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Influence of Probiotics Administration Before Liver Resection in Patients with Liver Disease: A Randomized Controlled Trial

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A Correction to this article was published on 15 December 2021

This article has been updated

Abstract

Background

By inhibiting the growth of pathogenic bacteria and modulating the local intestinal immune system, probiotics may reduce bacterial translocation and systemic endotoxaemia, factors partially responsible for post-operative complications following liver resection for hepatocellular carcinoma in patients with cirrhosis.

Methods

Patients with resectable hepatocellular carcinoma developed in the setting of chronic liver disease were prospectively divided into two equal-sized groups: one receiving probiotic treatment 14 days prior to surgery and the other receiving placebo. The primary endpoint was the level of circulating endotoxins after hepatectomy. Secondary endpoints were systemic inflammation (inflammatory cytokine levels), post-operative liver function and overall post-operative complication rate.

Results

From May 2013 to December 2018, 64 patients were randomized, and 54 patients were included in the analysis, 27 in each arm. No significant change in endotoxin levels was observed over time in either group (P = 0.299). No difference between the groups in terms of post-operative liver function and overall complication rates was observed. The only differences observed were significant increases in the levels of TNFalpha (P = 0.019) and interleukin 1-b (P = 0.028) in the probiotic group in the post-operative period.

Conclusion

Contrary to the modest data reported in the literature, the administration of probiotics before minor liver resection for hepatocellular carcinoma developed in the setting of compensated chronic liver disease does not seem to have an impact on circulating endotoxin levels or post-operative complication rates.

Trial registration

Trial registration: NCT02021253.

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Change history

Abbreviations

ASA:

American Society of Anesthesiologists

AUC:

Area under the curve

HCC:

Hepatocellular carcinoma

LAL:

Limulus amoebocyte lysate

LPS:

Lipopolysaccharide

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Acknowledgements

We thank Valentin Harter, from the department of data management -Cancéropôle Nord-Ouest—for assistance with the statistical analysis.

Funding

No financial support.

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France

    Edouard Roussel, Jean-Jacques Tuech, Eloise Papet, Pauline Tortajada & Lilian Schwarz

  2. Department of Metabolic Biochemistry, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France

    Carole Brasse-Lagnel & Soumeya Bekri

  3. Rouen University Hospital and Normandie Univ, UNIROUEN, Normandy Centre for Genomic and Personalized Medicine, INSERM U1245, 76000, Rouen, France

    Carole Brasse-Lagnel & Soumeya Bekri

  4. Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie University, UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, 76000, Rouen, France

    Jean-Jacques Tuech & Lilian Schwarz

  5. Department of Hepatology, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France

    Helène Montialoux

  6. Hôpital Charles-Nicolle (Rouen), 37 Boulevard Gambetta, 76038, Rouen Cedex, France

    Edouard Roussel

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  1. Edouard Roussel
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Contributions

Conception and design of the study: CBL, JJT, HM, PT, SB, LS. Acquisition, analysis and interpretation of the data: ER, CBL, JJT, HM, EP, PT, SB, LS. Drafting the article: ER, EP, LS. Revising the article critically for important intellectual content: ER, CBL, JJT, HM, EP, PT, SB, LS.

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Correspondence to Edouard Roussel.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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The original online version of this article was revised: The authors' names were corrected.

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Roussel, E., Brasse-Lagnel, C., Tuech, JJ. et al. Influence of Probiotics Administration Before Liver Resection in Patients with Liver Disease: A Randomized Controlled Trial. World J Surg 46, 656–665 (2022). https://doi.org/10.1007/s00268-021-06388-7

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