Oleh Admin Kalbe Medical pada September 29, 2017 07:30

Probiotik sebagai Strategi Preventif pada Komplikasi Pembedahan Kanker Kolorektal

Kanker kolorektal berada di urutan ke-2 sebagai penyebab kematian karena tumor, yang berasal dari saluran pencernaan, secara khusus kolon dan rektum, serta liver (hati) sebagai tempat umum terjadinya metastasis. Reseksi pembedahan masih menjadi andalan untuk terapi CRC dan seiring dengan terapi pembedahan, infeksi pasca-bedah abdomen berlanjut menjadi faktor penting yang mempengaruhi morbiditas pasien-pasien CRC. Infeksi pasca-bedah, salah satunya SSI (surgical site infection/infeksi di lokasi pembedahan) menyebabkan perpanjangan waktu di RS, meningkatkan biaya, dan berpotensi menurunkan kualitas hidup dari pasien-pasien. Menurut peneliti, faktor penting yang menginduksi SSI pasca-operasi adalah gangguan pada flora pencernaan yang disebabkan oleh stres invasif dari pembedahan, penggunaan antibiotik, kelemahan motilitas saluran pencernaan, dan atrofi mukosa pencernaan karena puasa perioperatif dan iskemia intestinal.

Peneliti lain menyebutkan bahwa terapi dengan probiotik diduga dapat memperbaiki prognosis klinis dari pasien yang menjalani pembedahan gastrointestinal. Pemberian probiotik pada pasien ini ditujukan untuk berkompetisi dengan bakteri-bakteri yang bertanggung jawab terhadap peradangan pasca pembedahan. Hubungan asupan probiotik dan infeksi daerah insisi, dari salah studi meta-analisis oleh Aisu, et al, total 5 dari 70 pasien mengalami SSI pada kelompok probiotik. Hasil ini cukup kontras dibandingkan dengan kelompok kontrol-plasebo di mana 16 dari 65 pasien mengalami infeksi pasca-pembedahan. Di lihat dari parameter lain yakni deteksi bakteri dalam darah, Gianotti, et al, dalam studinya menggunakan probiotik dalam intervensi farmakologi selama periode perioperatif dan ditemukan 30% dari kelompok probiotik terdeteksi bakteri dalam darah, sedangkan pada kelompok kontrol 60% pasien terdeteksi bakteri patogen dalam darah.


Dari parameter lainnya yaitu kejadian komplikasi infeksi pada studi Liu, et al, pemberian probiotik memberikan OR=0,1926; p=0,0003; dan hasil yang signifikan secara statistik pada kelompok intervensi yang dibandingkan dengan kelompok kontrol di mana kelompok kontrol sebanyak 88% dari subjek mengalami infeksi pasca-pembedahan. Dari meta-analisis ini juga dikemukakan bahwa penggunaan probiotik atau sinbiotik saat periode perioperatif bagi pasien yang akan menjalani reseksi kolorektal diduga dapat memperbaiki outcome klinis.


Dalam studi disebutkan bahwa beberapa strain bakteri seperti Lactobacillus acidophillus dan Bifidobacterium longum dikaitkan dengan penghambatan dari induksi karsinogenik dan perkembangan CRC. Peneliti Jepang, Okazaki, et al, memberikan hasil Lactobacillus casei dan Bifidobacterium breve pada kelompok intervensi dan mendapatkan 12% dari kelompok intervensi yang mengalami komplikasi pembedahan, hal ini kontras dengan kelompok kontrol di mana 36% kelompok kontrol mengalami komplikasi pembedahan. Pada studi lain oleh Tanaka, et al, pemberian Lactobacillus casei dan Bifidobacterium breve 1x108 CFU pada periode perioperatif pada pasien dengan kanker esofagus ditemukan insidens infeksi lebih rendah pada kelompok probiotik dibandingkan dengan kelompok kontrol, 10% dan 29,4%, secara berurutan.


Pada kesimpulannya, penggunaan probiotik dapat diperluas untuk pasien yang akan menjalani tindakan pembedahan untuk kasus CRC. Yang dianjurkan adalah penggunaan kombinasi mikroorganisme seperti Lactobacillus dan Bifidobacterium. Lebih lanjut peneliti pun menyebutkan bahwa penggunaan probiotik/sinbiotik harus tetap diikuti dengan terapi utama yang tepat agar keuntungan yang didapat pasien semakin banyak. (OEP)


Image : Ilustrasi
Referensi:
1.De Andrade Calaca PR, Bezerra RP, Albuquerque WWC, Porto ALF, Cavalcanti MTH. Transl Gastroenterol Hepatol. 2017 doi: 10.21037/tgh.2017.08.01.
2.Gianotti L, Morelli L, Galbiatti F, Rocchetti S, Coppola S, Beneduce A, et al. A randomized double-blind trial on perioperative administration of probiotics in colorectal cancer patients. World J Gastroenterol. 2010 doi: 10.3748/wjg.v16.i2.167

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