Gastroenterology and hepatology from bed to bench · 2026
The role of probiotics in modulating complications and intestinal barrier integrity after colorectal cancer surgery: a systematic review and meta-analysis of clinical trials.
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Kiarsi Armaghan, Salehi Mohammadreza, Jameie Melika, Zareie Shab Khaneh Amirali
Аннотация
AIM: This systematic review and meta-analysis evaluated the impact of probiotics on postoperative complications and intestinal barrier integrity markers in patients with colorectal cancer (CRC) undergoing surgery.
BACKGROUND: Postoperative complications pose a substantial challenge in CRC. Probiotics have been shown to alleviate these complications through various mechanisms, including improving intestinal barrier integrity.
METHODS: Following PRISMA guidelines, a systematic search was conducted in MEDLINE, Web of Science, Cochrane Library, and Scopus up to February 1, 2026, to identify randomized controlled trials (RCTs) investigating the effects of probiotics on post-surgical complications, recovery parameters, and functional intestinal barrier biomarkers (lactulose/mannitol [L/M] ratio and transepithelial electrical resistance [TER]). Statistical analysis was performed using random-effects models in R. Effect sizes were expressed as risk differences (RD) for binary outcomes and standardized mean differences (SMD) for continuous outcomes. Heterogeneity was assessed using Cochran's Q and I² statistics (PROSPERO: CRD420251172153).
RESULTS: Eleven RCTs involving 1,234 CRC patients were included. Probiotic supplementation significantly reduced the risk of septicemia (RD=-0.158, p=0.029), surgical site infection (RD=-0.060, p=0.024), respiratory tract infection (RD=-0.079, p<0.001), central line infection (RD=-0.096, p=0.007), diarrhea (RD=-0.137, p=0.005), and abdominal distension (RD=-0.172, p=0.005). Functional intestinal barrier markers were significantly improved, evidenced by a decreased L/M ratio (SMD=-1.78, p=0.018) and increased TER (SMD=1.10, p<0.001). Furthermore, the duration of postoperative antibiotic use was significantly shortened (SMD=-0.45, p=0.001). No significant differences were observed for bacteremia, abscess, urinary infection, ileus, anastomotic leak, pyrexia, or hospital stay (p>0.05). Sensitivity analyses showed outcome variability, and substantial heterogeneity existed for pyrexia, septicemia, ileus, and the L/M ratio.
CONCLUSION: Probiotics reduced the risk of specific infectious and gastrointestinal complications and enhanced intestinal barrier function after CRC surgery, highlighting their potential as a safe and effective adjunct to improve postoperative outcomes.
BACKGROUND: Postoperative complications pose a substantial challenge in CRC. Probiotics have been shown to alleviate these complications through various mechanisms, including improving intestinal barrier integrity.
METHODS: Following PRISMA guidelines, a systematic search was conducted in MEDLINE, Web of Science, Cochrane Library, and Scopus up to February 1, 2026, to identify randomized controlled trials (RCTs) investigating the effects of probiotics on post-surgical complications, recovery parameters, and functional intestinal barrier biomarkers (lactulose/mannitol [L/M] ratio and transepithelial electrical resistance [TER]). Statistical analysis was performed using random-effects models in R. Effect sizes were expressed as risk differences (RD) for binary outcomes and standardized mean differences (SMD) for continuous outcomes. Heterogeneity was assessed using Cochran's Q and I² statistics (PROSPERO: CRD420251172153).
RESULTS: Eleven RCTs involving 1,234 CRC patients were included. Probiotic supplementation significantly reduced the risk of septicemia (RD=-0.158, p=0.029), surgical site infection (RD=-0.060, p=0.024), respiratory tract infection (RD=-0.079, p<0.001), central line infection (RD=-0.096, p=0.007), diarrhea (RD=-0.137, p=0.005), and abdominal distension (RD=-0.172, p=0.005). Functional intestinal barrier markers were significantly improved, evidenced by a decreased L/M ratio (SMD=-1.78, p=0.018) and increased TER (SMD=1.10, p<0.001). Furthermore, the duration of postoperative antibiotic use was significantly shortened (SMD=-0.45, p=0.001). No significant differences were observed for bacteremia, abscess, urinary infection, ileus, anastomotic leak, pyrexia, or hospital stay (p>0.05). Sensitivity analyses showed outcome variability, and substantial heterogeneity existed for pyrexia, septicemia, ileus, and the L/M ratio.
CONCLUSION: Probiotics reduced the risk of specific infectious and gastrointestinal complications and enhanced intestinal barrier function after CRC surgery, highlighting their potential as a safe and effective adjunct to improve postoperative outcomes.