Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Haidian, Beijing, 100853, China.
Tech Coloproctol. 2022 Jun;26(6):425-436. doi: 10.1007/s10151-022-02585-1. Epub 2022 Mar 29.
The health benefits of probiotics and synbiotics in healthy adults are well established, but their role in preventing infectious complications after surgery for colorectal cancer remains controversial. The aim of this meta-analysis was to assess the impact of probiotics/synbiotics on the incidence of infectious complications in patients who had surgery for colorectal cancer.
A comprehensive literature search of all randomized control trials (RCTs) was conducted using PubMed, Embase, World Health Organization (WHO) Global Index Medicus, WHO clinical trial registry, and Clinicaltrials.gov. Inclusion criteria included RCTs comparing the use of any strain or dose of a specified probiotic/synbiotic with placebo or a "standard care" control group. The incidence of postoperative infectious complications was analyzed.
Fourteen RCTs involving 1566 patients (502 receiving probiotics, 273 receiving synbiotics, and 791 receiving placebo) were analyzed. Overall, probiotic or synbiotic administration significantly reduced the risk of developing postoperative infectious complications by 37% (relative risk (RR) = 0.63, 95% confidence interval (CI) 0.54-0.74, p < 0.001). Furthermore, when considering the six different types of postoperative infectious complications (septicemia, incision infection, central line infection, pneumonia infection, urinary infection, and incidence of diarrhea), probiotic or synbiotic administration was beneficial in reducing the incidence of each one of them. The quality of evidence was listed below: incidence of diarrhea (high), septicemia (moderate), incision infection (moderate), pneumonia infection (moderate), urinary infection (moderate), and central line infection (low). However, for the main outcome of infectious complications, we found evidence of possible publication bias, although estimates still showed a reduction following trim-and-fill analysis (RR = 0.72, 95% CI 0.62-0.84, p < 0.001).
The use of probiotic/synbiotic supplementation is associated with a significant reduction in the risk of developing postoperative infectious complications in patients who had surgery for colorectal cancer. Additional studies are needed to confirm the findings due to publication bias and low quality of evidence.
益生菌和合生菌在健康成年人中的健康益处已得到充分证实，但它们在预防结直肠癌手术后感染性并发症中的作用仍存在争议。本荟萃分析旨在评估益生菌/合生菌对接受结直肠癌手术患者感染性并发症发生率的影响。
通过PubMed、Embase、世界卫生组织（WHO）全球医学索引、WHO 临床试验注册中心和 Clinicaltrials.gov 对所有随机对照试验（RCT）进行全面文献检索。纳入标准包括比较任何一种特定益生菌/合生菌菌株或剂量与安慰剂或“标准治疗”对照组的 RCT。分析术后感染性并发症的发生率。
分析了 14 项涉及 1566 名患者（502 名接受益生菌治疗，273 名接受合生菌治疗，791 名接受安慰剂治疗）的 RCT。总体而言，益生菌或合生菌给药可显著降低 37%的术后感染性并发症风险（相对风险（RR）=0.63，95%置信区间（CI）0.54-0.74，p<0.001）。此外，当考虑六种不同类型的术后感染性并发症（败血症、切口感染、中心静脉感染、肺炎感染、尿路感染和腹泻发生率）时，益生菌或合生菌给药均有益于降低每种并发症的发生率。证据质量如下：腹泻发生率（高）、败血症（中）、切口感染（中）、肺炎感染（中）、尿路感染（中）和中心静脉感染（低）。然而，对于感染性并发症的主要结局，我们发现存在可能的发表偏倚的证据，但在进行修剪和填充分析后，估计值仍显示出降低（RR=0.72，95%CI 0.62-0.84，p<0.001）。
在接受结直肠癌手术的患者中，使用益生菌/合生菌补充剂与术后感染性并发症风险显著降低相关。由于存在发表偏倚和证据质量低，需要进一步的研究来证实这些发现。
