title: Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized controlled trial.
abstract: 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.
authors.affiliation: Division of Surgical Oncology, Department of Surgery; Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Gen
authors.initials: G
authors.lastname: Sugawara
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Hideki
authors.initials: H
authors.lastname: Nishio
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ebata
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: Yuji
authors.initials: Y
authors.lastname: Nimura
mesh_terms: 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
chemical_list: D015850:Interleukin-6; D006631:Amine Oxidase (Copper-Containing)