{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:09:36Z","timestamp":1790071776026,"version":"4.0.1"},"reference-count":88,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fecal diversion-induced dysbiosis in the defunctioned intestinal segment represents a common pathogenic basis for diversion colitis, anastomotic leakage, and long-term metabolic sequelae in patients with permanent stomas. This review proposes the novel concept of \u201cPeri-stoma Microbiome Management (PSMM)\u201d and critically evaluates the clinical evidence for fecal microbiota transplantation (FMT), defined microbial consortia, bacteriophages, and postbiotics. It is important to emphasize that PSMM is a proposed conceptual framework; most of its components have not been prospectively validated in stoma patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main body<\/jats:title>\n                    <jats:p>\n                      The core pathological process involves a dramatic reduction in butyrate-producing obligate anaerobes, depriving colonocytes of their primary energy substrate. In experimental models, butyrate depletion impairs mitochondrial function and autophagic flux, with subsequent NLRP3 inflammasome activation; whether this pathway operates identically in the defunctioned human colon remains to be directly investigated. Collagenolytic pathobionts such as\n                      <jats:italic>Enterococcus faecalis<\/jats:italic>\n                      may expand under antibiotic pressure and secrete matrix metalloproteinase-9 that degrades anastomotic extracellular matrix. However, anastomotic leakage is a multifactorial complication, involving tissue ischemia, tension, patient comorbidities, and microbial factors. The PSMM framework encompasses four phases: (I) pre-stoma creation microbial pre-habilitation and risk prediction; (II) microbiota monitoring and intervention during stoma maintenance; (III) pre-reversal targeted decolonization using bacteriophages and engineered microbiota reconstruction; and (IV) long-term metabolic maintenance for permanent stoma carriers. Bacteriophages show promise for precision decolonization but face significant challenges, including bacterial resistance, narrow host range, manufacturing complexity, and regulatory barriers. Multi-omics monitoring remains aspirational due to high costs, long turnaround times, and lack of clinical integration.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The PSMM framework provides a structured conceptual approach for integrating microbiome-targeted strategies into the care of patients with intestinal stomas. However, most interventions remain investigational and require validation in adequately powered randomized trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1913974","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:54:15Z","timestamp":1790070855000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Fecal microbiota transplantation and peri-stoma microbiome management in patients with intestinal stomas: from mechanisms to clinical translation"],"prefix":"10.3389","volume":"16","author":[{"given":"Qiujun","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal Surgery, General Hospital of Hunan University of Medicine","place":["Huaihua, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huifei","family":"Xiang","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal 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