Probiotics, Prebiotics, Synbiotics: Is There Enough Evidence to Support Their Use in Colorectal Cancer Surgery?

Abstract

Background/Aims: 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.

Efficacy of Using Probiotics with Antagonistic Activity against Pathogens of Wound Infections: An Integrative Review of Literature

“…It has been 15 years since the publication of the review by Howard and coauthors on the possible use of probiotics in surgical wound infections; however, not much has changed with regard to the traditional therapy of wound infections and more clinical evidence is still necessary for a paradigm shift in this area [117]. Several reviews on the use of probiotics for wounds in general or for specific conditions have been published [60,[118][119][120]; however, to the best of our knowledge, no systemic review specifically on the influence of probiotics against wound pathogens has been conducted. ere are also several reviews on the general effect of probiotics on healing after surgery [121][122][123]; however, our focus was on the antagonistic effect of probiotics.…”

Efficacy of perioperative synbiotics treatment for the prevention of surgical site infection after laparoscopic colorectal surgery: a randomized controlled trial

“…However, the evidence remains inconclusive, potentially due to differences in the patient groups, varying preparations of probiotics/synbiotics, and heterogeneity in the quality of methods [40][41][42]. Furthermore, the survival of the administered probiotic strains in the intestine, as well as their expected impact on gut microflora, was not fully examined in the previous studies.…”

Synbiotics, Surgical Infection and Colonization Resistance

“…Several randomized controlled trials, including pancreatoduodenectomy, hepatobiliary resection and liver transplantation, demonstrate that the use of probiotics in patients undergoing abdominal surgery is a promising approach to the prevention of post-operative infectious complications [8][9][10][11]. Nevertheless, the effectiveness of probiotics treatment for prevention of infectious complications after colorectal surgery remains inconclusive [1,3,[12][13][14][15][16][17][18][19][20][21], possibly due to differences in patient groups, varying preparations of probiotics, and heterogeneity in the quality of methods. Whether or not beneficial bacteria actually survive in the intestine also remains unclear.…”