Impact of mechanical bowel preparation on the gut microbiome of patients undergoing left-sided colorectal cancer surgery: randomized clinical trial.

IF 8.6 1区医学 Q1 SURGERY British Journal of Surgery Pub Date : 2024-08-30 DOI:10.1093/bjs/znae213

Kristina Žukauskaitė, Angela Horvath, Žilvinas Gricius, Mindaugas Kvietkauskas, Bernardas Baušys, Audrius Dulskas, Justas Kuliavas, Rimantas Baušys, Simona Rūta Letautienė, Ieva Vaicekauskaitė, Rasa Sabaliauskaitė, Augustinas Baušys, Vanessa Stadlbauer, Sonata Jarmalaitė

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Abstract

Background: Postoperative complications after colorectal cancer surgery have been linked to the gut microbiome. However, the impact of mechanical bowel preparation using oral preparation agents or rectal enema on postoperative infections remains poorly understood. This study aimed to compare the impact of oral preparation and rectal enema on the gut microbiome and postoperative complications.

Methods: This open-label pilot RCT was conducted at the National Cancer Institute, Vilnius, Lithuania. Patients with left-side colorectal cancer scheduled for elective resection with primary anastomosis were randomized 1 : 1 to preoperative mechanical bowel preparation with either oral preparation or rectal enema. Stool samples were collected before surgery, and on postoperative day 6 and 30 for 16S rRNA gene sequencing analysis. The primary outcome was difference in β-diversity between groups on postoperative day 6.

Results: Forty participants were randomized to oral preparation (20) or rectal enema (20). The two groups had similar changes in microbiome composition, and there was no difference in β-diversity on postoperative day 6. Postoperative infections occurred in 12 patients (32%), without differences between the study groups. Patients with infections had an increased abundance of bacteria from the Actinomycetaceae family, Actinomyces genus, Sutterella uncultured species, and Enterococcus faecalis species.

Conclusion: Mechanical bowel preparation with oral preparation or rectal enema resulted in similar dysbiosis. Patients who experienced postoperative infections exhibited distinct gut microbiome compositions on postoperative day 6, characterized by an increased abundance of bacteria from the Actinomycetaceae family, Actinomyces genus, Sutterella uncultured species, and Enterococcus faecalis species.

Registration number: NCT04013841 (http://www.clinicaltrials.gov).

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机械肠道准备对左侧结直肠癌手术患者肠道微生物组的影响：随机临床试验。

背景：结直肠癌手术后的并发症与肠道微生物群有关。然而，人们对使用口服制剂或直肠灌肠剂进行机械肠道准备对术后感染的影响仍知之甚少。本研究旨在比较口服制剂和直肠灌肠对肠道微生物组和术后并发症的影响：这项开放标签试验性 RCT 在立陶宛维尔纽斯国家癌症研究所进行。计划进行原位吻合择期切除术的左侧结直肠癌患者按照 1 : 1 的比例随机接受口服制剂或直肠灌肠的术前机械性肠道准备。术前、术后第 6 天和第 30 天采集粪便样本，进行 16S rRNA 基因测序分析。主要结果是术后第 6 天各组间 β 多样性的差异：结果：40 名参与者被随机分为口服制剂组（20 人）和直肠灌肠组（20 人）。两组的微生物群组成变化相似，术后第 6 天的β-多样性无差异。有 12 名患者（32%）发生了术后感染，研究组之间没有差异。感染患者体内放线菌科细菌、放线菌属细菌、未培养的沙特菌属细菌和粪肠球菌属细菌的数量有所增加：结论：使用口服制剂或直肠灌肠剂进行机械性肠道准备会导致类似的菌群失调。术后感染的患者在术后第 6 天表现出独特的肠道微生物组组成，其特点是放线菌科、放线菌属、未培养的 Sutterella 菌种和粪肠球菌菌种的数量增加：NCT04013841 (http://www.clinicaltrials.gov)。

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来源期刊

British Journal of Surgery 医学-外科

CiteScore

12.70

自引率

7.30%

发文量

1102

审稿时长

1.5 months

期刊介绍： The British Journal of Surgery (BJS), incorporating the European Journal of Surgery, stands as Europe's leading peer-reviewed surgical journal. It serves as an invaluable platform for presenting high-quality clinical and laboratory-based research across a wide range of surgical topics. In addition to providing a comprehensive coverage of traditional surgical practices, BJS also showcases emerging areas in the field, such as minimally invasive therapy and interventional radiology. While the journal appeals to general surgeons, it also holds relevance for specialty surgeons and professionals working in closely related fields. By presenting cutting-edge research and advancements, BJS aims to revolutionize the way surgical knowledge is shared and contribute to the ongoing progress of the surgical community.