Routine preoperative mechanical bowel preparation with additive oral antibiotics is associated with a reduced risk of anastomotic leakage in patients undergoing elective oncologic resection for colorectal cancer

Abstract

BackgroundAnastomotic leakage (AL) following colorectal resection is a serious issue. AL in oncologic patients might negatively affect the overall survival. Recently, mechanical bowel preparation with additive oral antibiotics (MBP + AB) prior to surgery has been suggested as a means of reducing AL. However, it is unclear whether this positive effect is secondary to MBP alone or secondary to the additive oral antibiotic (MBP + AB). The aim of this study was to investigate the effect of mechanical bowel preparation with additive oral antibiotics (MBP + AB) and without additive oral antibiotics (MBP − AB) on the rate of AL following colorectal resection for cancer.Materials and methodsPatients undergoing surgical management for colorectal cancer with anastomosis from January 2014 till September 2017 were included for analysis. Cases undergoing MBP + AB were included in the study group. Patients undergoing MBP − AB were included in the control group. Both groups were compared with regard to the rate of AL.ResultsFour hundred and ninety-six patients: 125 undergoing MBP + AB and 371 undergoing MBP – AB were included for analysis. Significantly, more male patients were included in the MBP – AB group compared to the MBP + AB group: 60.1% vs. 45.6% respectively (p = 0.03). Both groups were similar with regard to age distribution and clinicopathological findings (p > 0.05). The rate of AL was significantly higher in the control group (MBP − AB) compared to study group (MBP + AB) (9.1% vs. 4.0%, p = 0.03).ConclusionMechanical bowel preparation with additive oral antibiotics prior to elective colorectal resection with anastomosis significantly reduces the risk of AL. Therefore, mechanical bowel preparation with additive non-absorbable oral antibiotics should be recommended in all cases prior to elective colorectal surgery.

Preoperative Risk Factors for Anastomotic Leaks in Colorectal Surgery

“…The effectiveness of MBP with additive OA was confirmed. In conclusion, they recommended mechanical bowel preparation with additive non-absorbable oral antibiotics in preoperative period for elective colorectal surgery [33]. .035; open multivariable adjusted OR=0.3 (0.12-0.77), P=0.012).…”

“…MBP is performed before colorectal surgery to reduce massive bowel contents, which can be a source of colorectal AL and bacterial pathogens. Many studies have supported combined MBP and OA prior to planned colorectal surgery [32,33].…”

“…496 patients undergoing colorectal surgery with anastomosis were included for analysis in the study of Ambe et al (2019). Cases undergoing MBP + OA were included in the study group, patients undergoing MBP -OA were included in the control group.…”

Intestinal Microbiota in Colorectal Cancer Surgery

“…The oral antibiotics were reintroduced in the context of MOAB, with studies demonstrating a postoperative reduction of AL following colectomy to almost 50% [42]. A more recent clinical trial further confirmed that the usage of MOAB significantly decreases AL rates in patients after CRC surgery [9]. Opioids used in perioperative analgesia, such as morphine, have been demonstrated to promote the adherence of collagenolytic E. faecalis to the anastomotic site, leading to AL in rats [98].…”

“…The concept of MBP has long been a standard practice in colorectal surgery, as it offers numerous advantages such as allowing a more feasible colonic manipulation and facilitating the detection of small colorectal tumors via palpation [ 9 ]. However, many studies that focus on the clinical value of MBP have reported that MBP does not prevent any postoperative surgical complications related to infection, possibly aggravating these adverse effects [ 10 , 11 ].…”