Currently colorectal cancer (CRC) is the third most prevalent cancer worldwide. Body mass index (BMI) is frequently used in CRC screening and risk assessment to quantitatively evaluate weight. However, the impact of BMI on clinical strategies for CRC has received little attention. Within the framework of the predictive, preventive, and personalized medicine (3PM/PPPM), we hypothesized that BMI stratification would affect the primary, secondary, and tertiary care options for CRC and we conducted a critical evidence-based review. BMI dynamically influences CRC outcomes, which helps avoiding adverse treatment effects. The outcome of surgical and radiation treatment is adversely affected by overweight (BMI ≥ 30) or underweight (BMI < 20). A number of interventions, such as enhanced recovery after surgery and robotic surgery, can be applied to CRC at all levels of BMI. BMI-controlling modalities such as exercise, diet control, nutritional therapy, and medications may be potentially beneficial for patients with CRC. Patients with overweight are advised to lose weight through diet, medication, and physical activity while patients suffering of underweight require more focus on nutrition. BMI assists patients with CRC in better managing their weight, which decreases the incidence of adverse prognostic events during treatment. BMI is accessible, noninvasive, and highly predictive of clinical outcomes in CRC. The cost–benefit of the PPPM paradigm in developing countries can be advanced, and the clinical benefit for patients can be improved with the promotion of BMI-based clinical strategy models for CRC.
Purpose The object of this article was to assess the efficacy and safety of acupuncture and moxibustion therapy for patients recovering after surgical resection of Colorectal Cancer (CRC).Methods We systematically searched eight databases from the establishment of the database to October 2021 for randomized clinical trials (RCTs). We used the Cochrane risk of bias (ROB) tool to assess the ROB and the RevMan 5.3 for data analysis. The certainty of outcomes was summarized using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).Results Twenty-seven studies involving the recovery of GI function met the inclusion criteria. There was significant variability and a high or unknown ROB. For certain outcomes reflecting physiological recovery, in comparison to sham acupuncture or usual care, acupuncture had a clear therapeutic effect, as measured by the time to first flatus [MD=−13.87, 95% CI (−17.82, −9.93), I2 =94%, p<0.00001], time to first defecation [MD=−15.25, 95% CI (−19.76, −10.75), I2 =94%, p<0.00001] and time to first bowel sounds [MD=−8.56, 95% CI (10.9, −6.23) I2 =91%, p<0.00001). Five studies reported possible adverse events of acupuncture and moxibustion, while the other studies did not premeditate adverse events.Conclusion Acupuncture and moxibustion are appropriate adjunctive treatments for postoperative GI function and they improve other symptoms, such as postoperative pain, to a certain extent for patients with CRC. For other symptoms, the efficacy remains uncertain due to a high ROB among studies. Future research should focus on not only more rigorous, well-designed and larger RCTs but also on assessing the biological mechanisms.
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