title: Randomized clinical trial of the effect of perioperative synbiotics versus no synbiotics on bacterial translocation after oesophagectomy.
abstract: BACKGROUND
  The impact of perioperative synbiotics on bacterial translocation and subsequent bacteraemia after oesophagectomy is unclear. This study investigated the effect of perioperative synbiotic administration on the incidence of bacterial translocation to mesenteric lymph nodes (MLNs) and the occurrence of postoperative bacteraemia.
  
  
  METHODS
  Patients with oesophageal cancer were randomized to receive perioperative synbiotics or no synbiotics (control group). MLNs were harvested from the jejunal mesentery before dissection (MLN-1) and after the restoration of digestive tract continuity (MLN-2). Blood and faeces samples were taken before and after operation. Microorganisms in each sample were detected using a bacterium-specific ribosomal RNA-targeted reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) method.
  
  
  RESULTS
  Some 42 patients were included. There was a significant difference between the two groups in detection levels of microorganisms in the MLN-1 samples. Microorganisms were more frequently detected in MLN-2 samples in the control group than in the synbiotics group (10 of 18 versus 3 of 18; P = 0·035). In addition, bacteraemia detected using RT-qPCR 1 day after surgery was more prevalent in the control group than in the synbiotics group (12 of 21 versus 4 of 21; P = 0·025). Neutrophil counts on postoperative days 1, 2 and 7 after surgery were all significantly higher in the control group than in the synbiotics group.
  
  
  CONCLUSIONS
  Perioperative use of synbiotics reduces the incidence of bacteria in the MLNs and blood. These beneficial effects probably contribute to a reduction in the inflammatory response after oesophagectomy.
  
  
  BACKGROUND
  ID 000003262 (University Hospital Medical Information Network, http://www.umin.ac.jp).
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: E
authors.initials: E
authors.lastname: Nishigaki
authors.forename: T
authors.initials: T
authors.lastname: Abe
authors.forename: M
authors.initials: M
authors.lastname: Fukaya
authors.forename: T
authors.initials: T
authors.lastname: Asahara
authors.forename: K
authors.initials: K
authors.lastname: Nomoto
authors.forename: M
authors.initials: M
authors.lastname: Nagino
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000517:prevention & control*; D018988:Bacterial Translocation / Q000502:physiology*; D002097:C-Reactive Protein / Q000378:metabolism; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007902:Length of Stay; D007958:Leukocyte Count; D008198:Lymph Nodes / Q000382:microbiology; D008206:Lymphatic Diseases / Q000382:microbiology / Q000517:prevention & control*; D008297:Male; D008643:Mesentery / Q000382:microbiology; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D058616:Synbiotics
chemical_list: D002097:C-Reactive Protein