The effects of preoperative intestinal dysbacteriosis on postoperative recovery in colorectal cancer surgery: a prospective cohort study

Yuwei Liu,Jie Yang,Ka Li,Yuhua He,Wanbin He,Ziqiang Wang

doi:10.1186/s12876-021-02035-6

Abstract

BackgroundAccumulating evidence suggests a critical role of intestinal dysbacteriosis in surgical site infections and anastomotic leakage after abdominal surgery. However, a direct correlation between pre-existing dysbacteriosis and postoperative infectious complications has not yet been established clinically.MethodsA total of 353 consecutive patients who underwent colorectal cancer (CRC) surgery were enrolled. Gram-stained faecal smears were tested at admission and the first defecation after surgery. Intestinal dysbacteriosis was graded into three groups: normal or slightly decreased intestinal microflora (grade 1), moderate dysbacteriosis (grade 2), and severe dysbacteriosis (grade 3). Clinical outcomes were postoperative infections and anastomotic leakage within 30 days after surgery.ResultsAt the preoperative assessment, 268 (75.9%) patients had normal or slightly decreased intestinal microflora, 58 (16.4%) patients had moderate dysbacteriosis, and 27 (7.6%) patients had severe dysbacteriosis. The patients with preoperative dysbacteriosis had a higher rate of early postoperative diarrhoea (grade 2: OR = 4.53, 95% CI 2.28–9.00, grade 3: OR = 4.52, 95% CI 1.81–11.31), total complications (grade 3 40.7% vs. grade 2 25.9% vs. grade 1 12.7%, P < 0.001), and anastomotic leakage (grade 3 11.1% vs. grade 2 5.2% vs. grade 1 1.5%, P = 0.002). An interaction effect among preoperative dysbacteriosis and early postoperative diarrhoea on total complications was observed in rectal cancer patients (P for interaction = 0.007).ConclusionsAn imbalance of the intestinal microbiome exists in a considerable proportion of CRC patients before surgery. Preoperative dysbacteriosis is associated with higher rates of early postoperative diarrhoea, which further correlates with infectious complications and anastomotic leakage. However, the contribution of preoperative dysbacteriosis to the occurrence of anastomotic leakage needs to be clarified in further studies.Trial registration ChiCTR, ChiCTR1800018755. Registered 8 October 2018—Retrospectively registered, http://www.chictr.org.cn/ChiCTR1800018755.

Highlights

Accumulating evidence suggests a critical role of intestinal dysbacteriosis in surgical site infections and anastomotic leakage after abdominal surgery
There may be a slight bias in the subjective classification judgement, but the consistency of two stool smears in the diagnosis of dysbacteriosis reached an acceptable level of 90% (18/20), with a kappa coefficient of 0.806 (P < 0.001)
Risk factors for early postoperative diarrhoea Since our results showed that early postoperative diarrhoea was a risk factor for predicting postoperative complications, we further investigated the correlation between preoperative dysbacteriosis and early postoperative diarrhoea

Summary

Introduction

Accumulating evidence suggests a critical role of intestinal dysbacteriosis in surgical site infections and anastomotic leakage after abdominal surgery. Anastomotic leakage remains one of the most severe complications after surgery [4], leading to prolonged hospitalization [5], compromised quality of life, and increased mortality [6]. These complications were associated with increased healthcare expenditure [7]. Ralls et al [12] found that a low level of enteric microbial diversity correlated strongly with a higher incidence of postoperative infections and anastomotic disruption in paediatric and adult patients who underwent small intestinal resection. Animal studies demonstrated that Pseudomonas aeruginosa [13] and Enterococcus fecalis [14], commensal bacteria of the intestine, could transform into tissue destroying phenotypes, and cause anastomotic leakage by degrading collagen at the anastomosis

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Conclusion