Abstract
Simple SummaryThe microbial communities of the intestine exist in a delicate balance with the human. Colorectal cancer is one of the most common gastrointestinal malignancies, and the microbiota seems to be related to it. The intestinal microbiota of patients after colorectal surgery is changed due to surgical stress and other perioperative factors. The occurrence of complications after colorectal cancer (CRC) surgery may depend on these bacterial shifts, which could also be associated with prognosis and survival in postoperative CRC patients.The intestinal microbiota consists of numerous microbial species that collectively interact with the host, playing a crucial role in health and disease. Colorectal cancer is well-known to be related to dysbiotic alterations in intestinal microbiota. It is evident that the microbiota is significantly affected by colorectal surgery in combination with the various perioperative interventions, mainly mechanical bowel preparation and antibiotic prophylaxis. The altered postoperative composition of intestinal microbiota could lead to an enhanced virulence, proliferation of pathogens, and diminishment of beneficial microorganisms resulting in severe complications including anastomotic leakage and surgical site infections. Moreover, the intestinal microbiota could be utilized as a possible biomarker in predicting long-term outcomes after surgical CRC treatment. Understanding the underlying mechanisms of these interactions will further support the establishment of genomic mapping of intestinal microbiota in the management of patients undergoing CRC surgery.
Highlights
The human intestinal microbiota is a complex microbial ecosystem that maintains an intestinal homeostasis through constant synergistic interactions with the host [1]
These finding are in line with data from the Cochrane Database of Systematic Reviews, which suggest that mechanical bowel preparation (MBP) is not necessary in colorectal patients, since it does not decrease surgical site infections (SSI) rates unless MOAB
The results demonstrated a decreased abundance in obligate anaerobic bacteria, including members of Bacteroides, Bifidobacterium, Clostridium, and Prevotella, which are crucial for intestinal homeostasis [54], whereas pathogens such as Enterococcus, Pseudomonas, and Staphylococcus were enriched postoperatively
Summary
The human intestinal microbiota is a complex microbial ecosystem that maintains an intestinal homeostasis through constant synergistic interactions with the host [1]. Watanabe et al [20], in the first study that evaluated the impact of MBP on intestinal microbiota in patients undergoing CRC resection, reported decreased populations of Bifidobacteria, Clostridium coccoides, Clostridium leptum, Enterobacteriaceae, and Lactobacillus postoperatively, with no change in Enterococcus and Staphylococcus populations. These findings along with reduced levels of short-chain fatty acids (SCFAs) could result in impairment of the intestinal barrier, leading to bacterial translocation and possible infectious complications. Purging leads to a less anaerobic microenvironment through the introduction of oxygen into the colon in addition to increased pH due to the diminishment of SCFAs, which are events that are especially responsible for the increased abundance of Proteobacteria [25]
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