scholarly journals The effects of preoperative intestinal dysbacteriosis on postoperative recovery in colorectal cancer surgery: a prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuwei Liu ◽  
Wanbin He ◽  
Jie Yang ◽  
Yuhua He ◽  
Ziqiang Wang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Anastomotic Leakage ◽  
Intestinal Microflora ◽  
Critical Role ◽  
Infectious Complications ◽  
Intestinal Microbiome ◽  
Considerable Proportion ◽  
Colorectal Cancer Surgery ◽  
Grade 3 ◽  
Intestinal Dysbacteriosis

Abstract Background Accumulating evidence suggests a critical role of intestinal dysbacteriosis in surgical site infections and anastomotic leakage after abdominal surgery. However, a direct correlation between pre-existing dysbacteriosis and postoperative infectious complications has not yet been established clinically. Methods A total of 353 consecutive patients who underwent colorectal cancer (CRC) surgery were enrolled. Gram-stained faecal smears were tested at admission and the first defecation after surgery. Intestinal dysbacteriosis was graded into three groups: normal or slightly decreased intestinal microflora (grade 1), moderate dysbacteriosis (grade 2), and severe dysbacteriosis (grade 3). Clinical outcomes were postoperative infections and anastomotic leakage within 30 days after surgery. Results At the preoperative assessment, 268 (75.9%) patients had normal or slightly decreased intestinal microflora, 58 (16.4%) patients had moderate dysbacteriosis, and 27 (7.6%) patients had severe dysbacteriosis. The patients with preoperative dysbacteriosis had a higher rate of early postoperative diarrhoea (grade 2: OR = 4.53, 95% CI 2.28–9.00, grade 3: OR = 4.52, 95% CI 1.81–11.31), total complications (grade 3 40.7% vs. grade 2 25.9% vs. grade 1 12.7%, P < 0.001), and anastomotic leakage (grade 3 11.1% vs. grade 2 5.2% vs. grade 1 1.5%, P = 0.002). An interaction effect among preoperative dysbacteriosis and early postoperative diarrhoea on total complications was observed in rectal cancer patients (P for interaction = 0.007). Conclusions An imbalance of the intestinal microbiome exists in a considerable proportion of CRC patients before surgery. Preoperative dysbacteriosis is associated with higher rates of early postoperative diarrhoea, which further correlates with infectious complications and anastomotic leakage. However, the contribution of preoperative dysbacteriosis to the occurrence of anastomotic leakage needs to be clarified in further studies. Trial registration ChiCTR, ChiCTR1800018755. Registered 8 October 2018—Retrospectively registered, http://www.chictr.org.cn/ChiCTR1800018755.

scholarly journals Early postoperative pain as a marker of anastomotic leakage in colorectal cancer surgery

2021 ◽  
Author(s):  
Petrus Boström ◽  
Johan Svensson ◽  
Camilla Brorsson ◽  
Martin Rutegård
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Pain ◽  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Population Based ◽  
Colorectal Cancer Surgery ◽  
Increased Risk ◽  
Independent Marker

Abstract Purpose Even though anastomotic leakage after colorectal surgery is a major clinical problem in need of a timely diagnosis, early indicators of leakage have been insufficiently studied. We therefore conducted a population-based observational study to determine whether the patient’s early postoperative pain is an independent marker of anastomotic leakage. Methods By combining the Swedish Colorectal Cancer Registry and the Swedish Perioperative Registry, we retrieved prospectively collected data on 3084 patients who underwent anastomotic colorectal surgery for cancer in 2014–2017. Postoperative pain, measured with the numerical rating scale (NRS), was considered exposure, while anastomotic leakage and reoperation due to leakage were outcomes. We performed logistic regression to evaluate associations, estimating odds ratios (ORs) and 95% confidence intervals (CIs), while multiple imputation was used to handle missing data. Results In total, 189 patients suffered from anastomotic leakage, of whom 121 patients also needed a reoperation due to leakage. Moderate or severe postoperative pain (NRS 4–10) was associated with an increased risk of anastomotic leakage (OR 1.69, 95% CI 1.21–2.38), as well as reoperation (OR 2.17, 95% CI 1.41–3.32). Severe pain (NRS 8–10) was more strongly related to leakage (OR 2.38, 95% CI 1.44–3.93). These associations were confirmed in multivariable analyses and when reoperation due to leakage was used as an outcome. Conclusion In this population-based retrospective study on prospectively collected data, increased pain in the post-anaesthesia care unit is an independent marker of anastomotic leakage, possibly indicating a need for further diagnostic measures.

scholarly journals The Effect of Perioperative Administration of Probiotics on Colorectal Cancer Surgery Outcomes

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1451
Author(s):  
Louise Pitsillides ◽  
Gianluca Pellino ◽  
Paris Tekkis ◽  
Christos Kontovounisios
Keyword(s):  
Colorectal Cancer ◽  
Perioperative Management ◽  
Single Species ◽  
Infectious Complications ◽  
Mucosal Permeability ◽  
Colorectal Cancer Surgery ◽  
Rate Analysis ◽  
Surgery Outcomes ◽  
Randomised Controlled

The perioperative care of colorectal cancer (CRC) patients includes antibiotics. Although antibiotics do provide a certain protection against infections, they do not eliminate them completely, and they do carry risks of microbial resistance and disruption of the microbiome. Probiotics can maintain the microbiome’s balance postoperatively by maintaining intestinal mucosal integrity and reducing bacterial translocation (BT). This review aims to assess the role of probiotics in the perioperative management of CRC patients. The outcomes were categorised into: postoperative infectious and non-infectious complications, BT rate analysis, and intestinal permeability assessment. Fifteen randomised controlled trials (RCTs) were included. There was a trend towards lower rates of postoperative infectious and non-infectious complications with probiotics versus placebo. Probiotics reduced BT, maintained intestinal mucosal permeability, and provided a better balance of beneficial to pathogenic microorganisms. Heterogeneity among RCTs was high. Factors that influence the effect of probiotics include the species used, using a combination vs. single species, the duration of administration, and the location of the bowel resection. Although this review provided evidence for how probiotics possibly operate and reported notable evidence that probiotics can lower rates of infections, heterogeneity was observed. In order to corroborate the findings, future RCTs should keep the aforementioned factors constant.

scholarly journals The Incidence and Mortality of Anastomotic Leakage after Colorectal Cancer Surgery

2017 ◽  
Vol 13 (3) ◽  
Author(s):  
Gabriel Popescu ◽  
Daniela Sala ◽  
Miana Gliga ◽  
Sergiu Ciulic ◽  
Radu Mircea Neagoe ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Anastomotic Leakage ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
Incidence And Mortality

Anastomotic leakage as an outcome measure for quality of colorectal cancer surgery

2013 ◽  
Vol 22 (9) ◽  
pp. 759-767 ◽  
Author(s):  
H S Snijders ◽  
D Henneman ◽  
N L van Leersum ◽  
M ten Berge ◽  
M Fiocco ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Anastomotic Leakage ◽  
Outcome Measure ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery

scholarly journals Role of the intestinal microbiome in colorectal cancer surgery outcomes

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Lelde Lauka ◽  
Elisa Reitano ◽  
Maria Clotilde Carra ◽  
Federica Gaiani ◽  
Paschalis Gavriilidis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Surgery ◽  
Intestinal Microbiome ◽  
Colorectal Cancer Surgery ◽  
Microbiome Composition ◽  
Cancer Specific Mortality ◽  
Surgery Outcomes ◽  
Disease Free

Abstract Objectives Growing evidence supports the role of the intestinal microbiome in the carcinogenesis of colorectal cancers, but its impact on colorectal cancer surgery outcomes is not clearly defined. This systematic review aimed to analyze the association between intestinal microbiome composition and postoperative complication and survival following colorectal cancer surgery. Methods A systematic review was conducted according to the 2009 PRISMA guidelines. Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, Cochrane Oral Health Group Specialized Register, ProQuest Dissertations and Theses Database, and Google Scholar. Human studies investigating the association between the intestinal microbiome and the short-term (anastomotic leakage, surgical site infection, postoperative ileus) and long-term outcomes (cancer-specific mortality, overall and disease-free survival) of colorectal cancer surgery were selected. Patients with any stage of colorectal cancer were included. The Newcastle-Ottawa scale for case-control and cohort studies was used for the quality assessment of the selected articles. Results Overall, 8 studies (7 cohort studies and 1 case-control) published between 2014 and 2018 were included. Only one study focused on short-term surgical outcomes, showing that anastomotic leakage is associated with low microbial diversity and abundance of Lachnospiraceae and Bacteroidaceae families in the non-cancerous resection lines of the stapled anastomoses of colorectal cancer patients. The other 7 studies focused on long-term oncological outcomes, including survival and cancer recurrence. The majority of the studies (5/8) found that a higher level of Fusobacterium nucleatum adherent to the tumor tissue is associated with worse oncological outcomes, in particular, increased cancer-specific mortality, decreased median and overall survival, disease-free and cancer-specific survival rates. Also a high abundance of Bacteroides fragilis was found to be linked to worse outcomes, whereas the relative abundance of the Prevotella-co-abundance group (CAG), the Bacteroides CAG, and the pathogen CAG as well as Faecalibacterium prausnitzii appeared to be associated with better survival. Conclusions Based on the limited available evidence, microbiome composition may be associated with colorectal cancer surgery outcomes. Further studies are needed to elucidate the role of the intestinal microbiome as a prognostic factor in colorectal cancer surgery and its possible clinical implications.

scholarly journals Treatment strategy and outcome of anastomotic leakage after left-sided colorectal cancer surgery –Non-surgical V.S. Surgical treatment–

2019 ◽  
Vol 27 (2) ◽  
pp. 90-94
Author(s):  
Shunsuke Imanishi ◽  
Hideaki Miyauchi ◽  
Michihiro Maruyama ◽  
Gaku Ohira ◽  
Tetsuro Maruyama ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Surgical Treatment ◽  
Anastomotic Leakage ◽  
Treatment Strategy ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery
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