Effects of acupuncture treatment on postoperative gastrointestinal dysfunction in colorectal cancer: study protocol for randomized controlled trials

Abstract

Background Postoperative gastrointestinal dysfunction (PGID) is a common complication arising from colorectal cancer surgery. Attributing factors, such as anesthesia, surgical retraction, and early intake of water, can inhibit gastrointestinal motility, causing constipation, reduction or absence of bowel sounds, nausea, vomiting, and other symptoms. Delayed recovery in gastrointestinal function can lead to intestinal obstructions or paralysis, anastomotic leaks, and other complications, affecting the patient’s recovery and quality of life negatively. Due to its complex pathophysiology, treatment for PGID in colorectal patients has remained a challenge. Acupuncture is an alternative therapy commonly used for postoperative recovery. This study aims to evaluate the therapeutic efficacy and safety of acupuncture on PGID. Through the complementation of acupuncture and enhanced recovery after surgery (ERAS) protocols, the advantages of acupuncture treatments could be demonstrated to promote its application in future clinical practice. Methods The study design is a prospective randomized controlled trial (RCT). One hundred sixty postoperative colorectal cancer patients will be recruited from Cancer Hospital Chinese Academy of Medical Sciences (CICAMS). Subjects who fulfill inclusion criteria will be randomly assigned into the acupuncture group (AG) (n = 80) or control group (CG) (n = 80). AG will receive acupuncture treatment and perioperative care guided by ERAS protocols, and CG will only receive perioperative care guided by ERAS protocols. The intervention will begin on the first day post-surgery, continuing for 4 days, with a follow-up assessment in a month. Time of first postoperative flatus would be the primary outcome measure. Secondary outcome measures include the time of first postoperative defecation, time of first fluid intake, time of first ambulation, postoperative hospital stay, gastrointestinal reaction score, acupuncture sensation evaluation scale, laboratory tests, postoperative quality of life, readmission rate, and postoperative complications. All results are evaluated from baseline, post-treatment, and upon follow-up. Discussion The results of the study would help elucidate evidence of the therapeutic effects of acupuncture on the recovery of postoperative gastrointestinal function. The objective of the study aims for the eventual inclusion of acupuncture in the ERAS protocol, allowing for wider application in clinical practice. Trial registration ClinicalTrials.gov ChiCTR2000036351. Registered on August 22, 2020

Effectiveness of acupuncture for postoperative gastrointestinal recovery in patients undergoing thoracoscopic surgery: a prospective randomized controlled study

“…The primary outcome of this study was time to first postoperative flatus. 18 This time period was measured as the interval between recovery from anesthesia and the first passage of flatus. The secondary outcomes included the time to first postoperative defecation, time to first fluid intake, time to first food intake, and time to first ambulation.…”

“…The secondary outcomes included the time to first postoperative defecation, time to first fluid intake, time to first food intake, and time to first ambulation. 18 Other secondary outcomes included postoperative pain scores, nausea, vomiting, 19 and other relevant complications (e.g. anorexia, insomnia, dizziness).…”

“…22 Previous studies have mostly been implemented in patients undergoing gastric or colorectal surgery. 18,23,24 It is unclear whether acupuncture is equally effective in thoracic surgery; therefore, a prospective, randomized trial is needed to evaluate its potential role in this setting. The aim of this study was to investigate the therapeutic effectiveness of acupuncture for postoperative recovery of gastrointestinal function in patients undergoing thoracoscopic surgery.…”

“…Clinical evidence suggests that acupuncture can promote the recovery of gastrointestinal function after major surgery, and both manual acupuncture and electroacupuncture have been reported to have preventive and therapeutic value. [18][19][20] However, the mechanism by which acupuncture promotes gastrointestinal peristalsis is still not clear. Acupuncture has been found to enhance gastric motility via the efferent parasympathetic pathway 21 and the N-methyl-D-aspartate (NMDA) receptor.…”