Preoperative Probiotics Decrease Postoperative Infectious Complications of Colorectal Cancer



      The objective is to elucidate the effects of oral bifid triple viable probiotics among patients with colorectal cancer.


      Sixty patients undergoing radical colorectal resection were randomly assigned to 3-day (days −5 to −3) preoperative probiotics (group A, n=30) or placebo (group B, n=30) treatment. The alteration of intestinal flora was evaluated by fecal cultures of Escherichia coli, Bifidobacterium longum and intestinal fungi; the gut barrier function by serum endotoxins and D-lactic acids and the immune and stress responses by peripheral blood immunoglobins, interleukin-6 and C-reactive protein. Postoperative infections were documented physically, radiologically and microbiologically.


      Inverted Bifidobacterium/Escherichia ratios were preoperatively and postoperatively present in group B (both P<0.05). Bifidobacterium counts increased significantly, whereas Escherichia counts decreased significantly on postoperative days 3 to 5 (P<0.05), along with reversing the Bifidobacterium/Escherichia ratio inversion until postoperative days 3 to 5 in group A. Group A also had lower levels of endotoxins, D-lactic acids, serum interleukin-6 and C-reactive protein but higher levels of serum IgG and sIgA (all P<0.05) than group B. The incidences of postoperative infectious complications were 3.3% to 6.7% and 3.3% to 30% in groups A and B (overall, 10.0% versus 33.3%, P<0.05), respectively.


      The preoperative oral bifid triple viable probiotics minimize the postoperative occurrence of infectious complications, with possible mechanisms attributed to the maintenance of the intestinal flora and restriction of bacterial translocation from the intestine. It was representative of the enhancement of systemic/localized immunity and concurrent attenuation of systemic stress response.

      Key Indexing Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of the Medical Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jemal A.
        • Siegel R.
        • Ward E.
        • et al.
        Cancer statistics, 2009.
        CA Cancer J Clin. 2009; 59: 225-249
        • Li M.
        • Gu J.
        Changing patterns of colorectal cancer in China over a period of 20 years.
        World J Gastroenterol. 2005; 11: 4685-4688
        • Tang R.
        • Chen H.H.
        • Wang Y.L.
        • et al.
        Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients.
        Ann Surg. 2001; 234: 181-189
        • Konishi T.
        • Watanabe T.
        • Kishimoto J.
        • et al.
        Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance.
        Ann Surg. 2006; 244: 758-763
        • Tsujimoto H.
        • Ichikura T.
        • Ono S.
        • et al.
        Impact of postoperative infection on long-term survival after potentially curative resection for gastric cancer.
        Ann Surg Oncol. 2009; 16: 311-318
        • Besselink M.G.
        • Timmerman H.M.
        • van Minnen L.P.
        • et al.
        Prevention of infectious complications in surgical patients: potential role of probiotics.
        Dig Surg. 2005; 22: 234-244
        • Kinross J.
        • von Roon A.C.
        • Penney N.
        • et al.
        The gut microbiota as a target for improved surgical outcome and improved patient care.
        Curr Pharm Des. 2009; 15: 1537-1545
        • Mai V.
        • Morris Jr, J.G.
        Colonic bacterial flora: changing understandings in the molecular age.
        J Nutr. 2004; 134: 459-464
        • Si J.M.
        • Yu Y.C.
        • Fan Y.J.
        • et al.
        Intestinal microecology and quality of life in irritable bowel syndrome patients.
        World J Gastroenterol. 2004; 10: 1802-1805
        • Wu Z.
        • Li L.
        • Ma W.
        • et al.
        [Study on the intestinal microbial colonization resistance in patients with chronic severe hepatitis].
        Zhonghua Gan Zang Bing Za Zhi. 2001; 9: 329-330
        • Guarner F.
        • Malagelada J.R.
        Gut flora in health and disease.
        Lancet. 2003; 361: 512-519
        • Fooks L.J.
        • Gibson G.R.
        Probiotics as modulators of the gut flora.
        Br J Nutr. 2002; 88: S39-49
        • Limdi J.K.
        • O’Neill C.
        • McLaughlin J.
        Do probiotics have a therapeutic role in gastroenterology?.
        World J Gastroenterol. 2006; 12: 5447-5457
        • Preidis G.A.
        • Versalovic J.
        Targeting the human microbiome with antibiotics, probiotics, and prebiotics: gastroenterology enters the metagenomics era.
        Gastroenterology. 2009; 136: 2015-2031
        • Sugawara G.
        • Nagino M.
        • Nishio H.
        • et al.
        Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized controlled trial.
        Ann Surg. 2006; 244: 706-714
        • Kinross J.
        • Warren O.
        • Silk D.
        • et al.
        Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized control trial.
        Ann Surg. 2007; 245: 1000
        • Reddy B.S.
        • Macfie J.
        • Gatt M.
        • et al.
        Randomized clinical trial of effect of synbiotics, neomycin and mechanical bowel preparation on intestinal barrier function in patients undergoing colectomy.
        Br J Surg. 2007; 94: 546-554
        • Anderson A.D.
        • McNaught C.E.
        • Jain P.K.
        • et al.
        Randomised clinical trial of synbiotic therapy in elective surgical patients.
        Gut. 2004; 53: 241-245
        • Gianotti L.
        • Morelli L.
        • Galbiati F.
        • et al.
        A randomized double-blind trial on perioperative administration of probiotics in colorectal cancer patients.
        World J Gastroenterol. 2010; 16: 167-175
        • Ohishi A.
        • Takahashi S.
        • Ito Y.
        • et al.
        Bifidobacterium septicemia associated with postoperative probiotic therapy in a neonate with omphalocele.
        J Pediatr. 2010; 156: 679-681
        • Horvat M.
        • Krebs B.
        • Potrc S.
        • et al.
        Preoperative synbiotic bowel conditioning for elective colorectal surgery.
        Wien Klin Wochenschr. 2011; 122: 26-30
        • Liu Z.
        • Qin H.
        • Yang Z.
        • et al.
        Randomised clinical trial: the effects of perioperative probiotic treatment on barrier function and post-operative infectious complications in colorectal cancer surgery—a double-blind study.
        Aliment Pharmacol Ther. 2011; 33: 50-63
        • de Vrese M.
        • Schrezenmeir J.
        Probiotics, prebiotics, and synbiotics.
        Adv Biochem Eng Biotechnol. 2008; 111: 1-66
        • Eguchi S.
        • Takatsuki M.
        • Hidaka M.
        • et al.
        Perioperative synbiotic treatment to prevent infectious complications in patients after elective living donor liver transplantation: a prospective randomized study.
        Am J Surg. 2011; 201: 498-502
        • Pitsouni E.
        • Alexiou V.
        • Saridakis V.
        • et al.
        Does the use of probiotics/synbiotics prevent postoperative infections in patients undergoing abdominal surgery? A meta-analysis of randomized controlled trials.
        Eur J Clin Pharmacol. 2009; 65: 561-570
        • Zuccotti G.V.
        • Meneghin F.
        • Raimondi C.
        • et al.
        Probiotics in clinical practice: an overview.
        J Int Med Res. 2008; 36: 1A-53A
        • Lee Y.K.
        • Nomoto K.
        • Salminen S.
        • et al.
        Handbook of probiotics. Wiley-Interscience, New York1999: 4-6
        • Marteau P.
        • Minekus M.
        • Havenaar R.
        • et al.
        Survival of lactic acid bacteria in a dynamic model of the stomach and small intestine: validation and the effects of bile.
        J Dairy Sci. 1997; 80: 1031-1037
        • Massi M.
        • Vitali B.
        • Federici F.
        • et al.
        Identification method based on PCR combined with automated ribotyping for tracking probiotic Lactobacillus strains colonizing the human gut and vagina.
        J Appl Microbiol. 2004; 96: 777-786
        • O’Sullivan D.J.
        • Kullen M.J.
        Tracking of probiotic bifidobacteria in the intestine.
        Int Dairy J. 1998; 8: 513-525
        • Vaughan E.E.
        • Heilig H.G.
        • Ben-Amor K.
        • et al.
        Diversity, vitality and activities of intestinal lactic acid bacteria and bifidobacteria assessed by molecular approaches.
        FEMS Microbiol Rev. 2005; 29: 477-490
        • Fedorak R.N.
        • Madsen K.L.
        Probiotics and prebiotics in gastrointestinal disorders.
        Curr Opin Gastroenterol. 2004; 20: 146-155
        • Duggan C.
        • Gannon J.
        • Walker W.A.
        Protective nutrients and functional foods for the gastrointestinal tract.
        Am J Clin Nutr. 2002; 75: 789-808
        • van Santvoort H.C.
        • Besselink M.G.
        • Timmerman H.M.
        • et al.
        Probiotics in surgery.
        Surgery. 2008; 143: 1-7
        • Hooper L.V.
        • Gordon J.I.
        Commensal host-bacterial relationships in the gut.
        Science. 2001; 292: 1115-1118