REVIEW PAPER
The role of gut microbiota support in the prehabilitation process for patients requiring gastrointestinal surgery
1
Department of Dietetics and Food Research, Faculty of Science and Technology, Jan Dlugosz University, Czestochowa, Poland
Submission date: 2024-08-28
Final revision date: 2025-04-09
Acceptance date: 2025-04-28
Publication date: 2025-12-15
Corresponding author
Cyprian Lisowski
Cyprian Lisowski Department of Dietetics and Food Research Faculty of Science and Technology Jan Dlugosz University Aleja Armii Krajowej 13/15 42-200 Czestochowa, Poland
Cyprian Lisowski Department of Dietetics and Food Research Faculty of Science and Technology Jan Dlugosz University Aleja Armii Krajowej 13/15 42-200 Czestochowa, Poland
Medical Studies 2025;41(4):313-321
KEYWORDS
TOPICS
ABSTRACT
Gastrointestinal surgery complications are common. Implementation of an interdisciplinary prehabilitation program could reduce their frequency and shorten hospital stays. Including gut microbiota support supplements in prehabilitation may be a new strategy to reduce treatment-related morbidity in patients undergoing gastrointestinal surgery. The current state of knowledge and previous studies are very heterogeneous in terms of interventions and results obtained. All studies indicate a positive impact of the use of supplements supporting gut microbiota in the perioperative period on the patient’s condition, as well as a reduction in postoperative morbidity, but they do not explain the effect of the microbiota on the entire prehabilitation process. Implementing nutritional interventions together with gut microbiota support supplements from the very beginning of prehabilitation could improve quality of life and reduce complications. The aim of this review is to determine the possibilities of supporting the gut microbiota in the perioperative period for patients requiring gastrointestinal surgery.
REFERENCES (53)
1.
Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Mérisier ED, El-Halabi S, Farmer PE, Gawande A, Gillies R, Greenberg SLM, Grimes CE, Gruen RL, Ismail EA, Kama- ra TB, Lavy C, Lundeg G, Mkandawire NC, Raykar NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G, Yip W. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015; 386: 569-624.
2.
McIsaac DI, Gill M, Boland L, Hutton B, Branje K, Shaw J, Grudzinski AL, Barone N, Gillis C; Prehabilitation Knowledge Network. Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews. Br J Anaesth. 2022; 128: 244-257.
3.
Hong M, Ghajar M, Allen W, Jasti S, Alvarez-Downing MM. Evaluating implementation costs of an enhanced recovery after surgery (ERAS) protocol in colorectal surgery: a systematic review. World J Surg. 2023; 47: 1589-1596.
4.
Gillis C, Ljungqvist O, Carli F. Prehabilitation, enhanced recovery after surgery, or both? A narrative review. Br J Anaesth. 2022; 128: 434-448..
5.
Pędziwiatr M, Mavrikis J, Witowski J, Adamos A, Major P, Nowakowski M, Budzyński A. Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery. Med Oncol. 2018; 35: 95.
6.
Noba L, Rodgers S, Chandler C, Balfour A, Hariharan D, Yip VS. Enhanced recovery after surgery (ERAS) reduces hospital costs and improve clinical outcomes in liver surgery: a systematic review and meta-analysis. J Gastrointest Surg. 2020; 24: 918-932..
7.
Banasiewicz T, Kobiela J, Cwaliński J, Spychalski P, Przybylska P, Kornacka K, Bogdanowska-Charkiewicz D, Leyk-Kolańczak M, Borejsza-Wysocki M, Batycka-Stachnik D, Drwiła R. Recommendations on the use of prehabilitation, i.e. comprehensive preparation of the patient for surgery. Pol J Surg. 2023; 95: 62-91.
9.
Lobo DN, Skořepa P, Gomez D, Greenhaff PL. Prehabilitation: high-quality evidence is still required. Br J Anaesth. 2023; 130: 9-14.
10.
Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale RG, Waitzberg D, Bischoff SC, Singer P. ESPEN practical guideline: clinical nutrition in surgery. Clin Nutr. 2021; 40: 4745-4761.
11.
Lobo DN, Gianotti L, Adiamah A, Barazzoni R, Deutz NEP, Dhatariya K, Greenhaff PL, Hiesmayr M, Jakobsen DH, Klek S, Krznaric Z, Ljungqvist O, McMillan DC, Rollins KE, Sekeljic MP, Skipworth RJE, Stanga Z, Stockley A, Stockley R, Weimann A. Perioperative nutrition: Recommendations from the ESPEN expert group. Clin Nutr. 2020; 39: 3211-3227.
12.
Ford KL, Prado CM, Weimann A, Schuetz P, Lobo DN. Unresolved issues in perioperative nutrition: a narrative review. Clin Nutr. 2022; 41: 1578-1590.
13.
Zhang B, Najarali Z, Ruo L, Alhusaini A, Solis N, Valencia M, Pinto Sanchez MI, Serrano PE. Effect of perioperative nutritional supplementation on postoperative complications – systematic review and meta-analysis. J Gastrointest Surg. 2019; 23: 1682-1693.
14.
Carli F, Bousquet-Dion G, Awasthi R, Elsherbini N, Liberman S, Boutros M, Stein B, Charlebois P, Ghitulescu G, Morin N, Jagoe T, Scheede-Bergdahl C, Minnella EM, Fiore Jr JF. Effect of multimodal prehabilitation vs postoperative rehabilitation on 30-day postoperative complications for frail patients undergoing resection of colorectal cancer: a randomized clinical trial. JAMA Surg. 2020; 155: 233-242.
15.
Horgan S, Hegarty J, Drennan J, Keane D, Saab MM. The effect of interventions on the incidence of surgical site infections in acute care settings: a systematic review. J Tissue Viab. 2024; 33(1): 75-88.
16.
Leeming ER, Johnson AJ, Spector TD, Le Roy CI. Effect of diet on the gut microbiota: rethinking intervention duration. Nutrients. 2019; 11: 2862.
17.
Cruellas M, Yubero A, Zapata M, Galvez EM, Gascón M, Isla D, Lastra R, Martínez-Lostao L, Ocariz M, Pardo J, Ramírez A, Sesma A, Torres-Ramón I Paño JR. How could antibiotics, probiotics, and corticoids modify microbiota and its influence in cancer immune checkpoint inhibitors: a review. Infect Immun. 2021; 89: e00665-20.
18.
Earley ZM, Akhtar S, Green SJ, Naqib A, Khan O, Cannon AR, Hammer AM, Morris NL, Li X, Eberhardt JM, Gamelli RL, Kennedy RH, Choudhry MA. Burn injury alters the intestinal microbiome and increases gut permeability and bacterial translocation. PLoS One. 2015; 10: e0129996.
19.
Shimizu K, Ogura H, Asahara T, Nomoto K, Matsushima A, Hayakawa K, Ikegawa H, Tasaki O, Yasuyuki Kuwagata 5, Takeshi Shimazu 2 . Gut microbiota and environment in patients with major burns – a preliminary report. Burns. 2015; 41: e28-33.
20.
Krishnan P, Frew Q, Green A, Martin R, Dziewulski P. Cause of death and correlation with autopsy findings in burns patients. Burns. 2013; 39: 583-588.
21.
McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015; 102(5): 462-479.
22.
Koller SE, Bauer KW, Egleston BL, Smith R, Philp MM, Ross HM, Esnaola NF. Comparative effectiveness and risks of bowel preparation before elective colorectal surgery. Ann Surg. 2018; 267: 734-742.
23.
Meyer J, Naiken S, Christou N, Liot E, Toso C, Buchs NC, Ris F. Reducing anastomotic leak in colorectal surgery: the old dogmas and the new challenges. World J Gastroenterol. 2019; 25: 5017-5025.
24.
Agnes A, Puccioni C, D’Ugo D, Gasbarrini A, Biondi A, Persiani R. The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review. BMC Surg. 2021; 21: 83.
25.
Shogan BD, Belogortseva N, Luong PM, Zaborin A, Lax S, Bethel C, Ward M, Muldoon JP, Singer M, An G, Umanskiy K, Konda V, Shakhsheer B, Luo J, Klabbers R, Hancock LE, Gilbert J, Zaborina O, Alverdy JC. Collagen degradation and MMP9 activation by Enterococcus faecalis contributes to intestinal anastomotic leak. Sci Transl Med. 2015; 7: 286-268.
26.
Mathew AJ, Wann VC, Abraham DT, Jacob PM, Selvan BS, Ramakrishna BS, Nair AN. The effect of butyrate on the healing of colonic anastomoses in rats. J Investig Surg. 2010; 23: 101-104.
27.
Hajjar R, Gonzalez E, Fragoso G, Oliero M, Alaoui AA, Calvé A, Rendos HV, Djediai S, Cuisiniere T, Laplante P, Gerkins C, Ajayi AS, Diop K, Taleb N, Thérien S, Schampaert F, Alratrout H, Dagbert F, Loungnarath R, Seba- jang H, Schwenter F, Wassef R, Ratelle R, Debroux E, Cailhier JF, Routy B, Annabi B, Brereton NJB, Richard C, Santos MM. Gut microbiota influence anastomotic healing in colorectal cancer surgery through modulation of mucosal proinflammatory cytokines. Gut. 2023; 72: 1143-1154.
28.
Boatman S, Kaiser T, Nalluri-Butz H, Khan MH, Dietz M, Kohn J, Johnson AJ, Gaertner WB, Staley C, Jahansouz C. Diet-induced shifts in the gut microbiota influence anastomotic healing in a murine model of colonic surgery. Gut Microbes. 2023; 15: 2283147.
29.
Doudakmanis C, Bouliaris K, Kolla C, Efthimiou M, Koukoulis GD. Bacterial translocation in patients undergoing major gastrointestinal surgery and its role in postoperative sepsis. World J Gastrointest Pathophysiol. 2021; 12: 106-114.
30.
Zhang H, Xu J, Wu Q, Fang H, Shao X, Ouyang X, He Z, Deng Y, Chen C. Gut microbiota mediates the susceptibility of mice to sepsis-associated encephalopathy by butyric acid. J Inflamm Res. 2022; 15: 2103-2119.
31.
Liu Z, Qin H, Yang Z, Xia Y, Liu W, Yang J, Jiang Y, Zhang H, Yang Y, Wang Y. Randomised clinical trial: the effects of perioperative probiotic treatment on barrier function and post-operative infectious complications in colorectal cancer surgery – a double-blind study. Aliment Pharmacol Ther. 2011; 33: 50-63.
32.
Wanitsuwan W, Pahumunto N, Surachat K, Thananimit S, Wonglapsuwan M, Laohawiriyakamol S, Teanpaisan R. Comparison of the effects of postbiotics and live-probiotics containing Lacticaseibacillus paracasei SD1 and Lacticaseibacillus rhamnosus SD11 in patients with previous colorectal cancer: a randomized controlled trial. J Funct Foods. 2024; 123: 106576.
33.
Franko J, Raman S, Patel S, Petree B, Lin M, Tee MC, Le VH, Frankova D. Survival and cancer recurrence after short-course perioperative probiotics in a randomized trial. Clin Nutr ESPEN. 2024; 60: 59-64.
34.
Grąt M, Wronka KM, Lewandowski Z, Grąt K, Krasnodębski M, Stypułkowski J, Hołówka W, Masior Ł, Kosińska I, Wasilewicz M, Raszeja-Wyszomirska J, Rejkowski S, Bik E, Patkowski W, Krawczyk M. Effects of continuous use of probiotics before liver transplantation: a randomized, double-blind, placebo-controlled trial. Clin Nutr. 2017; 36: 1530-1539.
35.
Zhang JW, Du P, Yang BR, Gao J, Fang WJ, Ying CM. Preoperative probiotics decrease postoperative infectious complications of colorectal cancer. Am J Med Sci. 2012; 343: 199-205.
36.
Liu G, Cao S, Liu X, Li Z, Tian Y, Zhang X, Zhong H, Zhou Y. Effect of perioperative probiotic supplements on postoperative short-term outcomes in gastric cancer patients receiving neoadjuvant chemotherapy: a doubleblind, randomized controlled trial. Nutrition. 2022; 96: 111574.
37.
Wang P, Yin X, Chen G, Li L, Le Y, Xie Z, Ouyang W, Tong J. Perioperative probiotic treatment decreased the incidence of postoperative cognitive impairment in elderly patients following non-cardiac surgery: a randomised double-blind and placebo-controlled trial. Clin Nutr. 2021; 40: 64-71.
38.
Chen JC, Lee WJ, Tsou JJ, Liu TP, Tsai PL. Effect of probiotics on postoperative quality of gastric bypass surgeries: a prospective randomized trial. Surg Obes Relat Dis. 2016; 12: 57-61.
39.
Liu W, Zheng C, Li Q, Xu T, Cao W, Shi M, Huang F, Liu L, Luo Y, Xiao Q, Liu Z, Deng X. Preoperative oral probiotics relieve insulin resistance and gut dysbacteriosis in patients with gastric cancer after gastrectomy. J Funct Foods. 2023; 101: 105426.
40.
Okazaki M, Matsukuma S, Suto R, Miyazaki K, Hidaka M, Matsuo M, Noshima S, Zempo N, Asahara T, Nomoto K. Perioperative synbiotic therapy in elderly patients undergoing gastroenterological surgery: a prospective, randomized control trial. Nutrition. 2013; 29: 1224-1230.
41.
Tanaka K, Yano M, Motoori M, Kishi K, Miyashiro I, Ohue M, Ohigashi H, Asahara T, Nomoto K, Ishikawa O. Impact of perioperative administration of synbiotics in patients with esophageal cancer undergoing esophagectomy: a prospective randomized controlled trial. Surgery. 2012; 152: 832-842.
42.
Xie X, He Y, Li H, Yu D, Na L, Sun T, Zhang D, Shi X, Xia Y, Jiang T, Rong S, Yang S, Ma X, Xu G. Effects of prebiotics on immunologic indicators and intestinal microbiota structure in perioperative colorectal cancer patients. Nutrition. 2019; 61: 132-142.
43.
Theodoropoulos GE, Memos NA, Peitsidou K, Karanta- nos T, Spyropoulos BG, Zografos G. Synbiotics and gastrointestinal function-related quality of life after elective colorectal cancer resection. Ann Gastroenterol. 2016; 29: 56-62.
44.
Xu Q, Xu P, Cen Y, Li W. Effects of preoperative oral administration of glucose solution combined with postoperative probiotics on inflammation and intestinal barrier function in patients after colorectal cancer surgery. Oncol Lett. 2019; 18: 694-698.
45.
Zhang T, Wu X, Liu B, Huang H, Zhou C, Liang P. The contribution of probiotics for the double-edge effect of cefazolin on postoperative neurocognitive disorders by rebalancing the gut microbiota. Front Neurosci. 2023; 17: 1156453.
46.
Chen Y, Qi A, Teng D, Li S, Yan Y, Hu S, Du X. Probiotics and synbiotics for preventing postoperative infectious complications in colorectal cancer patients: a systematic review and meta-analysis. Tech Coloproctol. 2022; 26: 425-436.
47.
Zeng J, Ji Y, Liang B, Zhang G, Chen D, Zhu M, Wu S, Kuang W. The effect of pro/synbiotics on postoperative infections in colorectal cancer patients: a systematic review and meta-analysis. Complement Ther Clin Pract. 2021; 43: 101370.
48.
Tang G, Zhang L, Tao J, Wei Z. Effects of perioperative probiotics and synbiotics on pancreaticoduodenectomy patients: a meta-analysis of randomized controlled trials. Front Nutr. 2021; 8: 715788.
49.
Xu J, Xu Y, Song Y. Efficacy of probiotics supplementation on the prognosis of patients after liver transplantation: a systematic review and meta-analysis. Indian J Surg. 2022; 84: 409-417.
50.
Bekiaridou A, Karlafti E, Oikonomou IM, Ioannidis A, Papavramidis TS. Probiotics and their effect on surgical wound healing: a systematic review and new insights into the role of nanotechnology. Nutrients. 2021; 13: 4265.
51.
Tang G, Huang W, Tao J, Wei Z. Prophylactic effects of probiotics or synbiotics on postoperative ileus after gastrointestinal cancer surgery: a meta-analysis of randomized controlled trials. PLoS One. 2022; 17: e0264759.
52.
Kotzampassi K. Why give my surgical patients probiotics. Nutrients. 2022; 14: 4389..
53.
Zhao LY, Mei JX, Yu G, Lei L, Zhang WH, Liu K, Chen XL, Kołat D, Yang K, Hu JK. Role of the gut microbiota in anticancer therapy: from molecular mechanisms to clinical applications. Signal Transduct Target Ther. 2023; 8: 201.
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