Perioperative gut microbial ecology: a new frontier for improving the prognosis of hepatocellular carcinoma surgery

Abstract For patients diagnosed with hepatocellular carcinoma (HCC), surgical intervention remains the primary treatment modality. Nonetheless, challenges such as poor postoperative prognosis and the potential for recurrence contribute significantly to patient suffering. During the perioperative period, the stability of the gut microbiota in patients with HCC is significantly disrupted. This disruption can substantially affect the liver microenvironment and ultimately influence postoperative outcomes. Notably, the metabolic reprogramming of the liver induced by gut microbiota dysbiosis, along with persistent inflammation and suppressed immune surveillance, are key factors in HCC recurrence. Consequently, the gut microbiota has emerged as a critical risk factor in improving perioperative outcomes for patients with HCC. In this review, we summarize the factors contributing to changes in the gut microbiota during the perioperative period in patients with HCC, as well as the potential mechanisms by which gut microbiota dysbiosis affects prognosis. More importantly, we have proposed strategies based on the aforementioned mechanisms affecting prognosis, including restoring the gut microbiota, repairing the gut-liver barrier, providing perioperative relief, and enhancing liver regeneration. Further, this review also outlines potential challenges in clinical applications aimed at improving postoperative outcomes for HCC patients through gut microbiota-based interventions, particularly regarding sampling and patient susceptibility stratification. Collectively, these studies will further advance the development of personalized therapies targeting the microbiome, ultimately improving prognostic strategies for patients undergoing surgical intervention for HCC.