Peri-operative or post-operative probiotics reduce treatment-related complications in adult colorectal cancer patients undergoing surgery: a systematic review and meta-analysis

Abstract

Purpose: Recent studies have investigated probiotics as a therapeutic approach for managing colorectal cancer treatment-related complications. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the efficacy and safety of probiotics in this population.Methods: MEDLINE, EMBASE, and Scopus were searched for RCTs comparing the use of peri-operative or post-operative probiotics with placebo in colorectal cancer patients undergoing surgery, with or without adjuvant therapy Results: We included 10 RCTs with 1,276 patients, of whom 639 (50.1%) received probiotics. The main outcome of diarrhea was significantly lower in the probiotic group (Odds Ratio [OR] 0.42; 95% CI 0.31 to 0.55; p < 0.001). There was also a significant decrease in the incidence of surgical site infection (OR 0.44; 95% CI 0.22 to 0.89; p = 0.023), urinary infection (OR 0.43; 95% CI 0.20 to 0.91; p=0.028), pulmonary infection (OR 0.30; 95% CI 0.15 to 0.60; p<0.001), abdominal distention (OR 0.43; 95% CI 0.25 to 0.76; p=0.004), length of ATB therapy (Mean Difference [MD] -1.66 days; 95% CI -2.13 days to -1.19 days; p < 0.001), and duration of postoperative pyrexia (MD -0.80 days; 95% CI -1.38 days to - 0.22 days; p=0.007) in the probiotic group. Nevertheless, length of hospital stay, time to first defecation, and time to first solid diet, were not different between groups. Conclusion: Our findings suggest that peri-operatory or post-operatory probiotics is effective for managing treatment-related complications in patients with colorectal cancer undergoing surgery, with a lower rate of adverse events.