ArticleUpdates in surgery2023
How to reduce the colorectal anastomotic leakage? The MIRACLe protocol experience in a cohort in a single high-volume centre.
Article in Updates in surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed, 19 citations in OpenAlex.
- Effects of stoma discharge reinfusion on low anterior resection syndrome and the gut microbiota following sphincter-preserving surgery for middle and low rectal cancer: a randomized clinical trial.Updates in surgery · 2026Trial
- Pre-, Pro-, Post- and Synbiotics in Pediatric Short Bowel Syndrome: A Narrative Review of Current Evidence.Children (Basel, Switzerland) · 2026Review
- How aging may impact the failure to rescue after colorectal laparoscopic surgery. Analysis of 1000 patients in a single high-volume center.Updates in surgery · 2025Article
- Radiomics Beyond Radiology: Literature Review on Prediction of Future Liver Remnant Volume and Function Before Hepatic Surgery.Journal of clinical medicine · 2025Review
- Transversalis fascia collagen content and the risk of surgical complications: results of a prospective study.Langenbeck's archives of surgery · 2025Article
- Review
- Gut Microbiota-Adversary or Ally? Its Role and Significance in Colorectal Cancer Pathogenesis, Progression, and Treatment.Cancers · 2024Review
- The role of superior hemorrhoidal vein ectasia in the preoperative staging of rectal cancer.Frontiers in oncology · 2024Article
- Editorial: Colorectal cancer awareness month 2023: diagnosis, clinical course, and surgical management of metastatic colorectal cancer.Frontiers in oncology · 2024Article
- Advancing surgical prehabilitation through microbiota modulation.Przeglad gastroenterologiczny · 2024Article
- Colorectal Cancer: Current Updates and Future Perspectives.Journal of clinical medicine · 2023Review
- Efficacy of Switching to Adalimumab for Maintenance of Remission Following Induction Therapy with Tacrolimus in Patients with Ulcerative Colitis.Journal of clinical medicine · 2023Article
- Artificial Intelligence to Early Predict Liver Metastases in Patients with Colorectal Cancer: Current Status and Future Prospectives.Life (Basel, Switzerland) · 2023Review
- Treatment for T1 colorectal cancers substratified by site and size: "horses for courses".Frontiers in medicine · 2023Article
- Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This article reports the results of a novel perioperative treatment implementing the gut microbiota to prevent anastomotic fistula and leakage (AL) in patients undergoing laparoscopic colorectal resections for cancer and represents the continuation of our pilot study on 60 cases. A series of 131 patients underwent elective colorectal surgery at the S. Eugenio Hospital (Rome-Italy) between December 1, 2020, and November 30, 2022, and received a perioperative preparation following the Microbiota Implementation to Reduce Anastomotic Colorectal Leaks (MIRACLe) protocol comprising oral antibiotics, mechanical bowel preparation and perioperative probiotics. The results obtained in the MIRACLe group (MG) were compared to those registered in a Control group (CG) of 500 patients operated on between March 2015 and November 30, 2020, who received a standard ERAS protocol. Propensity score-matching (PSM) analysis was performed to overcome patients' selection bias. Patients were categorised according to perioperative preparation (MIRACLe protocol vs standard ERAS protocol) into two groups: 118 patients were in post-matched MIRACLe group (pmMG) and 356 were in post-matched Control group (pmCG). In the pmMG, only 2 anastomotic leaks were registered, and the incidence of AL was just 1.7% vs. 6.5% in the pmCG (p = 0.044). The incidence of surgical site infections (1.7% vs. 3.1%; p = 0.536), reoperations (0.8% vs. 4.2%; p = 0.136) and postoperative mortality (0% vs. 2.0%; p = 0.200) was lower in pmMG. Additionally, the postoperative outcomes were better: the times to first flatus, to first stool and to oral feeding were shorter (1 vs. 2, 2 vs. 3 and 2 vs. 3 days, respectively; p < 0.001). The postoperative recovery was faster, with a shorter time to discharge (5 vs. 6 days; p < 0.001). The MIRACLe protocol was confirmed to be safe and significantly able to reduce anastomotic leaks in patients receiving elective laparoscopic colorectal surgery for cancer.
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