammatory cytokine levels), post-operative liver function and overall post-operative complication rate.
From May 2013 to December 2018, 64 patients were randomized, and 54 patients were included in the analysis, 27 in each arm. No significant change in endotoxin levels was observed over time in either group (P = 0.299). No difference between the groups in terms of post-operative liver function and overall complication rates was observed. The only differences observed were significant increases in the levels of TNFalpha (P = 0.019) and interleukin 1-b (P = 0.028) in the probiotic group in the post-operative period.
Contrary to the modest data reported in the literature, the administration of probiotics before minor liver resection for hepatocellular carcinoma developed in the setting of compensated chronic liver disease does not seem to have an impact on circulating endotoxin levels or post-operative complication rates.
Trial registration: NCT02021253.
通过抑制致病菌的生长和调节局部肠道免疫系统，益生菌可能减少细菌易位和全身内毒素血症，这是肝硬化患者行肝癌肝切除术后发生术后并发症的部分原因。
患有可切除的肝细胞癌且伴有慢性肝病的患者前瞻性地分为两组，每组各有 27 名患者：一组在术前 14 天接受益生菌治疗，另一组接受安慰剂治疗。主要终点是肝切除术后循环内毒素水平。次要终点是全身炎症（炎症细胞因子水平）、术后肝功能和总体术后并发症发生率。
从 2013 年 5 月至 2018 年 12 月，共随机分配了 64 名患者，其中 54 名患者纳入分析，每组 27 名。两组患者的内毒素水平在随访期间均无明显变化（P=0.299）。两组患者术后肝功能和总体并发症发生率无差异。仅观察到益生菌组术后 TNFalpha（P=0.019）和白细胞介素 1-b（P=0.028）水平显著升高。
与文献中报道的少量数据相反，在代偿性慢性肝病背景下，为行小范围肝切除治疗肝细胞癌而给予益生菌治疗，似乎对内毒素血症或术后并发症发生率无影响。
NCT02021253。
