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Background and Objective: The gastrointestinal microflora is involved in the development and regulation of the immune response. Non-pathogenic bacteria are important to prevent the development and subsequent invasion of enteropathogenic bacteria. Surgical trauma and intestinal preparation can disrupt the intestinal microbiota balance. Modulating the microbiota in the preoperative period in patients with colorectal cancer may have an impact in the occurrence of postoperative complications. The objective of this study is to assess the impact of preoperative synbiotic administration in patients with colorectal cancer subjected to colorectal resection.
Methods: A prospective, randomized, double-blind, placebo-controlled study of 73 colorectal cancer patients. Eight days before surgery, patients were randomized to receive either synbiotics (Simbioflora®) or placebo (maltodextrin). The envelopes were identical and labeled A or B. All patients underwent nutritional assessment, measurements of C-reactive protein (CRP), interleukin-6 (IL-6), serum albumin and transferrin. Patients were given a diluted envelope in 100 ml of water twice daily for 7 days. The occurrence of infectious or non-infectious complications, time of antibiotic use, duration of hospitalization and occurrence of deaths were recorded for 30 days postoperatively.
Results: Mean age, demographic data and tumor staging were similar between the groups at baseline. After 7 days of synbiotic intake there were significant reductions in IL-6 levels (163.2 ± 19.5 vs. 138.8 ± 12.5, p <0.001) and CRP (10.0 ± 5.2 vs 7.17 ± 3.2, p <0.001), whereas the control group did not present significant changes (IL-6: 154.2 ± 18.3 vs. 160.9 ± 18.6, NS and CRP:10.6 ± 6.18 vs 10.4 ± 6.1, NS). Serum albumin and transferrin did not show significant changes. Postoperative infectious complications occurred in 2.8% of patients in the synbiotic group and in 18,9% in the control group (p=0.02). The mean antibiotic usage time was 1.42 ± 0.5 days in the synbiotic group and 3.74 ± 4.3 days in the control group (p <0.001). The mean length of hospital stay was 3.0 ± 1.0 days in the synbiotic group and 4.0 ± 18 in the control group (p <0.001). There were 3 deaths in the control group and no mortality in the synbiotic group (p = 0.115).
Conclusions: The use of synbiotics for 7 days preoperatively in patients with colorectal cancer attenuates the inflammatory state and is associated with reduced morbidity, length of hospital stay and use of antibiotics.
Camila Brandão Polakowski
Camila Brandão Polakowski
Camila Brandão Polakowski,Massakazu Kato,Vinicius Basso Preti,Maria Eliana Madalozzo Schieferdecker,Antonio Carlos Ligocki Campos