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Exploring the clinical value of probiotics in the perioperative management of colorectal cancer: Meta-analysis with trial sequential analysis.

  • 2025-09-09
  • Oncology letters 30(5)
    • Yang Zhang
    • Jiepin Hu
    • Qiong Xu
    • Youjie Yu
    • Haozhe Yan
    • Wei Shao
    • Feng Zhang

Study Design

Type
Meta-Analysis
Sample size
n = 2
Population
patients who underwent CRC surgery
Methods
A meta-analysis combined with a trial sequential analysis (TSA) was performed to assess the efficacy and safety of probiotics in the adjuvant treatment of CRC; the meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines
Colorectal cancer (CRC) is the third most common malignant neoplasm, and there is currently no consensus on the clinical value of probiotics in perioperative CRC. A meta-analysis combined with a trial sequential analysis (TSA) was performed to assess the efficacy and safety of probiotics in the adjuvant treatment of CRC to provide an evidence-based recommendation for perioperative CRC. The present meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the study protocol was registered with the International Prospective Register of Systematic Reviews (CRD42024510734). The meta-analysis demonstrated that probiotics significantly reduced the incidence of postoperative infections in patients who underwent CRC surgery (risk ratio, 0.54; 95% CI, 0.45-0.65; P<0.05). Although the sample size was insufficient for the required information size (n=2,897), TSA results demonstrated that cumulative Z values exceeded both the conventional and TSA cut-offs, which indicated that this meta-analysis barely extended the probability of false positives. Meanwhile, probiotics reduced the mean number of days of hospitalization for patients with CRC (mean difference, -1.23; 95% CI, -2.18 to -0.28; P<0.05). Notably, different genera of probiotics used contributed to different outcomes, with subgroup analyses indicating that Lactobacillus, Bifidobacterium, combined Lactobacillus with Bifidobacterium, and multiple combination strains significantly reduced the incidence of postoperative infections in CRC, with statistically significant differences, whereas Saccharomyces boulardii alone did not confer a potential benefit. Overall, probiotics appeared to be effective in reducing postoperative infectious complications and shortening the length of hospital stay.

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