Exploring the clinical value of probiotics in the perioperative management of colorectal cancer: Meta‑analysis with trial sequential analysis

Colorectal cancer (CRC) is the third most common malignant neoplasm, and there is currently no consensus on the clinical value of probiotics in perioperative CRC. A meta-analysis combined with a trial sequential analysis (TSA) was performed to assess the efficacy and safety of probiotics in the adjuvant treatment of CRC to provide an evidence-based recommendation for perioperative CRC. The present meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the study protocol was registered with the International Prospective Register of Systematic Reviews (CRD42024510734). The meta-analysis demonstrated that probiotics significantly reduced the incidence of postoperative infections in patients who underwent CRC surgery (risk ratio, 0.54; 95% CI, 0.45-0.65; P<0.05). Although the sample size was insufficient for the required information size (n=2,897), TSA results demonstrated that cumulative Z values exceeded both the conventional and TSA cut-offs, which indicated that this meta-analysis barely extended the probability of false positives. Meanwhile, probiotics reduced the mean number of days of hospitalization for patients with CRC (mean difference, -1.23; 95% CI, -2.18 to -0.28; P<0.05). Notably, different genera of probiotics used contributed to different outcomes, with subgroup analyses indicating that <i>Lactobacillus, Bifidobacterium</i>, combined <i>Lactobacillus</i> with <i>Bifidobacterium</i>, and multiple combination strains significantly reduced the incidence of postoperative infections in CRC, with statistically significant differences, whereas <i>Saccharomyces boulardii</i> alone did not confer a potential benefit. Overall, probiotics appeared to be effective in reducing postoperative infectious complications and shortening the length of hospital stay.