Effects of Daikenchuto (TJ-100) After Gastrointestinal Oncological Surgery: An Updated Meta-Analysis of Randomized Controlled Trials

Abstract

Introduction:

Daikenchuto is an herbal medicine that has been shown to improve gastrointestinal motility. Therefore, we aimed to perform a meta-analysis to evaluate the use of daikenchuto in patients undergoing gastrointestinal oncological surgery.

Methods:

We searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing daikenchuto with control (placebo or no medicine) in patients undergoing gastrointestinal oncological surgery. Statistical analysis was performed using R statistical software 4.2.1. Heterogeneity was assessed with I².

Results:

We included 1,158 patients from 9 RCTs. Daikenchuto significantly reduced the time to first bowel movement (TFBM) (mean difference [MD] −11.15 hours; 95% CI: −16.96—−5.34; P < .001), and the length of hospital stay (MD −0.5 days; 95% CI: −0.92–−0.07; P = .022). The time to initial flatus (TIF) (MD −8.82; 95% CI: −18.34 to 0.69; P = .069) and the postoperative ileus incidence (OR: 0.98; 95% CI: 0.58 to 1.64; P = .934) presented no differences between groups. Subgroup analyses yielded no differences between open and laparoscopic approaches in TFBM (P = .91). In TIF, the results presented differences between groups (P < .01) and a significant reduction for the laparoscopic approach (MD −14.54 hours; 95% CI: −22.04–−7.05; P < .01). When considering the type of cancer (foregut vs colorectal), we found no differences between groups in TFBM (P = .57), despite a reduction in colorectal surgery alone (MD −12.64 hours; 95% CI: −20.22–−5.06; P = .001). For TIF, colorectal surgery was also associated with a reduction (MD −14.54 hours; 95% CI: −22.04–−7.05; P < .01). Trial sequential analysis supported a beneficial effect for daikenchuto in the TFBM outcome.

Conclusion:

Our findings demonstrated a decrease in intestinal motility time and length of hospital stay with the use of daikenchuto, providing valuable evidence for the clinical context, particularly in consideration of laparoscopic and colorectal surgeries.