Gut Microbiota and Colorectal Surgery: Impact on Postoperative Complications

Abstract

Colorectal anastomotic leakage is a dreaded complication after colorectal surgery and causes high morbidity and mortality. The pathophysiology of anastomotic healing remains unclear despite numerous studies. In this article, our aim is to provide different perspectives on what is known about the role of the gastrointestinal tract microbiome and its relation to anastomotic integrity.

Keywords

anastomotic leak - postoperative complications - microbiome - colorectal

• References

• 1 Shogan BD, Belogortseva N, Luong PM , et al. Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak. Sci Transl Med 2015; 7 (286) 286ra68
• 2 Shogan BD, Carlisle EM, Alverdy JC, Umanskiy K. Do we really know why colorectal anastomoses leak?. J Gastrointest Surg 2013; 17 (9) 1698-1707
• 3 Paun BC, Cassie S, MacLean AR, Dixon E, Buie WD. Postoperative complications following surgery for rectal cancer. Ann Surg 2010; 251 (5) 807-818
• 4 Rahbari NN, Weitz J, Hohenberger W , et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 2010; 147 (3) 339-351
• 5 Lipska MA, Bissett IP, Parry BR, Merrie AE. Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg 2006; 76 (7) 579-585
• 6 Karanjia ND, Corder AP, Bearn P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 1994; 81 (8) 1224-1226
• 7 Karliczek A, Harlaar NJ, Zeebregts CJ, Wiggers T, Baas PC, van Dam GM. Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Colorectal Dis 2009; 24 (5) 569-576
• 8 Turnbaugh PJ, Ley RE, Hamady M, Fraser-Liggett CM, Knight R, Gordon JI. The human microbiome project. Nature 2007; 449 (7164) 804-810
• 9 Morowitz MJ, Babrowski T, Carlisle EM , et al. The human microbiome and surgical disease. Ann Surg 2011; 253 (6) 1094-1101
• 10 Lederberg J. Infectious history. Science 2000; 288 (5464) 287-293
• 11 Cohn Jr I, Rives JD. Antibiotic protection of colon anastomoses. Ann Surg 1955; 141 (5) 707-717
• 12 Blain III A, Kennedy JD. The effect of penicillin in experimental intestinal obstruction; studies on strangulated low ileal obstruction. Alexander Blain Hosp Bull 1946; 5 (4) 144-159
• 13 Cohn Jr I, Gelb A, Hawthorne HR. Strangulation obstruction; the effect of pre- and post-operative antibacterial agents. Ann Surg 1953; 138 (5) 748-758
• 14 Shogan BD, Smith DP, Christley S, Gilbert JA, Zaborina O, Alverdy JC. Intestinal anastomotic injury alters spatially defined microbiome composition and function. Microbiome 2014; 2: 35
• 15 Stern JR, Olivas AD, Valuckaite V, Zaborina O, Alverdy JC, An G. Agent-based model of epithelial host-pathogen interactions in anastomotic leak. J Surg Res 2013; 184 (2) 730-738
• 16 Wu L, Holbrook C, Zaborina O , et al. Pseudomonas aeruginosa expresses a lethal virulence determinant, the PA-I lectin/adhesin, in the intestinal tract of a stressed host: the role of epithelia cell contact and molecules of the Quorum Sensing Signaling System. Ann Surg 2003; 238 (5) 754-764
• 17 Seal JB, Alverdy JC, Zaborina O, An G. Agent-based dynamic knowledge representation of Pseudomonas aeruginosa virulence activation in the stressed gut: Towards characterizing host-pathogen interactions in gut-derived sepsis. Theor Biol Med Model 2011; 8: 33
• 18 Olivas AD, Shogan BD, Valuckaite V , et al. Intestinal tissues induce an SNP mutation in Pseudomonas aeruginosa that enhances its virulence: possible role in anastomotic leak. PLoS ONE 2012; 7 (8) e44326
• 19 Pasternak B, Rehn M, Andersen L , et al. Doxycycline-coated sutures improve mechanical strength of intestinal anastomoses. Int J Colorectal Dis 2008; 23 (3) 271-276
• 20 Siemonsma MA, de Hingh IH, de Man BM, Lomme RM, Verhofstad AA, Hendriks T. Doxycycline improves wound strength after intestinal anastomosis in the rat. Surgery 2003; 133 (3) 268-276
• 21 Agren MS, Andersen TL, Mirastschijski U , et al. Action of matrix metalloproteinases at restricted sites in colon anastomosis repair: an immunohistochemical and biochemical study. Surgery 2006; 140 (1) 72-82
• 22 Donohoe DR, Holley D, Collins LB , et al. A gnotobiotic mouse model demonstrates that dietary fiber protects against colorectal tumorigenesis in a microbiota- and butyrate-dependent manner. Cancer Discov 2014; 4 (12) 1387-1397
• 23 Roediger WE. The starved colon—diminished mucosal nutrition, diminished absorption, and colitis. Dis Colon Rectum 1990; 33 (10) 858-862
• 24 Bloemen JG, Schreinemacher MH, de Bruine AP, Buurman WA, Bouvy ND, Dejong CH. Butyrate enemas improve intestinal anastomotic strength in a rat model. Dis Colon Rectum 2010; 53 (7) 1069-1075
• 25 Mathew AJ, Wann VC, Abraham DT , et al. The effect of butyrate on the healing of colonic anastomoses in rats. J Invest Surg 2010; 23 (2) 101-104
• 26 Levison ME. Effect of colon flora and short-chain fatty acids on growth in vitro of Pseudomonas aeruginosa and Enterobacteriaceae. Infect Immun 1973; 8 (1) 30-35
• 27 Gilbert JA, Alverdy J. Stool consistency as a major confounding factor affecting microbiota composition: an ignored variable?. Gut 2016; 65 (1) 1-2
• 28 Leone V, Gibbons SM, Martinez K , et al. Effects of diurnal variation of gut microbes and high-fat feeding on host circadian clock function and metabolism. Cell Host Microbe 2015; 17 (5) 681-689
• 29 Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR ; Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Am J Infect Control 1999; 27 (2) 97-132 , quiz 133–134, discussion 96
• 30 Contant CM, Hop WC, van't Sant HP , et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet 2007; 370 (9605) 2112-2117
• 31 Slim K, Vicaut E, Launay-Savary MV, Contant C, Chipponi J. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg 2009; 249 (2) 203-209
• 32 Jung B, Påhlman L, Nyström PO, Nilsson E ; Mechanical Bowel Preparation Study Group. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surg 2007; 94 (6) 689-695
• 33 Güenaga KF, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2011; (9) CD001544
• 34 Fry DE. Colon preparation and surgical site infection. Am J Surg 2011; 202 (2) 225-232
• 35 Hayashi MS, Wilson SE. Is there a current role for preoperative non-absorbable oral antimicrobial agents for prophylaxis of infection after colorectal surgery?. Surg Infect (Larchmt) 2009; 10 (3) 285-288
• 36 Kiran RP, Murray AC, Chiuzan C, Estrada D, Forde K. Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg 2015; 262 (3) 416-425 , discussion 423–425
• 37 Chen M, Song X, Chen LZ, Lin ZD, Zhang XL. Comparing mechanical bowel preparation with both oral and systemic antibiotics versus mechanical bowel preparation and systemic antibiotics alone for the prevention of surgical site infection after elective colorectal surgery: a meta-analysis of randomized controlled clinical trials. Dis Colon Rectum 2016; 59 (1) 70-78