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Randomized Controlled Trial
. 2015 Mar 20:15:34.
doi: 10.1186/s12876-015-0260-z.

Positive regulatory effects of perioperative probiotic treatment on postoperative liver complications after colorectal liver metastases surgery: a double-center and double-blind randomized clinical trial

Zhihua Liu  1   2 , Chao Li  3 , Meijin Huang  4 , Chao Tong  5 , Xingwei Zhang  6 , Lei Wang  7 , Hui Peng  8 , Ping Lan  9 , Peng Zhang  10 , Nanqi Huang  11 , Junsheng Peng  12 , Xiaojian Wu  13 , Yanxing Luo  14 , Huanlong Qin  15 , Liang Kang  16 , Jianping Wang  17
Affiliations
Randomized Controlled Trial

Positive regulatory effects of perioperative probiotic treatment on postoperative liver complications after colorectal liver metastases surgery: a double-center and double-blind randomized clinical trial

Zhihua Liu et al. BMC Gastroenterol. .

Abstract

Background: Colorectal liver metastases (CLM) occur frequently and postoperative intestinal infection is a common complication. Our previous study showed that probiotics could decrease the rate of infectious complications after colectomy for colorectal cancer. To determine the effects of the perioperative administration of probiotics on serum zonulin levels which is a marker of intestinal permeability and the subsequent impact on postoperative infectious complications in patients with CLM.

Methods: 150 patients with CLM were randomly divided into control group (n = 68) and probiotics group (n = 66). Probiotics and placebo were given orally for 6 days preoperatively and 10 days postoperatively to control group and probiotics group respectively. We used the local resection for metastatic tumor ,while for large tumor, the segmental hepatectomy. Postoperative outcome were recorded. Furthermore, complications in patients with normal intestinal barrier function and the relation with serum zonulin were analyzed to evaluate the impact on the liver barrier dysfunction.

Results: The incidence of infectious complications in the probiotics group was lower than control group. Analysis of CLM patients with normal postoperative intestinal barrier function paralleled with the serum zonulin level. And probiotics could also reduce the concentration of serum zonulin (P = 0.004) and plasma endotoxin (P < 0.001).

Conclusion: Perioperative probiotics treatment could reduce the serum zonulin level, the rate of postoperative septicemia and maintain the liver barrier in patients undergoing CLM surgery. we propose a new model about the regulation of probiotics to liver barrier via clinical regulatory pathway. We recommend the preoperative oral intake of probiotics combined with postoperative continued probiotics treatment in patients who undergo CLM surgery.

Trial registration: ChiCTR-TRC- 12002841 . 2012/12/21.

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Figures

Figure 1
Figure 1
Flow chart of the randomization procedure used to enroll patients in the study.
Figure 2
Figure 2
Probiotics lowered the postoperative bacterial translocation and endotoxin (Intention-to-treat analysis). PRO effectively decreased the plasma concentration of endotoxin in patients of colorectal liver metastases with normal postoperative intestinal barrier function, compared with the control group (n = 30 for control group and n = 30 for PRO group). Black bar represents the control group, and gray bar represents the PRO group. * (Control) vs. Preoperative, P < 0.05; # (PRO) vs. Preoperative, P < 0.05; * vs. #, P < 0.05. Numerical data are expressed as the means ± standard deviation, and compared by the t-test between groups. Plasma endotoxin was determined preoperatively (hospital admission day), and postoperatively (10 d treatment after surgery).
Figure 3
Figure 3
Schematic diagram for the clinical regulatory pathway of probiotics.
See this image and copyright information in PMC

References

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