Comparison of Probiotic Effects of Lactobacillus casei Shirota with Lactobacillus acidophilus on the Outcomes of Patients after Colorectal Cancer Surgery: A Study of Gastrointestinal Function, Sepsis Incidence, C-Reactive Protein, Interleukin 6 and Length of Stay

Abstract Background: Colorectal cancer surgery is often complicated by postoperative infections, which increase morbidity and mortality. Probiotic administration can reduce these infections by enhancing the intestinal barrier, regulating inflammation, and modulating the gastrointestinal immune system. This study compared the effects of two different probiotics, Lactobacillus casei Shirota and Lactobacillus acidophilus, on surgical outcomes in patients after colorectal cancer surgery. Methods: This was a two-group unblinded randomized clinical trial involving 90 adult patients undergoing colorectal cancer surgery at Dharmais Cancer Hospital. Patients were randomized to receive either L. casei Shirota or L. acidophilus. Surgical outcomes were assessed by multiple measures. Gastrointestinal function was evaluated using the I-FEED score on the second postoperative day. The risk of sepsis was assessed with the NEWS2 score on the second, fourth, and sixth days. Inflammatory markers, C-reactive protein (CRP) and interleukin-6 (IL-6), were measured. CRP levels were taken before and after surgery, while IL-6 levels were measured once before and once after surgery. The length of hospital stay was also recorded. Results: Both probiotic groups showed similar clinical effectiveness and no significant differences in laboratory results. All subjects achieved an I-FEED score below 2, indicating that both probiotics were equally effective in meeting early nutritional targets. The NEWS2 scores for all subjects were in the 0-4 range, reflecting a low risk of sepsis in both groups. The mean increase in CRP was lower in the L. casei Shirota group compared to the L. acidophilus group (118.3 ± 82.4 vs. 120.1 ± 91.0; P=0.923). Similarly, the increase in IL-6 was lower with L. casei Shirota (33.75 vs. 37.3; P=0.575). However, these differences were not statistically significant. The average hospital stay was also identical for both groups at seven days. Conclusions: Administration of L. casei Shirota showed no statistical difference compared to the administration of L. acidophilus in improving the outcomes of patients after colorectal cancer surgery Trial registration: This trial was registered in ClinicalTrials.gov, identifier NCT07144475, https://clinicaltrials.gov/study/NCT07144475, first posted on 27/08/2025.