Preoperative probiotics decrease postoperative infectious complications of colorectal cancer.

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

Methods: 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.

Results: 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.

Conclusion: 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.