Efficacy of non-pharmacological interventions for the restoration of postoperative intestinal motility of patients with colorectal cancer: a systematic review and meta-analysis of randomized controlled trials.

Abstract

Purpose: As a major indicator for rehabilitation progress, the restoration of postoperative intestinal motility of patients with colorectal cancer (CRC) is highly publicized. Various non-pharmacological interventions (NPIs) are helpful for bowel recovery. This study aims to evaluate the efficacy of NPIs in enhancing the restoration of postoperative intestinal motility.

Methods: Systematic searches were conducted in the Cochrane Library, PubMed, EBSCO, and Embase databases from inception to March 2025, with language restrictions to English. Eligible studies that quantified the effect of NPIs for the restoration of postoperative intestinal motility of patients with colorectal cancer were selected. The primary outcomes were time to first flatus and time to first defecation. The secondary outcomes were time to tolerate fluid food or solid food and length of hospital stay (LOS). Statistical analysis was performed in Review Manager 5.4, Stata v.15.1, and R 4.4.3 software.

Results: A total of 23 randomized controlled trials (RCTs) involving 3264 patients and 11 NPIs were selected. Gum chewing significantly shortened the time to first flatus (MD =  - 5.88, 95% CI - 10.33 to - 1.43; I² = 83.1%) and defecation (MD =  - 15.18, 95% CI - 21.67 to - 8.69; I² = 83.1%). Transcutaneous tibial nerve stimulation and electroacupuncture also significantly reduced the time to first flatus (MD =  - 14.95, 95% CI - 18.28 to - 11.61; I² = 39%) and defecation (MD =  - 7.29, 95% CI - 12.43 to - 2.14; I² = 0%), respectively. Network meta-analysis (NMA) identified 100 mg caffeine as the most effective intervention for shortening the time to first flatus, while decaffeinated coffee was the most effective for reducing the time to first defecation and length of hospital stay. In traditional pairwise meta-analysis and NMA, 65.7% (23/35) and 10% (1/10) of comparisons were rated as high confidence of evidence, respectively.

Conclusion: Dietary treatments are characterized by their low cost, diverse taste profiles, and lack of dependence on medical settings, making them more amenable to large-scale clinical practice promotion. Particularly, 100 mg caffeine, decaffeinated coffee, and gum chewing are worth paying attention to and recommending. For physical treatments, the limited number of studies and restricted application countries, coupled with higher costs and more stringent implementation requirements, pose significant challenges; therefore, they should be approached with caution. Given the limited evidence currently available, clinical decision-making regarding NPIs should integrate these findings with a focused consideration of the clinical setting, patient needs and preferences, and professional judgment.