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

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.

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.

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.

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.