Novel insight into the role of microbiota in colorectal surgery

Abstract

Recent literature undeniably supports the idea that the microbiota has a strong influence on the healing process of an intestinal anastomosis. Understanding the mechanisms by which the bacterial community of the gut influences intestinal healing could open the door for new preventive and therapeutic approaches. Among the different mechanisms, data have shown that the production of specific reactive oxygen species (ROS) and the activation of specific formyl peptide receptors (FPRs) regulate intestinal wound healing. Evidence suggests that specific gut microbes such as spp and help to regulate healing processes through both ROS-dependent and FPR-dependent mechanisms. In this review, we will discuss the current knowledge and future perspectives concerning the impact of microbiota on wound healing. We will further review available evidence on whether mechanical bowel preparation and the use of specific antibiotics are beneficial or harmful procedures, an ongoing matter of debate. These practices have a profound effect on the gut microbiota composition at the level of both the mucosal and the luminal compartments. Therefore, a key question remains unanswered: Current knowledge and data do not clearly support the use of one technique or another to avoid complications such as anastomotic leak. There is an urgent need for appropriate interventions with a deep microbiota analysis to investigate both the surgical technical benefits of a proper anastomosis compared with the potential effect of the gut microbes (beneficial vs harmful) on the processes of wound healing and anastomotic leakage reduction.

Efficacy of prophylactic probiotics in combination with antibiotics versus antibiotics alone for colorectal surgery: A meta‐analysis of randomized controlled trials

“…The gut microbiota is inhabited by hundreds of species of symbiotic microbes, which provides resistance against colonization and invasion of pathogens, modulates gut immunity, inhibits the inflammatory signaling pathways . Antibiotics or mechanical bowel preparation can damage the intestinal microbiota, impair barrier function and, paradoxically, increase the rate of bacterial translocation and infectious complications after surgery . Although overwhelming evidence shows that combination of antibiotics and mechanical bowel preparation effectively reduces SSI rate in colorectal surgery, the current review indicates a further reduction of SSI risk by 28% for the use of probiotics.…”

“…[61][62][63] Antibiotics or mechanical bowel preparation can damage the intestinal microbiota, impair barrier function and, paradoxically, increase the rate of bacterial translocation and infectious complications after surgery. 64,65 Although overwhelming evidence shows that combination of antibiotics and mechanical bowel preparation effectively reduces SSI rate in colorectal surgery, [66][67][68] the current review indicates a further reduction of SSI risk by 28% for the use of probiotics. Currently, it is difficult to comment on the mechanistic benefit of a prophylactic regimen using probiotics and there are a lot of factors to explore.…”

Preparing the Bowel for Surgery: Learning from the Past and Planning for the Future

“…For example, a recent report from Leeds, United Kingdom, has emphasized the need to recalibrate antibiotic prophylaxis for colon surgery as ever more resistant Enterobactericiae are found to be responsible for surgical site infections (31). Perhaps the time has come for surgeons to “hold court” and forge the path forward for the rational design of intestinal antisepsis protocols based on new understanding of the evolving microbiology of the alimentary tract in response to surgery (32). …”

Prognostic value of a combination of innovative factors (gut microbiota, sarcopenia, obesity, metabolic syndrome) to predict surgical/oncologic outcomes following surgery for sporadic colorectal cancer: a prospective cohort study protocol (METABIOTE)

“…In the same way, a recent clinical study by Gopalakrishnan et al revealed that the composition of the gut microbiota could affect the antitumorous responses to anti-PD-1 immunotherapy in patients with metastatic melanomas 26. Finally, gut microbiota has been recently linked to the occurrence of postoperative complications after colorectal surgery, especially AL 10 27. Bacterial induction of an oxidative stress, notably through the production of ROS and the activation of specific pathways regulating intestinal scarring, is also suspected to be involved in the genesis of these postoperative complications 12 28…”