Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized controlled trial.
BACKGROUND
Use of synbiotics has been reported to benefit human health, but clinical value in surgical patients remains unclear.


OBJECTIVE
To investigate the effect of perioperative oral administration of synbiotics upon intestinal barrier function, immune responses, systemic inflammatory responses, microflora, and surgical outcome in patients undergoing high-risk hepatobiliary resection.


METHODS
Patients with biliary cancer involving the hepatic hilus (n = 101) were randomized before hepatectomy, into a group receiving postoperative enteral feeding with synbiotics (group A); or another receiving preoperative plus postoperative synbiotics (group B). Lactulose-mannitol (L/M) ratio, serum diamine oxidase (DAO) activity, natural killer (NK) cell activity, interleukin-6 (IL-6), fecal microflora, and fecal organic acid concentrations were determined before and after hepatectomy. Postoperative infectious complications were recorded.


RESULTS
Of 101 patients, 81 completed the trial. Preoperative and postoperative changes in L/M ratio and DAO activity were similar between groups. Preoperatively in group B, NK activity, and lymphocyte counts increased, while IL-6 decreased significantly (P < 0.05). Postoperative serum IL-6, white blood cell counts, and C-reactive protein in group B were significantly lower than in group A (P < 0.05). During the preoperative period, numbers of Bifidobacterium colonies cultured from and total organic acid concentrations measured in feces increased significantly in group B (P < 0.05). Postoperative concentrations of total organic acids and acetic acid in feces were significantly higher in group B than in group A (P < 0.05). Incidence of postoperative infectious complications was 30.0% (12 of 40) in group A and 12.1% (5 of 41) in group B (P < 0.05).


CONCLUSIONS
Preoperative oral administration of synbiotics can enhance immune responses, attenuate systemic postoperative inflammatory responses, and improve intestinal microbial environment. These beneficial effects likely reduce postoperative infectious complications after hepatobiliary resection for biliary tract cancer.
Sugawara
Gen
G
Division of Surgical Oncology, Department of Surgery; Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nagino
Masato
M
Nishio
Hideki
H
Ebata
Tomoki
T
Takagi
Kenji
K
Asahara
Takashi
T
Nomoto
Koji
K
Nimura
Yuji
Y
D006631:Amine Oxidase (Copper-Containing) / Q000097:blood; D001644:Bifidobacterium / Q000302:isolation & purification; D001650:Bile Duct Neoplasms / Q000097:blood / Q000601:surgery*; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006500:Hepatic Duct, Common; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007694:Killer Cells, Natural / Q000378:metabolism; D007780:Lacticaseibacillus casei / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D019936:Probiotics / Q000627:therapeutic use*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
D015850:Interleukin-6; D006631:Amine Oxidase (Copper-Containing)