Pharmacologic prevention and therapy of postoperative paralytic ileus after gastrointestinal cancer surgery: systematic review and meta-analysis

Electroacupuncture Reduces Duration of Postoperative Ileus After Laparoscopic Gastrectomy for Gastric Cancer: A Multicenter Randomized Trial

BACKGROUND & AIMS

Electroacupuncture (EA) may reduce the duration of postoperative ileus (POI) after laparoscopic gastrectomy for gastric cancer, although evidence is limited. We investigated the efficacy of EA in reducing POI duration and enhancing gastrointestinal (GI) recovery in patients undergoing laparoscopic surgery for gastric cancer.

METHODS

This multicenter randomized trial was conducted at 7 hospitals in China, enrolling 585 participants who underwent laparoscopic resection for gastric cancer from October 27, 2021, to December 21, 2023. Participants received perioperative standard care and were randomized to 4 sessions of EA, 4 sessions of sham EA (SA), or standard care only. The primary outcome was the time to first flatus. Secondary outcomes included time to first defecation, dietary recovery, quality of life, postoperative mobilization, and duration of hospital stay.

RESULTS

A total of 578 participants were in the full analysis set. EA exhibited a shorter time to first flatus compared with both SA and standard care, with differences of -12.96 hours (95% confidence interval (CI), -19.17 to -6.75; P < .001) and -24.46 hours (95% CI, -30.61 to -18.30; P < .001), respectively. Similarly, EA significantly reduced the time to first defecation: -15.41 hours (95% CI, -27.73 to -3.09; P = .007) vs SA; -24.66 hours (95% CI, -36.76 to -12.55; P < .001) vs standard care. Incidence of prolonged POI was significantly lower in the EA group than in the SA and standard care groups, with group differences of -0.41 (95% CI, -0.66 to -0.16; P < .001) and -0.56 (95% CI, -0.82 to -0.31; P < .001), respectively. No severe adverse events were reported.

CONCLUSIONS

EA was superior to SA and standard care only for reducing POI duration and the risk of prolonged POI in patients undergoing laparoscopic gastrectomy for gastric cancer (Chinese Clinical Trials Register identifier: ChiCTR2100050660).

Clinical Practice Guideline: Recommendations for the Perioperative Management of Pancreatic and Colorectal Cancer Patients

BACKGROUND

Colorectal and pancreatic carcinoma are the most common cancers of the gastrointestinal tract. Their surgical treatment carries a high morbidity: complications arise in 25% to 30% of cases, often prolonging recovery times and delaying the initiation of adjuvant therapy, leading, in turn, to worse oncological outcomes. The goal of multimodal perioperative management (mPOM) is to lower the postoperative complication rate through a combination of perioperative measures.

METHODS

This guideline on the perioperative management of gastrointestinal tumors (POMGAT) meets all requirements for an S3 guideline as specified by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). These include a systematic literature search, quality assessment of the included publications, an evaluation of the reliability of the evidence according to the GRADE approach, and a structured consensus process.

RESULTS

Meta-analyses have shown that mPOM lowers the complication rates of both pancreatic and colorectal resections (RD 0.96 with 95% confidence interval [0.92; 0.99] and RR 0.66 [0.54; 0.80], respectively). This shortens the hospital stay after pancreatic resections by a median of 2.33 days [-2.98; -1.69] and after colorectal resections by a median of 2.59 days [-3.22; -1.97].

CONCLUSION

Adherence to the POMGAT-S3 guideline for pancreatic and colorectal cancer surgery is associated with improved recovery, which can lead to a faster return to intended oncological treatment (RIOT) and thus to better long-term outcomes. These recommendations are not restricted to gastrointestinal cancer surgery; they can also be applied to visceral surgery for benign conditions, as well as to gynecological and urological operations.