Antibiotics | Selective Decontamination of the Esophagus Reduces Postoperative Infectious Complications After Esophagectomy

This study is the first to explore the impact of Selective Oral Decontamination (SOD) on the esophageal microbiome and postoperative infectious complications in patients with esophageal cancer. The results indicate that SOD significantly reduces the incidence of postoperative pneumonia and other infectious complications while altering the composition of the esophageal microbiome, offering new insights for optimizing perioperative management.

 

Literature Overview
This article, titled "Selective Oral Decontamination of the Esophagus to Reduce Microbial Burden of the Digestive Tract in Elective Esophagectomy: A Proof-of-Principle Study," published in the journal Antibiotics, reviews and summarizes the preliminary effects of selective oral decontamination on postoperative infectious complications in patients with esophageal cancer. The research team analyzed changes in the esophageal microbiome of 22 patients undergoing robot-assisted minimally invasive esophagectomy using 16S rRNA sequencing. They found that SOD treatment significantly reduced the incidence of infectious complications and pneumonia, suggesting a foundation for future large-scale randomized controlled trials.

Background Knowledge
Esophageal cancer is among the malignant tumors with high incidence and postoperative complication rates globally. Infectious complications after esophagectomy, particularly pneumonia and anastomotic leakage, significantly affect patient prognosis and healthcare resource utilization. In recent years, Selective Digestive Tract Decontamination (SDD) has been widely applied in intensive care and abdominal surgeries to reduce colonization and infection risks from potential pathogens. However, systematic investigations into its application before esophagectomy for esophageal cancer are still lacking. The composition of the esophageal microbiome has been closely linked to the development of esophagitis, Barrett's metaplasia, and esophageal cancer. Therefore, modulating the esophageal microbiota may play a significant role in postoperative infections and disease prognosis. This study aims to provide preliminary evidence to validate the impact of SOD on the esophageal microbiome and postoperative infectious complications, offering a novel intervention strategy for infection control during the perioperative period.

 

 

Research Methods and Experiments
The study enrolled 22 patients with esophageal cancer undergoing robot-assisted minimally invasive esophagectomy, of which 13 received selective oral decontamination treatment (oral administration of amphotericin B, tobramycin, and polymyxin) from 7 days preoperatively to 5 days postoperatively, while 9 received standard treatment. All patients had esophageal biopsy samples collected preoperatively and intraoperatively for microbiome analysis. The incidence of infectious complications was evaluated during postoperative follow-up until discharge or 30 days. The microbiome was analyzed using 16S rRNA gene amplicon sequencing, with taxonomic annotations performed using the Ribosomal Data Project. Statistical analysis was conducted using Student’s t-test, χ2 test, or Fisher’s exact test, with significance set at p < 0.05.

Key Conclusions and Perspectives

• The incidence of infectious complications was significantly lower in the selective oral decontamination group compared to the control group (7.7% vs. 55.5%, p = 0.008).
• The incidence of postoperative pneumonia was 0% in the SOD group and 33.3% in the control group (p = 0.007).
• Postoperative microbiome analysis showed an increased abundance of Lactobacillus and decreased abundance of Prevotella in the decontamination group.
• Patients with postoperative infectious complications showed higher abundance of Neisseria and lower abundance of Streptococcus in the esophageal microbiome.
• Despite high inter-individual variability in the microbiome, SOD had a detectable effect on microbiome structure (PERMANOVA, p = 0.03).

Research Significance and Prospects
This study represents the first systematic evaluation of SOD’s impact on postoperative infectious complications and the microbiome in patients undergoing esophagectomy for esophageal cancer, preliminarily confirming its potential in reducing infectious complications. Future studies should include larger-sample randomized controlled trials to further validate SOD’s efficacy and safety, as well as its long-term effects on the microbiome. Additionally, the findings suggest the esophageal microbiome may serve as a potential biomarker for predicting postoperative infections, opening the door for personalized anti-infective strategies.

 

 

Conclusion
This study provides preliminary evidence for the application of selective oral decontamination before esophagectomy in patients with esophageal cancer, suggesting it may reduce postoperative infectious complications by modulating the esophageal microbiome. Despite the small sample size, the results highlight the critical role of the microbiome in postoperative infections. Future research should increase the sample size and incorporate metagenomic and metabolomic analyses to further elucidate the causal relationship between the microbiome and infectious complications. Exploring the dynamic changes in the microbiome and their associations with clinical outcomes may offer new intervention targets for perioperative anti-infective strategies, promoting the application of precision medicine in esophageal cancer surgery.

 

Johannes Klose, Konrad Lehr, Ulrich Ronellenfitsch, Alexander Link, and Jörg Kleeff. Selective Oral Decontamination of the Esophagus to Reduce Microbial Burden in Patients Undergoing Esophagectomy for Esophageal Cancer (SODA)—First Results from a Proof-of-Principle Study. Antibiotics.