Electroacupuncture vs Sham Electroacupuncture in the Treatment of Postoperative Ileus After Laparoscopic Surgery for Colorectal Cancer

Abstract

ImportanceDespite the adoption of the optimized Enhanced Recovery After Surgery (ERAS) protocol, postoperative ileus (POI) severely impairs recovery after colorectal resection and increases the burden on the health care system.ObjectiveTo assess the efficacy of electroacupuncture (EA) in reducing the duration of POI with the ERAS protocol.Design, Setting, and ParticipantsThis multicenter, randomized, sham-controlled trial was conducted in China from October 12, 2020, through October 17, 2021. There was a 1:1 allocation using the dynamic block random method, and analyses were by intention to treat. Patients 18 years or older undergoing laparoscopic resection of colorectal cancer for the first time were randomly assigned to treatment group by a central system.InterventionsPatients were randomly assigned to 4 sessions of EA or sham electroacupuncture (SA) after surgery. All patients were treated within the ERAS protocol.Main Outcomes and MeasuresThe primary outcome was the time to first defecation. Secondary outcomes included other patient-reported outcome measures, length of postoperative hospital stay, readmission rate within 30 days, and incidence of postoperative complications and adverse events.ResultsA total of 249 patients were randomly assigned to treatment groups. After the exclusion of 1 patient because of a diagnosis of intestinal tuberculosis, 248 patients (mean [SD] age, 60.2 [11.4] years; 153 men [61.7%]) were included in the analyses. The median (IQR) time to first defecation was 76.4 (67.6-96.8) hours in the EA group and 90.0 (73.6-100.3) hours in the SA group (mean difference, −8.76; 95% CI, −15.80 to −1.73; P = .003). In the EA group compared with the SA group, the time to first flatus (median [IQR], 44.3 [37.0-58.2] hours vs 58.9 [48.2-67.4] hours; P < .001) and the tolerability of semiliquid diet (median [IQR], 105.8 [87.0-120.3] hours vs 116.5 [92.0-137.0] hours; P = .01) and solid food (median [IQR], 181.8 [149.5-211.4] hours vs 190.3 [165.0-228.5] hours; P = .01) were significantly decreased. Prolonged POI occurred in 13 of 125 patients (10%) in the EA group vs 25 of 123 patients (20%) in the SA group (risk ratio [RR], 0.51; 95% CI, 0.27-0.95; P = .03). Other secondary outcomes were not different between groups. There were no severe adverse events.Conclusions and RelevanceResults of this randomized clinical trial demonstrated that in patients undergoing laparoscopic surgery for colorectal cancer with the ERAS protocol, EA shortened the duration of POI and decreased the risk for prolonged POI compared with SA. EA may be considered as an adjunct to the ERAS protocol to promote gastrointestinal function recovery and prevent prolonged POI after surgery.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2000038444

Acupoint Stimulation for Enhanced Recovery After Colon Surgery: A Prospective Multicenter Randomized Controlled Trial

“…In patients undergoing laparoscopic surgery, the time to defecation was shortened as well. 20 However, whether the potential benefit of TEAS on gastrointestinal function could shorten the length of stay after surgery is not clear. Therefore, the aim of this multicenter randomized trial was to evaluate whether perioperative TEAS could further improve the gastrointestinal function and shorten the time to meet the discharge criteria in patients undergoing laparoscopic colon surgery with current ERAS approaches.…”

Will Acupuncture Be the Next Addition to Enhanced Recovery After Surgery Protocols?

“…Still, delayed gastrointestinal function prolongs hospital stay in well-functioning ERAS settings. 2 In JAMA Surgery, Wang et al 3 present data suggesting that the use of electroacupuncture could be an additional element to consider in the multimodal approach to speed up the return of gut motility and function after colorectal surgery.…”

“…In their randomized clinical trial, Wang and colleagues found a reduction of the duration of postoperative ileus and 50% decreased risk of prolonged postoperative ileus in patients treated with electroacupuncture compared with sham electroacupuncture. This holds interest because the mode of action, although not fully clear, is likely different from other treatments for this condition and could be complementary in the multimodal approach.…”

Methods, Complications, and Outcomes in a Randomized Clinical Trial of Electroacupuncture After Colorectal Cancer Surgery

“…To the Editor We read with great interest the Original Investigation by Wang et al 1 focusing on the efficacy of electroacupuncture (EA) treatment for postoperative ileus (POI) after laparoscopic colorectal cancer (CRC) resection. They concluded that EA contributed to a shortened duration of POI and reduced risk for prolonged POI compared with sham electroacupuncture (SA).…”