Chen XF, Zhang HY, Gao PQ, Zhuang FN, Chen WJ, Wang F. Multi-omics reveal the effects of probiotics on the postoperative rehabilitation of patients with esophageal cancer. World J Gastrointest Surg 2026; 18(9): 118081 [DOI: 10.4240/wjgs.118081]
Corresponding Author of This Article
Feng Wang, Chief Physician, Department of Thoracic Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No. 420 Fuma Road, Fuzhou 350001, Fujian Province, China. wfmd120@163.com
Research Domain of This Article
Oncology
Article-Type of This Article
research-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Chen XF, Zhang HY, Gao PQ, Zhuang FN, Chen WJ, Wang F. Multi-omics reveal the effects of probiotics on the postoperative rehabilitation of patients with esophageal cancer. World J Gastrointest Surg 2026; 18(9): 118081 [DOI: 10.4240/wjgs.118081]
Xiao-Feng Chen, Huai-Yuan Zhang, Peng-Qiang Gao, Feng-Nian Zhuang, Wei-Jie Chen, Feng Wang, Department of Thoracic Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350001, Fujian Province, China
Co-first authors: Xiao-Feng Chen and Huai-Yuan Zhang.
Author contributions: Chen XF and Zhang HY contributed equally to this manuscript and are co-first authors. Chen XF and Wang F contributed to manuscript concept and data collection and/or processing; Chen XF, Zhang HY, and Wang F contributed to manuscript design; Zhang HY and Wang F contributed to supervision and literature search; Zhuang FN, Chen WJ, and Wang F contributed to resources; Chen XF, Zhang HY, and Chen WJ contributed to materials; Chen XF and Gao PQ contributed to analysis and/or interpretation; Chen XF and Zhang HY contributed to writing manuscript; Chen XF, Gao PQ, and Wang F contributed to critical review.
AI contribution statement: The authors declare that this manuscript did not use AI tools.
Supported by the Fujian Medical University Sailing Fund Project, No. 2020QH1235.
Institutional review board statement: The Ethics Committee of Fujian Cancer Hospital conducted the ethical review and approved this study on November 20, 2024 (No. K2024-524-01).
Informed consent statement: All the study subjects provided informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Corresponding author: Feng Wang, Chief Physician, Department of Thoracic Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No. 420 Fuma Road, Fuzhou 350001, Fujian Province, China. wfmd120@163.com
Received: March 17, 2026 Revised: May 6, 2026 Accepted: July 20, 2026 Published online: September 27, 2026 Processing time: 181 Days and 23.9 Hours
Abstract
BACKGROUND
The intestinal microbial imbalance and metabolic disorders that occur in patients with esophageal cancer after surgery can hinder recovery. Probiotics have been proven to be effective in improving clinical outcomes, but the impact of probiotics on the intestinal microbiome and metabolic profile of this population has not been fully elucidated.
AIM
To investigate the effects of the combined application of probiotics and enteral nutrition on the intestinal microbiome and metabolic profile of patients with esophageal cancer after surgery.
METHODS
A total of 26 patients with esophageal squamous cell carcinoma were enrolled and equally divided into a probiotic group (PRO, n = 13) receiving enteral nutrition plus live combined Bifidobacterium and Lactobacillus tablets and a control group (NC, n = 13) receiving enteral nutrition alone. Fecal samples were collected on postoperative day 7. 16S rRNA gene sequencing and untargeted LC-MS metabolomics were performed to characterize microbial and metabolic alterations. Independent t tests, χ2 tests, linear discriminant analysis effect size (LEfSe), Wilcoxon rank-sum tests, and Spearman correlations (adjusted by false discovery rate) were used for statistical analyses.
RESULTS
No significant differences in baseline clinical characteristics were observed between the two groups (P > 0.05). Probiotic treatment altered gut microbial diversity, as evidenced by reduced, Chao1 and ACE indices and distinct beta diversity separation (nonmetric multidimensional scaling). LEfSe analysis revealed 18 differentially abundant bacterial markers, including an increased relative abundance of Bifidobacterium and the commensal Clostridium innocuum in the PRO group and decreased levels of the pathobiont Eggerthella lenta. PICRUSt2-based functional prediction revealed the activation of eight carbohydrate metabolism pathways (e.g., fructose and mannose metabolism, and ascorbate and aldarate metabolism) and the suppression of the citrate cycle (tricarboxylic acid cycle) in the PRO group. Metabolomics revealed 109 differentially abundant metabolites (Variable Importance in Projection > 1, P < 0.05), 19 of which were upregulated in the PRO group, including carbohydrates, flavonoids (e.g., yatein), and antioxidants. Spearman correlation analysis revealed potential associations between specific microbes and metabolites, such as a positive correlation between Lactobacillus and 2-(phenylethenyl)-1,3-dioxolane.
CONCLUSION
Probiotics can affect the intestinal flora and metabolites of patients after surgery and may promote their rehabilitation.
Core Tip: In this study, analysis of the clinical outcomes of the postoperative rehabilitation of patients with esophageal squamous cell carcinoma (ESCC) receiving live combined Bifidobacterium and Lactobacillus tablets revealed the underlying mechanisms including changes in the gut microbiome and fecal metabolome. Our research offers substantial evidence regarding the role of the gut microbiota in patients with ESCC after surgery, suggesting novel avenues for targeted interventions.
