Tesis

Perbandingan Efek Probiotik Lactobacillus casei Shirota dengan Lactobacillus acidophilus pada Luaran Pasien Pascabedah Kanker Kolorektal: Kajian terhadap Fungsi Gastrointestinal, Kejadian Sepsis, C-Reactive Protein, IL- 6, dan Lama Rawatan = Comparison of Lactobacillus casei Shirota with Lactobacillus acidophilus Probiotics Effect on Post-Colorectal Cancer Surgery Patient Outcomes: A Study of Gastrointestinal Function, Sepsis Incidence, C-Reactive Protein, IL-6, and Length of Stay.

Latar Belakang: Pembedahan merupakan salah satu bagian dari tatalaksana berbasis komprehensif pada pasien dengan kanker kolorektal. Kejadian infeksi pascabedah kanker kolorektal berkontribusi terhadap tingginya morbiditas dan mortalitas dari operasi kanker kolorektal. Pemberian probiotik yang meningkatkan sawar usus, menurunkan regulasi peradangan serta memodulasi sistem imun saluran pencernaan mampu menurunkan kejadian infeksi pascabedah. Studi ini bertujuan untuk membandingkan efek pemberian probiotik Lactobacillus casei Shirota dengan Lactobacillus acidophilus pada luaran pasien pascabedah kanker kolorektal. Luaran yang dinilai pada studi ini adalah fungsi gastrointestinal, kejadian sepsis, C-reactive protein (CRP), interleukin 6 (IL-6), dan lama rawatan. Metode: Penelitian ini merupakan uji klinis acak tidak tersamar pada 90 (Sembilan puluh) pasien dewasa yang menjalani bedah kanker kolorektal yang dirawat di ICU, HCU dan bangsal perawatan RS Kanker Dharmais. Subyek yang memenuhi kriteria dibagi menjadi 2 (dua) kelompok: kelompok yang diberikan probiotik Lactobacillus casei Shirota dan Lactobacillus acidophilus. Penilaian fungsi gastrointestinal menggunakan I-FEED score terhadap early feeding dilakukan pada hari perawatan kedua di ICU setelah operasi. Diagnosis sepsis menggunakan skoring NEWS2 yang diperiksa pada hari perawatan kedua, keempat, dan keenam. Kadar CRP diukur sebanyak tiga kali, yaitu pada hari kunjungan ke poli perioperatif, empat jam sebelum operasi dan tiga hari setelah operasi. Kadar IL-6 diukur sebanyak dua kali pada hari kunjungan ke pada hari kunjungan ke poli perioperatif dan tiga hari setelah operasi. Lama rawatan dihitung mulai dari setelah operasi hingga pasien rawat jalan. Hasil: Kedua intervensi menunjukkan efektivitas yang tidak berbeda secara klinis, dan perbedaan yang tidak signifikan pada parameter laboratorium. Skor I-FEED pada semua subjek penelitian yaitu  2, yang memiliki makna klinis bahwa baik kelompok Lactobacillus casei Shirota maupun Lactobacillus acidophilus tidak berbeda dalam memenuhi target nutrisi yang ditetapkan. Skor NEWS2 pada seluruh subjek penelitian sama yaitu antara 0 sampai 4, yang memiliki makna klinis risiko rendah sepsis. Hasil penelitian ini menunjukkan mean peningkatan CRP Lactobacillus casei Shirota lebih rendah dibanding Lactobacillus acidophilus (118.3 ± 82.4 vs. 120.1 ± 91.0; p > 0.05). Sama halnya dengan CRP, peningkatan IL-6 Lactobacillus casei Shirota lebih rendah dibanding Lactobacillus acidophilus (33.75 (0-875) vs. 37.3 (1.35-817.3); p > 0.05). Hasil penelitian juga menunjukkan bahwa kedua kelompok memiliki durasi lama rawatan yang sama yaitu tujuh hari. Kesimpulan: Pemberian Lactobacillus casei Shirota tidak berbeda dibandingkan Lactobacillus acidophilus dalam memperbaiki luaran pasien pascabedah kanker kolorektal yang dinilai melalui fungsi gastrointestinal, kejadian sepsis, CRP, IL-6, dan lama rawatan.
Kata kunci: Probiotik, Lactobacillus casei Shirota, Lactobacillus acidophilus, Kanker Kolorektal, Luaran Pascabedah


Background: Surgery is one part of a comprehensive management approach for patients with colorectal cancer. The incidence of postoperative infection after colorectal cancer surgery contributes to the high morbidity and mortality rates of colorectal cancer. Probiotic administration, which enhances the intestinal barrier, reduces inflammation regulation, and modulates the gastrointestinal immune system, can reduce the incidence of postoperative infections. This study aims to compare the effects of administering Lactobacillus casei Shirota probiotics with Lactobacillus acidophilus on the outcomes of patients after colorectal cancer surgery. The outcomes assessed in this study include gastrointestinal function, sepsis incidence, C-Reactive Protein (CRP), IL-6, and length of stay. Methods: This research is a non-blinded randomized clinical trial in 90 adult patients undergoing colorectal cancer surgery who are treated in the ICU, HCU and wards of Dharmais Cancer Hospital. Subjects who meet the criteria are divided into 2 (two) groups: the group given Lactobacillus casei Shirota and Lactobacillus acidophilus probiotics. Assessment of gastrointestinal function using the I-FEED score for early feeding was carried out on the second day after surgery. Sepsis diagnosis used the NEWS2 scoring assessed on the second, fourth and sixth days of treatment. CRP levels were measured three times, namely during perioperative visit before surgery, four hours before surgery and three days after surgery. IL-6 levels were measured twice, namely perioperative visit before surgery and 3 days after surgery. Length of stay was calculated from after surgery until the patient was discharged Results: Both interventions showed similar clinical effectiveness, while laboratory results showed no significant differences. The I-FEED score in all study subjects was below 2, which has a clinical meaning that both the Lactobacillus casei Shirota and Lactobacillus acidophilus groups were equally able to meet the set nutritional targets. The NEWS2 score in all study subjects was the same, which was in the range of 0 to 4, which has a clinical meaning of a low risk of sepsis. The results of this study showed that the mean increase in CRP ofLactobacillus casei Shirota was lower than of Lactobacillus acidophilus (118.3 ± 82.4 vs. 120.1 ± 91.0; p > 0.05). Similar to CRP, the increase in IL-6 of Lactobacillus casei Shirota was lower than of Lactobacillus acidophilus (33.75 (0-875) vs. 37.3 (1.35-817.3); p > 0.575). The results of the study also showed that both groups had the same average duration of hospitalization, namely seven days. Conclusions: Lactobacillus casei Shirota shows no difference compared to Lactobacillus acidophilus on improving the outcomes of patients after colorectal cancer surgery as assessed by gastrointestinal function, sepsis incidence, CRP, IL- 6, and length of stay.
Keywords: Probiotics, Lactobacillus casei Shirota, Lactobacillus acidophilus, Colorectal Cancer, Surgical Outcomes