Perioperative changes in the microbiome during rectal cancer surgery: exploratory analysis of the National Institute for Health and Care Research (NIHR) IntAct trial - Scorecard - MDSpire
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Perioperative changes in the microbiome during rectal cancer surgery: exploratory analysis of the National Institute for Health and Care Research (NIHR) IntAct trial
Clinical Scorecard: Exploring Microbiome Alterations During Rectal Cancer Surgery: Insights from the NIHR IntAct Trial
At a Glance
Category
Detail
Condition
Rectal cancer undergoing surgical resection
Key Mechanisms
Perioperative alterations in gut microbiome composition including shifts in bacterial diversity and collagenase-producing organisms potentially influencing anastomotic healing
Target Population
Patients undergoing rectal cancer surgery
Care Setting
Surgical and perioperative care in NHS hospitals
Key Highlights
Significant perioperative shifts in rectal microbiome diversity and composition were observed, influenced by factors such as smoking, hospital site, bowel preparation, oral antibiotics, and defunctioning stoma.
Postoperative increases in Enterococcus and Prevotella and presence of collagenase-producing bacteria were common, but no clear microbiome differences were found between patients with and without anastomotic leak.
This is the largest human study to date characterizing microbiome dynamics around rectal cancer surgery, highlighting the complexity and need for further research on microbiome impact on surgical outcomes.
Guideline-Based Recommendations
Diagnosis
Consider perioperative rectal microbiome profiling to understand bacterial community changes during rectal cancer surgery.
Management
Recognize that factors such as mechanical bowel preparation, oral antibiotics, and use of defunctioning stoma influence microbiome composition and may impact postoperative outcomes.
Maintain awareness of collagenase-producing bacteria presence postoperatively as a potential contributor to tissue degradation.
Monitoring & Follow-up
Monitor perioperative microbiome changes longitudinally to identify shifts that may correlate with complications such as anastomotic leak.
Risks
Anastomotic leak remains a significant postoperative risk with multifactorial etiology including microbiome alterations, though direct causal links remain unconfirmed.
Patient & Prescribing Data
202 patients undergoing rectal cancer surgery in multiple NHS hospitals
Preoperative oral antibiotics and mechanical bowel preparation modestly alter microbiome diversity; defunctioning stoma is associated with reduced alpha-diversity and increased pathogenic bacteria.
Clinical Best Practices
Optimize perioperative care considering microbiome influences, including judicious use of bowel preparation and antibiotics.
Consider the potential impact of hospital-specific factors on microbiome and postoperative outcomes.
Further research is needed before microbiome-targeted interventions can be recommended to reduce anastomotic leak risk.
by Jack A Helliwell, Caroline H Chilton, Caroline Young, Emma V Clark, Lyndsay Wilkinson, Alba Fuentes Balaguer, Daniel Bottomley, Julie Croft, Neil Corrigan, Andrew Kirby, Philip Quirke, Deborah D Stocken, David G Jayne, Henry M Wood
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