Functional outcome, quality of life, and efficacy of probiotics in postoperative patients with colorectal cancer

Abstract

Purpose

We investigated the functional outcome and health-related quality of life (QOL) of patients who underwent a surgical resection of colorectal cancer, and reviewed the efficacy of probiotics for improving bowel function.

Methods

A questionnaire was mailed to 193 patients. Questionnaires contained the Medical Outcomes Study Short-Form 36-Item Health Survey and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 as QOL scores, the Wexner incontinence score, and original questionnaire items about bowel functions. Probiotics, containing Bacillus natto and Lactobacillus acidophilus, were given to 77 patients for 3 months; after 3 months of treatment, the same questionnaire was administered. The results were analyzed by location of the resected cancer: rectal, colonic, right, and left.

Results

In the rectal group, defecation frequency, anal pain, and the Wexner score were significantly worse than in the colonic group. In the right group, the fecal form was looser and nighttime defecation frequency was higher than those of the left group. Three items in the QOL score of the right group were significantly worse compared with the left group. Functional outcome including defecation frequency, feeling of incomplete defecation, and five items in the QOL score were significantly improved after taking probiotics. Improvement in functional outcome and/or QOL was observed in all groups.

Conclusions

Not only rectal resection but also rightside colectomy affected bowel dysfunction. Probiotics could be an effective treatment for improvement in functional outcome and QOL after colorectal resection.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Reuter G. Present and future of probiotics in Germany and central Europe. Biosci Microflora 1997;16:43–51.

    Google Scholar 

  2. 2.

    Quigley EM. Bacteria: a new player in gastrointestinal motility disorders — infection, bacterial overgrowth, and probiotics. Gastroenterol Clin North Am 2007;36:735–748.

    PubMed  Article  Google Scholar 

  3. 3.

    Floch MH, Madsen KK, Jenkins DJ, Guandalin S, Katz JA, Onderdonk A, et al. Recommendation of probiotic use. J Clin Gastroenterol 2006;40:275–278.

    PubMed  Article  Google Scholar 

  4. 4.

    Kato K, Mizuno S, Umesaki Y, Ishii Y, Sugitani M, Imaoka A, et al. Randomized placebo-controlled trial assessing the effect of bifidobacteria-fermented milk on active ulcerative colitis. Aliment Pharmacol Ther 2004;20:1133–1141.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Eckburg PB, Relman DA. The role of microbes in Crohn’s disease. Clin Infect Dis 2007;44:252–262.

    Article  Google Scholar 

  6. 6.

    Camilleri M. Probiotics and irritable bowel syndrome: rationale, putative mechanisms, and evidence of clinical efficacy. J Clin Gastroenterol 2006;40:264–269.

    PubMed  Article  Google Scholar 

  7. 7.

    Lewis WG, Holdsworth PJ, Stephenson BM, Finan PJ, Johnston D. Role of the rectum in the physiological and clinical results of coloanal and colorectal anastomosis after anterior resection for rectal cancer. Br J Surg 1992;79:1082–1086.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Vironen JH, Kairaluoma M, Aalto AM, Kellokumpu IH. Impact of functional results on quality of life after rectal surgery. Dis Colon Rectum 2006;49:568–578.

    PubMed  Article  Google Scholar 

  9. 9.

    Fazio VW, Zutshi M, Remzi FH, Parc Y, Ruppert R, Furst A, et al. A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedure for low rectal cancers. Ann Surg 2007;246:481–490.

    PubMed  Article  Google Scholar 

  10. 10.

    Philipps E, Braitman LE, Stites S, Leighton JC. Quality of life and symptom attribution in long-term colon cancer survivors. J Eval Clin Pract 2008;14:254–258.

    Article  Google Scholar 

  11. 11.

    Ware JE, Sherbourne CD. The MOS 36-Item Short Form Health Status Survey (SF-36): conceptual framework and item selection. Med Care 1993;30:473–482.

    Article  Google Scholar 

  12. 12.

    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality of life instrument for use in international clinical trial in oncology. J Natl Cancer Inst 1993;85:365–376.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36:77–97.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Suzuki H, Amano S, Fujioka M, Honzumi M. Anorectal pressure and rectal compliance after low anterior resection. Br J Surg 1980;67:655–657.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Batignani G, Monaci I, Ficari F, Tonelli F. What affects continence after anterior resection of the rectum? Dis Colon Rectum 1991;34:329–335.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Malbert CH. The ileocolic sphincter. Neurogastroenterol Motil 2005;17:41–49.

    PubMed  Article  Google Scholar 

  17. 17.

    Mitchell JE, Breuer RI, Zuckerman L, Berlin J, Schilli R, Dunn JK. The colon influences ileal resection diarrhea. Dig Dis Sci 1980;25:33–41.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Richardson JD, Griffen WO. Ileocecal valve substitutes as bacteriologic barriers. Am J Surg 1972;123:149–153.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Shafik A, El-Shibai O, Shafik AA. Physiological assessment of the function of the ileocecal junction with evidence of ileocecal junction reflex. Med Sci Monitor 2002;8:629–635.

    Google Scholar 

  20. 20.

    Thompson JS, Quigley EM, Adrian TE, Path FR. Role of the ileocecal junction in the mortar response to intestinal resection. J Gastrointest Surg 1998;2:174–185.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Cazet JG, Kopp J. The surgical significance of the ileocecal junction. Surgery 1964;56:565–573.

    Google Scholar 

  22. 22.

    Yasuno M, Mori T, Takahashi K. Our new proposal for the length of the bowel to be resected in the colorectal cancer operation — the study of the bowel habits after the right hemicolectomy and the low anterior resection (in Japanese with English abstract). Nihon Syokakigeka Gakkaizashi (Jpn J Gastroenterol Surg) 1997;30:2112–2116.

    Google Scholar 

  23. 23.

    Nakamura T, Ohya M, Ishikawa H. Total and segmental colonic transit times in patients after anterior resection of sigmoid colon and rectal cancer — their relationship with postoperative abdominal symptoms and anal function (in Japanese with English abstract). Nihon Daichokoumonbyo Gakkaizashi (J Jpn Soc Coloproctol) 1998;50:17–32.

    Article  Google Scholar 

  24. 24.

    Rao GN, Drew PJ, Lee PWR, Monson JRT, Duthie GS. Anterior resection syndrome is secondary to sympathetic denervation. Colorectal Dis 1996;11:250–258.

    Article  CAS  Google Scholar 

  25. 25.

    Hollabaugh RS, Steiner MS, Sellers KD, Samm BJ, Dmochowski RR. Neuroanatomy of the pelvis — implications for colonic and rectal resection. Dis Colon Rectum 2000;43:1390–1397.

    PubMed  Article  Google Scholar 

  26. 26.

    Kawahara H, Yanaga K. The herbal medicine Dai-Kenchu-To directly stimulates colonic motility. Surg Today 2009;39:175–177.

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Seiji Ohigashi.

Additional information

The data concerning the effects of probiotics on the QOL have previously been published in part (in Japanese) in the Journal of the Japan Society of Coloproctology 2008;61: 389–95.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ohigashi, S., Hoshino, Y., Ohde, S. et al. Functional outcome, quality of life, and efficacy of probiotics in postoperative patients with colorectal cancer. Surg Today 41, 1200 (2011). https://doi.org/10.1007/s00595-010-4450-6

Download citation

Key words

  • Postoperative quality of life
  • Colorectal cancer
  • Bowel function
  • Probiotics