Hideki Kogo, Akihisa Matsuda, Yasuyuki Negishi, Rimpei Morita, Hiroshi Yoshida
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A meta-analysis was performed using random-effects models to calculate mean difference (MD) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Eleven true RCTs involving 1413 patients (with DKT group, n = 716; Without DKT group, n = 697) were included. The meta-analysis demonstrated a significant improvement of the time to first postoperative flatus in the With DKT group than in the Without DKT group, with an MD of - 0.19 (95% CI - 0.34 to - 0.04, P = 0.01), and no significant between-study heterogeneity was observed (χ<sup>2</sup> = 8.12, I<sup>2</sup> = 26%, P = 0.23). Subgroup analysis demonstrated a significantly shorter time to first postoperative flatus in categories of surgery other than colorectal, studies of double-blinded, multi-institutional, 100 or more patients included.</p><p><strong>Conclusions: </strong>This meta-analysis suggests that DKT can improve postoperative intestinal dysfunction (i.e., first postoperative flatus) after gastroenterological cancer surgery, but the efficacy was modest. 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引用次数: 0
摘要
背景：术后肠道功能障碍是腹部手术的主要并发症。日本中草药大kenchuto （DKT）对术后肠功能障碍的疗效进行了研究。然而，这些研究得出了不确定的结果，之前的荟萃分析不仅包括真正的随机对照试验（rct），还包括低质量的随机对照试验。方法：到2025年4月进行全面的电子文献检索，以确定真正的随机对照试验，比较胃肠癌手术围手术期给予或不给予DKT的患者。主要观察指标为术后首次放屁的时间。采用随机效应模型进行meta分析，以95%置信区间（ci）计算平均差（MD）。结果：纳入11项真实rct，共1413例患者（有DKT组，n = 716；无DKT组，n = 697）。荟萃分析显示，与未行DKT组相比，有DKT组术后首次放屁时间显著缩短，MD为- 0.19 (95% CI - 0.34 ~ - 0.04, P = 0.01)，研究间无显著异质性（χ2 = 8.12, I2 = 26%, P = 0.23）。亚组分析显示，在双盲、多机构、100例或更多患者的研究中，除结直肠手术外，其他手术类别患者术后首次出现肠胃胀气的时间显著缩短。结论：本荟萃分析提示，DKT可改善胃肠癌术后肠道功能障碍（即术后首次肠胃胀气），但疗效一般。因此，DKT改善术后肠功能障碍的疗效值得在更多高质量的随机对照试验中进一步研究。注册和注册号：本系统评价和荟萃分析已在UMIN-CTR注册（ID: UMIN000066046） （https://www.umin.ac.jp/ctr/index-j.htm）。
Is daikenchuto effective for postoperative intestinal dysfunction after gastroenterological cancer surgery? An updated meta-analysis of randomized controlled trials.
Backgrounds: Postoperative intestinal dysfunction is a major complication following abdominal surgery. Daikenchuto (DKT), Japanese herbal (Kampo) medicine, has been investigated the efficacy for postoperative intestinal dysfunction. However, the studies have conveyed inconclusive results and previous meta-analysis included not only true randomized controlled trials (RCTs), but low-quality RCTs.
Methods: A comprehensive electronic literature search was conducted through April 2025 to identify true RCTs comparing patients between with or without perioperative DKT administration in gastroenterological cancer surgery. The primary outcome was the time to first postoperative flatus. A meta-analysis was performed using random-effects models to calculate mean difference (MD) with 95% confidence intervals (CIs).
Results: Eleven true RCTs involving 1413 patients (with DKT group, n = 716; Without DKT group, n = 697) were included. The meta-analysis demonstrated a significant improvement of the time to first postoperative flatus in the With DKT group than in the Without DKT group, with an MD of - 0.19 (95% CI - 0.34 to - 0.04, P = 0.01), and no significant between-study heterogeneity was observed (χ2 = 8.12, I2 = 26%, P = 0.23). Subgroup analysis demonstrated a significantly shorter time to first postoperative flatus in categories of surgery other than colorectal, studies of double-blinded, multi-institutional, 100 or more patients included.
Conclusions: This meta-analysis suggests that DKT can improve postoperative intestinal dysfunction (i.e., first postoperative flatus) after gastroenterological cancer surgery, but the efficacy was modest. Thus, the efficacy of DKT on improving postoperative intestinal dysfunction warrants further investigation in more high quality RCTs.
Registry and registration number: This systematic review and meta-analysis was registered with UMIN-CTR (ID: UMIN000066046) ( https://www.umin.ac.jp/ctr/index-j.htm ).
期刊介绍：
The International Journal of Clinical Oncology (IJCO) welcomes original research papers on all aspects of clinical oncology that report the results of novel and timely investigations. Reports on clinical trials are encouraged. Experimental studies will also be accepted if they have obvious relevance to clinical oncology. Membership in the Japan Society of Clinical Oncology is not a prerequisite for submission to the journal. Papers are received on the understanding that: their contents have not been published in whole or in part elsewhere; that they are subject to peer review by at least two referees and the Editors, and to editorial revision of the language and contents; and that the Editors are responsible for their acceptance, rejection, and order of publication.
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