Strengths and Limitations
Our study has several limitations. Firstly, the small sample size,
limited us from performing subgroup analysis to various conditions that
are known to affect microbial composition such as menopausal state, age,
and former use of antibiotics. The latter is also a limitation in terms
of the comparison of microbiota between cases and controls. While such
studies are difficult to perform on a prospective cohort, larger studies
are definitely needed. Another limitation may be our decontamination
protocols, which could be filtering out outputs that might have been of
importance, and the choice to set a high rarefaction cutoff in the
setting of a low biomass microbial environment causing many samples to
fail the positivity criterion. While our preference was to optimize our
analyzed data, it came with the cost of losing a substantial number of
eligible samples. The study was performed at a single center, by the
same surgical team, which is an advantage when considering the
consistency (internal validity) of the sampling technique in all
patients but its external validity and generalizability may be limited.