Effect of Probiotics on the Clinical Outcome and Inflammatory Response in Gastric Cancer Surgery: A Double Blinded Randomized Control Trial

Clinical Snapshot

Key Findings

• P Value: <0.05

• Effect Size: 3-day reduction in median hospital stay

• Primary Outcome: Length of hospital stay: 9 days (probiotic) vs 12 days (placebo)

• Nnt Or Sensitivity: Not calculable from available data

• Confidence Interval: Not reported

Clinical Application

Highly feasible - probiotics are readily available, well-tolerated, and easy to administer postoperatively Relevant to Australian practice; probiotics available over-the-counter and through PBS for specific indications. Results align with enhanced recovery after surgery (ERAS) protocols increasingly adopted in Australian hospitals Patients undergoing gastrectomy for gastric cancer in tertiary surgical centres

Abstract

BACKGROUND AND AIM: Gut dysbiosis contributes to postoperative complications and worsens the inflammatory and immune dysfunction in gastric cancer (GC) patients. Probiotics may mitigate these effects by modulating gut microbiota. This study aimed to evaluate the effect of probiotics on the length of hospital stay, other post-operative clinical outcomes, nutritional status, inflammatory and immune markers in patients undergoing gastrectomy for gastric cancer. METHODS: This was a single-centred, prospective, double blinded, placebo-controlled trial. Participants were patients who underwent open gastrectomy for gastric cancer. Participants were randomized to receive probiotics or placebo for 10 days starting on postoperative day (POD) 1. Blood samples were collected preoperatively and POD 10 to assess haemoglobin, total counts, albumin, IL6, TNFα, and IgA. Clinical outcomes including time to first flatus, first passage of stools, oral diet resumption and length of hospital stay (LOHS). Postoperative complications were monitored for 30 days and classified using the Clavien-Dindo system. RESULTS: Of 42 participants (22 probiotic, 20 placebo), baseline characteristics were comparable. The probiotic group had a significantly shorter median LOHS (9 vs. 12 days, p<0.05), earlier time to first passage of flatus (2.6 vs. 4.3 days, p<0.05), earlier time to first passage of stools (3.6 vs. 5.7 days, p<0.05), and oral diet resumption (3.6 vs. 5.7 days, p<0.05). No significant differences were observed in inflammatory markers (TLC, IL-6, TNF-α), immune markers (IgA), nutritional status (albumin, haemoglobin), or postoperative complications (p>0.05). CONCLUSION: Postoperative probiotic supplementation reduced LOHS and improved gastrointestinal recovery in GC patients undergoing gastrectomy, but did not significantly affect inflammatory, immune, or nutritional markers.

References

1. 1.Pal, D., Anandhi, A., Keerthi, A. R., Nanda, N., & Kate, V. (2026). Effect of probiotics on the clinical outcome and inflammatory response in gastric cancer surgery: A double blinded randomized control trial. Journal of Gastrointestinal Cancer. https://doi.org/10.3748/wjg.v28.i18.1946