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Luo R, Ji HF, Wang LD. Preoperative gut dysbiosis and its correlation with postoperative infectious complications and tumor recurrence in colorectal cancer patients. World J Gastrointest Oncol 2026; 18(12): 123043 [DOI: 10.4251/wjgo.123043]
World J Gastrointest Oncol. Dec 15, 2026; 18(12): 123043 Published online Dec 15, 2026. doi: 10.4251/wjgo.123043
Preoperative gut dysbiosis and its correlation with postoperative infectious complications and tumor recurrence in colorectal cancer patients
Rui Luo, Hai-Fen Ji, Lin-Ding Wang
Rui Luo, Department of Clinical Laboratory, The Third Affiliated Hospital of Anhui Medical University (Hefei First People’s Hospital), Hefei 230061, Anhui Province, China
Rui Luo, Hai-Fen Ji, Lin-Ding Wang, Department of Microbiology, Anhui Medical University, Hefei 230032, Anhui Province, China
Co-first authors: Rui Luo and Hai-Fen Ji.
Author contributions: Luo R was responsible for study design, data collection, and manuscript drafting; Ji HF contributed to sample processing, sequencing data analysis, and manuscript preparation; Wang LD supervised the study, provided critical manuscript revision, and obtained ethical approval. All authors approved the final manuscript. Luo R and Ji HF contributed equally to this work as co-first authors.
AI contribution statement: In accordance with the journal’s AI Tool Usage Policy, the authors declare that no AI tools were used in the preparation of this manuscript, including study design, data collection, data analysis, interpretation of results, or manuscript writing. The authors assume full responsibility and accountability for the content of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Hefei First People’s Hospital, No. 2026-140-01.
Informed consent statement: The requirement for written informed consent was waived by the Ethics Committee of Hefei First People’s Hospital because of the retrospective nature of the study.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest to disclose.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.
Corresponding author: Lin-Ding Wang, Department of Microbiology, Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei 230032, Anhui Province, China. 2035010018@stu.ahmu.edu.cn
Received: June 10, 2026 Revised: July 24, 2026 Accepted: October 28, 2026 Published online: December 15, 2026 Processing time: 152 Days and 0.8 Hours
Abstract
BACKGROUND
Postoperative infectious complications and tumor recurrence have been observed to occur at high rates in colorectal cancer (CRC). Gut dysbiosis is associated with CRC tumorigenesis and immune dysregulation but whether preoperative microbiome status independently predicts adverse surgical outcomes remains unresolved. The aim of this study was to analyze the association between preoperative gut dysbiosis and 30-day infectious complications and 2-year recurrence-free survival (RFS) in CRC patients undergoing curative resection.
AIM
To determine whether the presence of preoperative gut dysbiosis in CRC patients is associated with postoperative infectious complications and tumor recurrence, and assess the potential predictive value of combining gut microbiome diversity metrics with inflammatory biomarkers for adverse postoperative outcomes.
METHODS
Using a retrospective design, we enrolled 152 CRC patients, who underwent curative resection between February 2022 and April 2025. Fecal specimens collected preoperatively were sequenced using 16S rRNA gene sequencing. Based on the Shannon diversity index and Dysbiosis Index (DI), patients were stratified into the dysbiosis group (n = 94) and the normal microbiome group (n = 58). The inflammatory biomarkers measured were C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 and fecal calprotectin. The main endpoint was the 30-day postoperative infectious complication rate; the secondary endpoint was 2-year RFS. Independent predictors were identified using logistic regression and Cox proportional hazards models.
RESULTS
Gut dysbiosis occurred in 61.8% (94/152) of patients preoperatively. The rate of infectious complications was significantly higher in the dysbiosis group (37.2% vs 17.2%, P = 0.008), as were postoperative length of stay and duration of antibiotic usage (both P < 0.001). The 2-year rate of tumor recurrence was also significantly higher in the dysbiosis group (35% vs 16.7%, P = 0.016), and the 2-year RFS rate was markedly lower (65.1% vs 84 %, Log-rank P = 0.016). Multivariable analyses verified that the presence of preoperative gut dysbiosis was an independent risk factor for both infectious complications [odds ratio = 2.85, 95% confidence interval (CI): 1.32-6.15, P = 0.008] and tumor recurrence (hazard ratio = 2.42, 95%CI: 1.04-5.63, P = 0.041).
CONCLUSION
Our results show that preoperative gut dysbiosis is an independent predictor of postoperative infectious complications and 2-year tumor recurrence in CRC patients. A combined biomarker model integrating the DI, CRP, and PCT achieved an area under the curve of 0.82 (sensitivity 78.0%, specificity 74.6%) for predicting postoperative infectious complications, suggesting a clinically actionable risk stratification tool. More evidence is required to incorporate gut microbiome assessment in perioperative management.
Core Tip: Preoperative gut dysbiosis, defined by Shannon diversity index < 3.0 or Dysbiosis Index (DI) ≥ 2, was identified in 61.8% of colorectal cancer (CRC) patients undergoing curative resection. Dysbiosis independently predicted 30-day postoperative infectious complications (odds ratio = 2.85) and 2-year tumor recurrence (hazard ratio = 2.42) after multivariable adjustment. A combined biomarker model integrating the DI, C-reactive protein, and procalcitonin achieved area under the curve = 0.82 for infectious complication prediction. These findings support routine preoperative gut microbiome assessment as a clinically actionable risk stratification tool in perioperative CRC management.
