title: Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy.
abstract: OBJECTIVE
  The clinical value of synbiotics in surgical patients remains unclear. The aim of this study was to investigate the effect of synbiotics on intestinal integrity and microflora, as well as on surgical outcome, in patients undergoing high-risk hepatectomy.
  
  
  METHODS
  Fifty-four patients with biliary cancer were randomly allocated to two groups before hepatectomy. One group received postoperative enteral feeding that included synbiotics; the other received enteral feeding only. Lactulose/mannitol (L/M) ratio, serum diamine oxidase (DAO) activity, and fecal microflora and organic acid concentrations were determined. Postoperative infectious complications were recorded.
  
  
  RESULTS
  Of the 54 patients, 44 completed the trial (21 receiving synbiotics and 23 others as controls). Postoperative changes in L/M ratios and serum DAO activities were identical between the two groups. Numbers of beneficial bacteria increased in the synbiotics group after surgery but decreased in controls. Numbers of harmful microorganisms decreased in the synbiotics group but increased in controls. Total organic acid concentrations increased in the synbiotics group but decreased in controls. Incidence of infectious complications was 19% (4/21) in the synbiotics group and 52% (12/23) in controls (P<0.05). All study patients tolerated surgery (mortality 0%).
  
  
  CONCLUSIONS
  Synbiotics, combined with early enteral nutrition, can reduce postoperative infections. This beneficial effect presumably involves correction of an intestinal microbial imbalance induced by surgical stress.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Kanazawa
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kamiya
authors.forename: Shunichiro
authors.initials: S
authors.lastname: Komatsu
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Mayumi
authors.forename: Kenji
authors.initials: K
authors.lastname: Takagi
authors.forename: Takashi
authors.initials: T
authors.lastname: Asahara
authors.forename: Koji
authors.initials: K
authors.lastname: Nomoto
authors.forename: Ryuichiro
authors.initials: R
authors.lastname: Tanaka
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
mesh_terms: D000368:Aged; D001644:Bifidobacterium; D001653:Bile Ducts, Intrahepatic; D001661:Biliary Tract Neoplasms / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D004750:Enteral Nutrition; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000382:microbiology / Q000473:pathology; D007780:Lacticaseibacillus casei; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome