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New challenges in cholangiocarcinoma candidates for elective surgery: harnessing the microbiome dysbiosis

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Abstract

Background

The gut microbiota, composed by several species of microorganisms, works to preserve the liver–gut homeostasis and plays an important role during digestion and absorption of nutrients, and in the immune response of the host. In this review, we analyzed the influence of microbiota in patients with cholangiocarcinoma (CCA) who were candidates for elective surgery.

Methods

A literature review was conducted to identify papers that provided empiric evidence to support that the altered microbiota composition (dysbiosis) is related also to CCA development.

Results

Bacteria such as Helicobacter pylori, Helicobacter hepaticus, and Opisthorchis viverrini increase the risk of CCA. The most abundant genera were Enterococcus, Streptococcus, Bacteroides, Klebsiella, and Pyramidobacter in CCA’s biliary microbiota. Additionally, levels of Bacteroides, Geobacillus, Meiothermus, and Anoxybacillus genera were significantly higher. An enrichment of Bifidobacteriaceae, Enterobacteriaceae, and Enterococcaceae families has also been observed in CCA tumor tissue. Microbiota is related to postoperative outcomes in abdominal surgery. The combination of caloric restriction diets in liver cancer or CCA increases the effect of the chemotherapy treatment.

Conclusion

The correct use of nutrition for microbiota modulation according to each patient’s needs could be a therapeutic tool in combination with elective surgery and chemotherapy to diminish side effects and improve prognosis. Further investigations are needed to fully understand the mechanisms by which they are related.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials.

Code availability

The data for this project are confidential but may be obtained with Data Use Agreements with the Massachusetts Department of Elementary and Secondary Education (DESE). Researchers interested in access to the data may contact Victor Lopez-Lopez. It can take some months to negotiate data use agreements and gain access to the data. The author will assist with any reasonable replication attempts for 2 years following publication.

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Funding

This work was funded by the Institute of Health “Carlos III” (ISCIII), and co-funded by the Fondo Europeo de Desarrollo Regional-FEDER (grant number PI20/00505). B.R-M was supported by the “Miguel Servet Type I” program (CP19/00098, ISCIII, Spain; co-funded by the Fondo Europeo de Desarrollo Regional-FEDER). M.A.M-S was supported by a PFIS contract from the ISCIII (FI21/00003, ISCIII, Spain; co-funded by the Fondo Europeo de Desarrollo Regional-FEDER).

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Authors and Affiliations

  1. International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic

    Oriana Lo Re

  2. Department of Translational Stem Cell Biology, Research Institute of the Medical University of Varna, Varna, Bulgaria

    Oriana Lo Re

  3. Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, 30120, Murcia, Spain

    Victor López-López, Andrés Balaguer-Román, Pablo Ramírez & Ricardo Robles-Campos

  4. Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain

    Victor López-López, Alberto Baroja-Mazo, Pablo Ramírez & Ricardo Robles-Campos

  5. Obesity and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain

    Andrés Balaguer-Román, María Antonia Martínez-Sánchez & Bruno Ramos-Molina

  6. Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, Zurich, Switzerland

    Dilmurodjon Eshmuminov

  7. Department of Hepatology, Virgen de La Arrixaca University Hospital, Murcia, Spain

    Camilo Julio Llamoza-Torres

  8. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

    Kohei Miura

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  1. Oriana Lo Re
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Contributions

Study conception and design: OLR, VLL, RRC, and BRM. Acquisition of data: OLR, VLL, ABR, MMS, DE, CLT, KM, ABM, and PR. Analysis and interpretation of data: OLR, VLL, ABR, MMS, DE, CLT, KM, ABM, PR, RRC, and BRM. Drafting of manuscript: OLR, VLL, RRC, and BRM. Critical revision of manuscript: all authors.

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Correspondence to Victor López-López.

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Oriana Lo Re and Victor López-López shared first authorship.

Ricardo Robles-Campos and Bruno Ramos-Molina shared last authorship.

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Re, O.L., López-López, V., Balaguer-Román, A. et al. New challenges in cholangiocarcinoma candidates for elective surgery: harnessing the microbiome dysbiosis. Langenbecks Arch Surg 408, 134 (2023). https://doi.org/10.1007/s00423-023-02867-8

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