Simo Decoction and Acupuncture on POI in Colorectal Cancer
Efficacy of Simo Decoction and Acupuncture or Chewing Gum Alone on Postoperative Ileus in Colorectal Cancer Resection: a Randomized Clinical Trial
Colorectal cancer resection is one of the most common types of abdominal surgery. Though
most patients undergoing colorectal resection show recovery of bowel movements within a
week, some have prolonged intestinal paralysis or postoperative ileus, resulting in
decreasing patient comfort, increasing morbidity and mortality, a longer hospital stay and
subsequent increased healthcare costs.
Prevention the incidence of postoperative ileus (POI) is quite important because of the
negative clinical outcomes it causes. In the past two decades, many treatments and care
approaches, such as fluid restriction, early enteral nutrition, and nonsteroidal
anti-inflammatory drug are used for the management of POI. In theory of traditional Chinese
medicine, oral simo decoction (SMD) or acupuncture at the tsusanli acupoint can boost
gastrointestinal hypomotility. The efficacy of accelerating the return of gastrointestinal
function by such single method or combination of them has been validated in randomized
controlled trials and systematic review following several types of surgery. In recent years,
chewing gum, a new and simple modality, has become a commonly applied method in order to
prevent and reduce the POI. Systematic reviews and meta-analyses revealed that chewing gum
provided significant benefits for the improvement of postoperative bowel function. More
importantly, many official guidelines recommend chewing gum for an evidence-based approach
in the prevention of POI. Despite these positive evidence, three newest randomized
controlled trials are unable to demonstrate an effect of chewing gum on the recovery of
bowel function after colorectal resection.
It is important to note that almost all previous randomized controlled trials are based on
small sample size. This raises the question whether postoperative SMD, acupuncture at the
tsusanli acupoint, or chewing gum can reduce risk of POI following colorectal resection
among patients with large sample size. To examine this question, we conducted this
randomized controlled trial to compare incidence of POI and length of hospital stay in
colorectal cancer patients who received SMD and acupuncture, chewing gum or no intervention
Guangxi Medical University
Guangxi Medical University
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Kobayashi T, Masaki T, Kogawa K, Matsuoka H, Sugiyama M. Efficacy of Gum Chewing on Bowel Movement After Open Colectomy for Left-Sided Colorectal Cancer: A Randomized Clinical Trial. Dis Colon Rectum. 2015 Nov;58(11):1058-63. doi: 10.1097/DCR.0000000000000452.
Atkinson C, Penfold CM, Ness AR, Longman RJ, Thomas SJ, Hollingworth W, Kandiyali R, Leary SD, Lewis SJ. Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection. Br J Surg. 2016 Jul;103(8):962-70. doi: 10.1002/bjs.10194.