Case Control Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2024; 16(5): 1259-1270
Published online May 27, 2024. doi: 10.4240/wjgs.v16.i5.1259
Clinical characteristics and risk factors of post-operative intestinal flora disorder following laparoscopic colonic surgery: A propensity-score-matching analysis
Gan-Bin Li, Chen-Tong Wang, Xiao Zhang, Xiao-Yuan Qiu, Wei-Jie Chen, Jun-Yang Lu, Lai Xu, Bin Wu, Yi Xiao, Guo-Le Lin
Gan-Bin Li, Chen-Tong Wang, Xiao Zhang, Xiao-Yuan Qiu, Wei-Jie Chen, Jun-Yang Lu, Lai Xu, Bin Wu, Yi Xiao, Guo-Le Lin, Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China
Co-first authors: Gan-Bin Li and Chen-Tong Wang.
Author contributions: Li GB and Wang CT contributed equally to this study, they are co-first authors of this manuscript. Li GB, Wang CT and Lin GL conceptualized and designed the research; Li GB, Wang CT, Zhang X, Qiu XY, Lu JY, Xu L, Wu B, Xiao Y, and Lin GL screened patients and acquired clinical data; Li GB, Wang CT, Zhang X, and Chen WJ collected the clinical data; Li GB and Wang CT performed Data analysis, wrote the paper. All the authors have read and approved the final manuscript.
Supported by The National High Level Hospital Clinical Research Funding, No. 2022-PUMCH-C-005.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Peking Union Medical College Hospital (Approval No: I-23PJ157).
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Le Lin, MD, PhD, Chief Physician, Doctor, Professor, Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, No. 1 Shuai Fu Yuan, Dongcheng District, Beijing 100730, China. linguole@126.com
Received: January 15, 2024
Revised: April 4, 2024
Accepted: April 19, 2024
Published online: May 27, 2024
Processing time: 128 Days and 22.7 Hours
Abstract
BACKGROUND

Intestinal flora disorder (IFD) poses a significant challenge after laparoscopic colonic surgery, and no standard criteria exists for its diagnosis and treatment.

AIM

To analyze the clinical features and risk factors of IFD.

METHODS

Patients with colon cancer receiving laparoscopic surgery were included using propensity-score-matching (PSM) methods. Based on the occurrence of IFD, patients were categorized into IFD and non-IFD groups. The clinical characteristics and treatment approaches for patients with IFD were analyzed. Multivariate regression analysis was performed to identify the risk factors of IFD.

RESULTS

The IFD incidence after laparoscopic surgery was 9.0% (97 of 1073 patients). After PSM, 97 and 194 patients were identified in the IFD and non-IFD groups, respectively. The most common symptoms of IFD were diarrhea and abdominal, typically occurring on post-operative days 3 and 4. All patients were managed conservatively, including modulation of the intestinal flora (90.7%), oral/intravenous application of vancomycin (74.2%), and insertion of a gastric/ileus tube for decompression (23.7%). Multivariate regression analysis identified that pre-operative intestinal obstruction [odds ratio (OR) = 2.79, 95%CI: 1.04–7.47, P = 0.041] and post-operative antibiotics (OR = 8.57, 95%CI: 3.31–23.49, P < 0.001) were independent risk factors for IFD, whereas pre-operative parenteral nutrition (OR = 0.12, 95%CI: 0.06–0.26, P < 0.001) emerged as a protective factor.

CONCLUSION

A stepwise approach of probiotics, vancomycin, and decompression could be an alternative treatment for IFD. Special attention is warranted post-operatively for patients with pre-operative obstruction or early use of antibiotics.

Keywords: Colon cancer, Laparoscopy; Intestinal flora disorder; Clinical characteristics; Risk factors

Core Tip: Intestinal flora disorders (IFD) pose challenges in laparoscopic colonectomy. This study provides a detailed analysis of IFD-related factors, offering valuable insights to improve clinical strategies. The results of this study have certain clinical practical significance. We summarized the clinical characteristics, management strategies, and prognosis of IFD in patients receiving laparoscopic colonectomy. The risk factors associated with IFD was also identified. This will help us focus on the subgroup of patients combined with risk factors during clinical practice and implement targeted preventive measures.