Perioperative Synbiotic Treatment to Prevent Postoperative Infectious Complications in Biliary Cancer Surgery

TLDR

Synbiotics are known to benefit human health, yet their clinical value in surgical patients remains uncertain. This study aimed to assess the effect of perioperative oral synbiotics on intestinal barrier integrity, immune and inflammatory responses, gut microbiota, and surgical outcomes in high‑risk hepatobiliary resection. Patients with biliary cancer were randomized to receive either postoperative enteral feeding with synbiotics (group A) or pre‑ and postoperative synbiotics (group B); intestinal permeability (L/M ratio), serum DAO, NK cell activity, IL‑6, fecal microflora, and organic acids were measured before and after hepatectomy, and postoperative infections were recorded. Group B showed increased preoperative NK activity and lymphocytes, reduced IL‑6, lower postoperative IL‑6, WBC, and CRP, higher fecal bifidobacteria and organic acids, and a significantly lower postoperative infection rate (12.1 % vs 30 %), indicating that perioperative synbiotics improve immune function, reduce inflammation, and lower infection risk after hepatobiliary surgery.

Abstract

Use of synbiotics has been reported to benefit human health, but clinical value in surgical patients remains unclear.To investigate the effect of perioperative oral administration of synbiotics upon intestinal barrier function, immune responses, systemic inflammatory responses, microflora, and surgical outcome in patients undergoing high-risk hepatobiliary resection.Patients with biliary cancer involving the hepatic hilus (n = 101) were randomized before hepatectomy, into a group receiving postoperative enteral feeding with synbiotics (group A); or another receiving preoperative plus postoperative synbiotics (group B). Lactulose-mannitol (L/M) ratio, serum diamine oxidase (DAO) activity, natural killer (NK) cell activity, interleukin-6 (IL-6), fecal microflora, and fecal organic acid concentrations were determined before and after hepatectomy. Postoperative infectious complications were recorded.Of 101 patients, 81 completed the trial. Preoperative and postoperative changes in L/M ratio and DAO activity were similar between groups. Preoperatively in group B, NK activity, and lymphocyte counts increased, while IL-6 decreased significantly (P < 0.05). Postoperative serum IL-6, white blood cell counts, and C-reactive protein in group B were significantly lower than in group A (P < 0.05). During the preoperative period, numbers of Bifidobacterium colonies cultured from and total organic acid concentrations measured in feces increased significantly in group B (P < 0.05). Postoperative concentrations of total organic acids and acetic acid in feces were significantly higher in group B than in group A (P < 0.05). Incidence of postoperative infectious complications was 30.0% (12 of 40) in group A and 12.1% (5 of 41) in group B (P < 0.05).Preoperative oral administration of synbiotics can enhance immune responses, attenuate systemic postoperative inflammatory responses, and improve intestinal microbial environment. These beneficial effects likely reduce postoperative infectious complications after hepatobiliary resection for biliary tract cancer.