Ohigashi, S., Hoshino, Y., Ohde, S., & Onodera, H. (2011). Functional outcome, quality of life, and efficacy of probiotics in postoperative patients with colorectal cancer. Surgery Today, 41, 1200–1206.

To compare functional outcome and quality of life (QOL) in patients who received surgical resection for rectal versus colon cancer, and to review the efficacy of the use of probiotics in bowel function afterwards.

A questionnaire was sent to 193 patients with non–stage IV colon cancer. Some patients with stage III disease received adjuvant chemotherapy over the six-month postoperative period, but no patients were undergoing chemotherapy when the questionnaire was administered. Seventy-seven respondents agreed to take probiotics. Patients received a probiotic that contained Bacillus natto and Lactobacillus acidophilus as the principal ingredients.

Patients took three tablets after meals TID for a total of nine tablets. The questionnaire was readministered three months after probiotic initiation.

• The study reported on a sample of 77 patients with colorectal cancer, divided into right-side, left-side, and rectal groups.
• Patient age ranged from 52 to 77 years across all study groups.
• The final sample comprised 35 men (right side: n = 11; left side: n = 12; rectal: n = 12) and 26 women (right side: n = 7; left side: n = 9; rectal: n = 10).

• Single site
• Multiple settings
• Japan

• Patients were in the late-effect and survivorship phases of care.
• The study has clinical applicability to older adult care.

 This was a questionnaire-based study with a cross-sectional design.

• Medical Outcomes Study (MOS) 36-item Short-Form Health Survey (SF-36) in Japanese
• European Organization for Research and Treatment of Cancer (EORTC) Cancer Core Quality of Life Questionnaire (QLQ-C30) in Japanese
• Functional outcome was scored using the Wexner Fecal Incontinence Score and questions specific to bowel function.

• Functional outcomes (related to defecation frequency and anal pain), Wexner score, and social function on the QLQ-C30 were worse in the rectal group.
• The right-side group had a tendency toward softer stools and more frequent nighttime defecation than the left-side group.
• Global QOL, constipation, and diarrhea on the QLQ-C30 was improved in the rectal group.
• Frequency of defecation, role of emotion on the SF-36, and constipation on the QLQ-C30 were improved in the left-side group.
• Defecation, frequency, feeling of incomplete evacuation, and global QOL on the SF-36 were significantly improved in the right-side group.
• Patients who were receiving probiotics had a statistically significant reduction in frequency of stools per day (0.4 change; p < 0.05), and 50% fewer patients with right-side colon disease experienced the feeling of incomplete defecation after probiotic use (p < 0.05).
• Specific aspects of QOL scores showed mixed results, with some improving and some subscale scores worsening.

Some improvements were observed in all groups after the administration of probiotics. Changes in defecation and related symptoms differed according to disease location over time. The role of probiotic use cannot be determined from this study report.

• The sample size was small (fewer than 100 patients).
• Risk of bias existed because the study lacked a control group, blinding, and random assignment.
• Unintended interventions or applicable interventions that may have influenced the results were not described.
• Changes over time were not compared between patients who received probiotics and those who did not. As bowel habits and problems can be expected to change over time after surgery and according to tumor location, the impact of probiotic use cannot be determined based on this study.

The study did not provide sufficient evidence to demonstrate the efficacy of probiotic use for managing bowel symptoms in patients after colorectal surgery. However, the study showed differences in bowel symptoms based on initial tumor location and surgical area.