title: Probiotics, prebiotics, synbiotics: is there enough evidence to support their use in colorectal cancer surgery?.
abstract: OBJECTIVE
  Pro-/pre-/synbiotics supplementation seems to provide beneficial effects in various aspects of abdominal pathology. Skepticism exists with respect to their effects on colorectal cancer (CRC) patients. This review presents the potential clinical applications of pro-/pre-/synbiotics in CRC surgery.
  
  
  METHODS
  A literature search of electronic databases was conducted and all studies published on 'probiotics', 'prebiotics' and 'synbiotics' were collected. Among them, the ones referring to CRC and which had any clinical relevance offering information on perioperative parameters were used.
  
  
  RESULTS
  Incorporation of pre-/pro-/synbiotic formulations in the preoperative mechanical bowel preparation cannot be supported by the current evidence. Limited clinical studies may be promising in supporting their potentially protective role against postoperative infectious complications. Encouraging are the results on their protective role against adjuvant (chemo)radiation-induced diarrhea. Such supplementation may also hold promise to improve postcolectomy gastrointestinal related quality of life.
  
  
  CONCLUSIONS
  Despite the positive results and plethora of agents, bacterial combinations and concentrations, the inconsistency in administration, the inhomogeneity of comparison groups and lack of stringent clinical endpoints remain obstacles in the effort to establish a definitive clinical strategy at this time. Further work is warranted to gain a keen understanding of their clinical value in CRC patients.
authors.affiliation: Colorectal Unit, 1st Department of Propaedeutic Surgery, Athens Medical School, Athens, Greece.
authors.forename: Kiriaki
authors.initials: K
authors.lastname: Peitsidou
authors.forename: Theodoros
authors.initials: T
authors.lastname: Karantanos
authors.forename: George E
authors.initials: GE
authors.lastname: Theodoropoulos
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D003082:Colectomy / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000628:therapy*; D003967:Diarrhea / Q000209:etiology / Q000517:prevention & control; D019587:Dietary Supplements; D006801:Humans; D056692:Prebiotics; D011300:Preoperative Care; D019936:Probiotics / Q000627:therapeutic use; D011878:Radiotherapy / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control; D058616:Synbiotics
chemical_list: D000970:Antineoplastic Agents; D056692:Prebiotics