Abstract
BackgroundColorectal 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.Methods150 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.ResultsThe 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).ConclusionPerioperative 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 registrationChiCTR-TRC-12002841. 2012/12/21Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-015-0260-z) contains supplementary material, which is available to authorized users.
Highlights
Colorectal liver metastases (CLM) occur frequently and postoperative intestinal infection is a common complication
As liver barrier may have an impact on the incidence of postoperative liver complications, we proposed the hypothesis that pre- and postoperative PRO may reduce liver permeability, decrease the rate of bacterial translocation (BT) and infectious complications after CLM surgery. we aimed to investigate the effects of the perioperative administration of PRO on serum zonulin levels, liver permeability and the subsequent impact on postoperative liver complications in patients undergoing CLM
Inclusion and exclusion criteria Inclusion criteria in our study included: 1) age between 25 and 75 years; 2) the diagnosis of colorectal cancer (CRC) were confirmed by biopsy and histological testing, liver metastases were diagnosed by CT preoperatively and confirmed by postoperative histological report; 3) patients underwent a radical resection of primary colorectal tumors and liver metastases; and 4) they had no other metastasis
Summary
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. Because morbidity and mortality of colorectal cancer (CRC) increased year by year, CRC has been ranked as the second cause of tumor death around the world [3] and liver is the most common site of metastases of CRC [4,5,6]. The incidence of postoperative infectious complications are becoming more and more common [10,11] These complications may lead to higher rates of recurrence and death [12,13,14,15]
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