Prophylactic effects of probiotics or synbiotics on postoperative ileus after gastrointestinal cancer surgery: A meta-analysis of randomized controlled trials

Abstract

Background Postoperative ileus is a major problem following gastrointestinal cancers surgery, several randomized controlled trials have been conducted investigating the use of probiotics or synbiotics to reduce postoperative ileus, but their findings are controversial. Objective We conducted a meta-analysis to determine the effect of probiotics or synbiotics on early postoperative recovery of gastrointestinal function in patients with gastrointestinal cancer. Methods The Embase, Cochrane Library, PubMed, and Web of Science databases were comprehensively searched for randomized controlled trials (RCTs) that evaluated the effects of probiotics or synbiotics on postoperative recovery of gastrointestinal function as of April 27, 2021. Outcomes included the time to first flatus, time to first defecation, days to first solid diet, days to first fluid diet, length of postoperative hospital stay, incidence of abdominal distension and incidence of postoperative ileus. The results were reported as the mean difference (MD) and relative risk (RR) with 95% confidence intervals (CI). Results A total of 21 RCTs, involving 1776 participants, were included. Compared with the control group, probiotic and synbiotic supplementation resulted in a shorter first flatus (MD, -0.53 days), first defecation (MD, -0.78 days), first solid diet (MD, -0.25 days), first fluid diet (MD, -0.29 days) and postoperative hospital stay (MD, -1.43 days). Furthermore, Probiotic and synbiotic supplementation reduced the incidence of abdominal distension (RR, 0.62) and incidence of postoperative ileus (RR, 0.47). Conclusion Perioperative supplementation of probiotics or synbiotics can effectively promote the recovery of gastrointestinal function after gastrointestinal cancer surgery.

Why Give My Surgical Patients Probiotics

“…Gastrointestinal motility, as the core part of the accelerated recovery of patients undergoing gastrointestinal surgery, has important clinical significance and has received close attention from surgeons [ 35 ]. A delayed recovery of gastrointestinal function after surgery, namely, postoperative ileus, with the clinical manifestations of abdominal distension and pain, sometimes delayed gastric emptying and vomiting, and gastrointestinal dysmotility with delayed passing of first flatus and defecation, eventually leading to the prolongation of hospital stay and even increased morbidity [ 36 , 37 ].…”

“…Then, the inflammatory phase follows, with the release of a large number of inflammatory mediators, such as interleukin-6, interleukin-1, monocyte chemoattractant protein-1 and cell adhesion molecule-1, which damage intestinal muscles and further inhibit the recovery of gastrointestinal function. Last, but not least, anesthesia and the pharmacological interventions thereafter, mainly opioids often used as analgesics, have a major impact by means of activation of μ-opioid receptors, which in turn inhibit acetylcholine release from myenteric fibers [ 35 , 38 , 39 ].…”

“…The most recent meta-analysis, in 2022, based on 21 RCTs involving 1776 participants focused exclusively on the effect of peri-operatively given probiotics (or synbiotics) on the early postoperative recovery of gastrointestinal function. Compared to the control group, they reduced the incidence of abdominal distension and of postoperative ileus, and resulted in a shorter time to first flatus (MD, −0.53 days), first defecation (MD, −0.78 days), first fluid (MD, −0.29 days) and first solid diet (MD, −0.25 days), as well as a reduction in the length of postoperative hospital stay (MD, −1.43 days) [ 35 ].…”

Probiotics enhances anti‐tumor immune response induced by gemcitabine plus cisplatin chemotherapy for urothelial cancer

“…Meta‐analyses and systematic reviews have revealed that gut dysbiosis is closely related to human health, chemotherapy‐related side effects, and surgery‐related complications and diseases 12–14 . In this study, we investigated the effects of systemic chemotherapy with GC on the gut microbiome.…”

“…Meta‐analyses and systematic reviews have revealed that gut dysbiosis is closely related to human health, chemotherapy‐related side effects, and surgery‐related complications and diseases. 12 , 13 , 14 In this study, we investigated the effects of systemic chemotherapy with GC on the gut microbiome. We hypothesized a potential link between chemotherapy‐induced gut dysbiosis and decreased anti‐tumor immunity, driving us to explore novel interventions for targeted microbiome modulation by supplementing with probiotics, prebiotics, and synbiotics to retain anti‐tumor immunity.…”