Effect of chewing gum on gastrointestinal function after colorectal cancer surgery: a meta<b>-</b>analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HUANG Liping , WEN Shiqi , LI Jiafei ,  LI Ka

West China School of Nursing, Sichuan University / West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

LI Ka, Email: lika127@163.com

Keywords：

chewing gum; colon cancer; rectal cancer; colorectal cancer; gastrointestinal function; meta-analysis

DOI：

10.7507/1007-9424.202407025

Video：

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Objective To assess the effect of chewing gum on the recovery of postoperative gastrointestinal function in patients with colorectal cancer. Methods A comprehensive search for relevant randomised controlled trials (RCTs) was conducted in domestic and international databases such as PubMed, The Cochrane Library, Web of Science, Chinese Science and Technology Journal Full-text Database, Chinese Periodicals Full-text Database, Wanfang data, and other databases, with a timeframe up to September 2023. The literature was screened according to the inclusion and exclusion criteria. Simultaneously, the literature quality evaluation and data extraction were performed. The continuous variables were described using mean difference (95% confidence interval) and the binary variables were described using odds ratio (95% confidence interval). Test level was α=0.05. Results A total of 28 RCTs covering 2 523 postoperative colorectal cancer patients were included. The meta-analysis results showed that the postoperative chewing gum could shorten the time of the first flatus [–11.99 (–14.45, –9.53)], the first defecation [–18.79 (–23.58, –14.00)], the first bowel sounds [–6.35 (–6.64, –6.06)] or the first starvation [–5.20 (–10.11, –0.28)], and the hospital stay [–1.35 (–1.99, –0.70)], as well as could increase the serum gastrin level [23.70 (14.88, 32.53)]. Furthermore, it also could decrease the incidence of postoperative complications, such as nausea [0.66 (0.48, 0.91)], abdominal distension [0.48 (0.35, 0.67)], and intestinal obstruction [0.34 (0.20, 0.59)]. However, there was a non-significant effect on vomiting [0.81 (0.60, 1.09)] or time of the first oral intake [–0.67 (–1.99, 0.65)]. Conclusions From the results of this meta-analysis, postoperative gum chewing aids to promote the recovery of gastrointestinal function and reduce the risk of postoperative complications in colorectal cancer patients. Although further studies are needed to verify the long-term effects and the feasibility of clinical application, the results of this study provide an important empirical support for the utilize of chewing gum in the management of postoperative gastrointestinal function.

Citation： HUANG Liping, WEN Shiqi, LI Jiafei, LI Ka. Effect of chewing gum on gastrointestinal function after colorectal cancer surgery: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(12): 1466-1473. doi: 10.7507/1007-9424.202407025 Copy

1.	黃理賓, 黃秋實, 楊烈. 全球及中國的結直腸癌流行病學特征及防治: 2022《全球癌癥統計報告》解讀. 中國普外基礎與臨床雜志, 2024, 31(5): 530-537.
2.	姚一菲, 孫可欣, 鄭榮壽. 《2022全球癌癥統計報告》解讀: 中國與全球對比. 中國普外基礎與臨床雜志, 2024, 31(7): 769-780.
3.	鄭榮壽, 陳茹, 韓冰峰, 等. 2022年中國惡性腫瘤流行情況分析. 中華腫瘤雜志, 2024, 46(3): 221-231.
4.	Asgeirsson T, El-Badawi KI, Mahmood A, et al. Postoperative ileus: it costs more than you expect. J Am Coll Surg, 2010, 210(2): 228-231.
5.	Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS?) Society Recommendations: 2018. World J Surg, 2019, 43: 659-695.
6.	Lunding JA, Nordstr?m LM, Haukelid AO, et al. Vagal activation by sham feeding improves gastric motility in functional dyspepsia. Neurogastroenterol Motil, 2008, 20(6): 618-624.
7.	Gero D, Gié O, Hübner M, et al. Postoperative ileus: in search of an international consensus on definition, diagnosis, and treatment. Langenbecks Arch Surg, 2017, 402(1): 149-158.
8.	Noble EJ, Harris R, Hosie KB, et al. Gum chewing reduces postoperative ileus? A systematic review and meta-analysis. Int J Surg, 2009, 7(2): 100-105.
9.	Su’a BU, Pollock TT, Lemanu DP, et al. Chewing gum and postoperative ileus in adults: a systematic literature review and meta-analysis. Int J Surg, 2015, 14: 49-55.
10.	熊方麗, 賀育華, 蔣曉蓮. 加速康復外科模式下胃癌患者術后早期下床活動現狀及影響因素分析. 中國普外基礎與臨床雜志, 2022, 29(12): 1618-1622.熊方麗, 賀育華, 蔣曉蓮. 加速康復外科模式下胃癌患者術后早期下床活動現狀及影響因素分析. 中國普外基礎與臨床雜志, 2022, 29(12): 1618-1622.
11.	Lassen K, Kjaeve J, Fetveit T, et al. Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity: a randomized multicenter trial. Ann Surg, 2008, 247(5): 721-729.
12.	Higgins J, Thomas J. Cochrane handbook for systematic reviews of interventions. https://training.cochrane.org/handbook/current.
13.	李佳霏, 任秋平, 葉佳怡, 等. 肝部分切除術患者加速康復外科失敗的影響因素分析. 中國普外基礎與臨床雜志, 2024, 31(7): 827-832.李佳霏, 任秋平, 葉佳怡, 等. 肝部分切除術患者加速康復外科失敗的影響因素分析. 中國普外基礎與臨床雜志, 2024, 31(7): 827-832.
14.	Roslan F, Kushairi A, Cappuyns L, et al. The impact of sham feeding with chewing gum on postoperative ileus following colorectal surgery: a meta-analysis of randomised controlled trials. J Gastrointest Surg, 2020, 24(11): 2643-2653.
15.	凡慶東, 耿協強, 陳輝, 等. 咀嚼口香糖對結直腸癌根治術患者術后腸動力恢復的影響. 西南國防醫藥, 2009, 19(12): 1240-1241.
16.	王少淵, 侯英奎, 董世平, 等. 直腸癌術后咀嚼口香糖促進胃腸康復的隨機對照研究. 四川醫學, 2011, 32(12): 1956-1958.
17.	李燕君. 術后早期咀嚼口香糖對結腸癌患者胃腸功能的影響. 中外健康文摘, 2012, (41): 69-70.
18.	田敏. 咀嚼口香糖對直腸癌患者手術后胃腸功能恢復的作用. 現代臨床護理, 2013, 12(2): 45-47.
19.	章曉霞, 彭鋒, 袁小娟. 術后早期咀嚼口香糖對結直腸癌術后胃腸道功能恢復的影響. 護理實踐與研究, 2015, 12(12): 45-46.
20.	王小麗, 倪金鑫. 結直腸癌患者術后咀嚼口香糖對早期恢復腸功能的護理研究. 齊齊哈爾醫學院學報, 2016, 37(5): 674-675.
21.	周歡, 呂桂芬. 咀嚼運動促進腹腔鏡結直腸癌術后腸功能恢復的研究. 護士進修雜志, 2017, 32(22): 2079-2080.
22.	賴淑蓉, 賴小令, 張四芳, 等. 咀嚼口香糖對腹腔鏡下結直腸癌術后腸功能恢復的影響. 消化腫瘤雜志(電子版), 2019, 11(4): 377-380.
23.	高滿倉, 張慧力, 趙力波. 結直腸癌術后早期咀嚼口香糖對胃腸功能恢復的研究. 健康必讀, 2020, (2): 219.
24.	高曉英. 咀嚼口香糖對結直腸癌根治術后胃腸功能恢復的影響. 母嬰世界, 2021, (28): 279.
25.	黃永亨, 吳國忠, 龐紹春, 等. 咀嚼口香糖對腹腔鏡左半結腸癌切除術后胃腸功能的影響及機制研究. 臨床普外科電子雜志, 2021, 9(2): 14-18.
26.	Asao T, Kuwano H, Nakamura J, et al. Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. J Am Coll Surg, 2002, 195(1): 30-32.
27.	Quah HM, Samad A, Neathey AJ, et al. Does gum chewing reduce postoperative ileus following open colectomy for left-sided colon and rectal cancer? A prospective randomized controlled trial. Colorectal Dis, 2006, 8(1): 64-70.
28.	Schuster R, Grewal N, Greaney GC, et al. Gum chewing reduces ileus after elective open sigmoid colectomy. Arch Surg, 2006, 141(2): 174-176.
29.	Park SY, Chung M. Can gum chewing reduce postoperative ileus after open abdominal surgery?. Ann Surg Treat Res, 2009, 77(5): 306-309.
30.	Al-Kharabsheh M, Alwahedi H, Elhamshary J, et al. The effect of chewing sugar-free gum to improve bowel movement after colorectal surgeries in patients with colorectal cancer. SAGE Open Nurs, 2023, 9: 23779608231170725. doi: 10.1177/23779608231170725.
31.	Lim P, Morris OJ, Nolan G, et al. Sham feeding with chewing gum after elective colorectal resectional surgery: a randomized clinical trial. Ann Surg, 2013, 257(6): 1016-1024.
32.	Zaghiyan K, Felder S, Ovsepyan G, et al. A prospective randomized controlled trial of sugared chewing gum on gastrointestinal recovery after major colorectal surgery in patients managed with early enteral feeding. Dis Colon Rectum, 2013, 56(3): 328-335.
33.	Forrester DA, Doyle-Munoz J, McTigue T, et al. The efficacy of gum chewing in reducing postoperative ileus: a multisite randomized controlled trial. J Wound Ostomy Continence Nurs, 2014, 41(3): 227-232.
34.	Kobayashi T, Masaki T, Kogawa K, et al. Efficacy of gum chewing on bowel movement after open colectomy for left-sided colorectal cancer: a randomized clinical trial. Dis Colon Rectum, 2015, 58(11): 1058-1063.
35.	Atkinson C, Penfold CM, Ness AR, et al. Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection. Br J Surg, 2016, 103(8): 962-970.
36.	Shum NF, Choi HK, Mak JC, et al. Randomized clinical trial of chewing gum after laparoscopic colorectal resection. Br J Surg, 2016, 103(11): 1447-1452.
37.	Topcu SY, Oztekin SD. Effect of gum chewing on reducing postoperative ileus and recovery after colorectal surgery: A randomised controlled trial. Complement Ther Clin Pract, 2016, 23: 21-25.
38.	Vergara-Fernandez O, Gonzalez-Vargas AP, Castellanos-Juarez JC, et al. Usefulness of gum chewing to decrease postoperative ileus in colorectal surgery with primary anastomosis: a randomized controlled trial. Rev Invest Clin, 2016, 68(6): 314-318.
39.	Byrne CM, Zahid A, Young JM, et al. Gum chewing aids bowel function return and analgesic requirements after bowel surgery: a randomized controlled trial. Colorectal Dis, 2018, 20(5): 438-448.
40.	Yang P, Long WJ, Wei L. Chewing Xylitol gum could accelerate bowel motility recovery after elective open proctectomy for rectal cancer. Rev Invest Clin, 2018, 70(1): 53-58.
41.	Duluklu B, Senol Celik S. Effect of gum chewing on recovery after surgery for colorectal surgery patients: a randomized controlled trial. Gastroenterol Nurs, 2020, 43(6): 422-428.
42.	Hsu YC, Szu SY. Effects of gum chewing on recovery from postoperative ileus: a randomized clinical trail. J Nurs Res, 2022, 30(5): e233. doi: 10.1097/jnr.0000000000000510.
43.	Bragg D, El-Sharkawy AM, Psaltis E, et al. Postoperative ileus: Recent developments in pathophysiology and management. Clin Nutr, 2015, 34(3): 367-376.
44.	楊雪梅, 張正馨, 譚小義, 等. 術后早期咀嚼口香糖對結直腸癌術后胃腸道功能恢復效果的Meta分析. 中國循證醫學雜志, 2015, 15(5): 542-549.
45.	溫尊甲, 王文婷, 梅彬彬, 等. 咀嚼口香糖對結直腸癌術后腸道功能作用的Meta分析. 世界華人消化雜志, 2017, 25(2): 147-158.

1. 黃理賓, 黃秋實, 楊烈. 全球及中國的結直腸癌流行病學特征及防治: 2022《全球癌癥統計報告》解讀. 中國普外基礎與臨床雜志, 2024, 31(5): 530-537.
2. 姚一菲, 孫可欣, 鄭榮壽. 《2022全球癌癥統計報告》解讀: 中國與全球對比. 中國普外基礎與臨床雜志, 2024, 31(7): 769-780.
3. 鄭榮壽, 陳茹, 韓冰峰, 等. 2022年中國惡性腫瘤流行情況分析. 中華腫瘤雜志, 2024, 46(3): 221-231.
4. Asgeirsson T, El-Badawi KI, Mahmood A, et al. Postoperative ileus: it costs more than you expect. J Am Coll Surg, 2010, 210(2): 228-231.
5. Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS?) Society Recommendations: 2018. World J Surg, 2019, 43: 659-695.
6. Lunding JA, Nordstr?m LM, Haukelid AO, et al. Vagal activation by sham feeding improves gastric motility in functional dyspepsia. Neurogastroenterol Motil, 2008, 20(6): 618-624.
7. Gero D, Gié O, Hübner M, et al. Postoperative ileus: in search of an international consensus on definition, diagnosis, and treatment. Langenbecks Arch Surg, 2017, 402(1): 149-158.
8. Noble EJ, Harris R, Hosie KB, et al. Gum chewing reduces postoperative ileus? A systematic review and meta-analysis. Int J Surg, 2009, 7(2): 100-105.
9. Su’a BU, Pollock TT, Lemanu DP, et al. Chewing gum and postoperative ileus in adults: a systematic literature review and meta-analysis. Int J Surg, 2015, 14: 49-55.
10. 熊方麗, 賀育華, 蔣曉蓮. 加速康復外科模式下胃癌患者術后早期下床活動現狀及影響因素分析. 中國普外基礎與臨床雜志, 2022, 29(12): 1618-1622.熊方麗, 賀育華, 蔣曉蓮. 加速康復外科模式下胃癌患者術后早期下床活動現狀及影響因素分析. 中國普外基礎與臨床雜志, 2022, 29(12): 1618-1622.
11. Lassen K, Kjaeve J, Fetveit T, et al. Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity: a randomized multicenter trial. Ann Surg, 2008, 247(5): 721-729.
12. Higgins J, Thomas J. Cochrane handbook for systematic reviews of interventions. https://training.cochrane.org/handbook/current.
13. 李佳霏, 任秋平, 葉佳怡, 等. 肝部分切除術患者加速康復外科失敗的影響因素分析. 中國普外基礎與臨床雜志, 2024, 31(7): 827-832.李佳霏, 任秋平, 葉佳怡, 等. 肝部分切除術患者加速康復外科失敗的影響因素分析. 中國普外基礎與臨床雜志, 2024, 31(7): 827-832.
14. Roslan F, Kushairi A, Cappuyns L, et al. The impact of sham feeding with chewing gum on postoperative ileus following colorectal surgery: a meta-analysis of randomised controlled trials. J Gastrointest Surg, 2020, 24(11): 2643-2653.
15. 凡慶東, 耿協強, 陳輝, 等. 咀嚼口香糖對結直腸癌根治術患者術后腸動力恢復的影響. 西南國防醫藥, 2009, 19(12): 1240-1241.
16. 王少淵, 侯英奎, 董世平, 等. 直腸癌術后咀嚼口香糖促進胃腸康復的隨機對照研究. 四川醫學, 2011, 32(12): 1956-1958.
17. 李燕君. 術后早期咀嚼口香糖對結腸癌患者胃腸功能的影響. 中外健康文摘, 2012, (41): 69-70.
18. 田敏. 咀嚼口香糖對直腸癌患者手術后胃腸功能恢復的作用. 現代臨床護理, 2013, 12(2): 45-47.
19. 章曉霞, 彭鋒, 袁小娟. 術后早期咀嚼口香糖對結直腸癌術后胃腸道功能恢復的影響. 護理實踐與研究, 2015, 12(12): 45-46.
20. 王小麗, 倪金鑫. 結直腸癌患者術后咀嚼口香糖對早期恢復腸功能的護理研究. 齊齊哈爾醫學院學報, 2016, 37(5): 674-675.
21. 周歡, 呂桂芬. 咀嚼運動促進腹腔鏡結直腸癌術后腸功能恢復的研究. 護士進修雜志, 2017, 32(22): 2079-2080.
22. 賴淑蓉, 賴小令, 張四芳, 等. 咀嚼口香糖對腹腔鏡下結直腸癌術后腸功能恢復的影響. 消化腫瘤雜志(電子版), 2019, 11(4): 377-380.
23. 高滿倉, 張慧力, 趙力波. 結直腸癌術后早期咀嚼口香糖對胃腸功能恢復的研究. 健康必讀, 2020, (2): 219.
24. 高曉英. 咀嚼口香糖對結直腸癌根治術后胃腸功能恢復的影響. 母嬰世界, 2021, (28): 279.
25. 黃永亨, 吳國忠, 龐紹春, 等. 咀嚼口香糖對腹腔鏡左半結腸癌切除術后胃腸功能的影響及機制研究. 臨床普外科電子雜志, 2021, 9(2): 14-18.
26. Asao T, Kuwano H, Nakamura J, et al. Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. J Am Coll Surg, 2002, 195(1): 30-32.
27. Quah HM, Samad A, Neathey AJ, et al. Does gum chewing reduce postoperative ileus following open colectomy for left-sided colon and rectal cancer? A prospective randomized controlled trial. Colorectal Dis, 2006, 8(1): 64-70.
28. Schuster R, Grewal N, Greaney GC, et al. Gum chewing reduces ileus after elective open sigmoid colectomy. Arch Surg, 2006, 141(2): 174-176.
29. Park SY, Chung M. Can gum chewing reduce postoperative ileus after open abdominal surgery?. Ann Surg Treat Res, 2009, 77(5): 306-309.
30. Al-Kharabsheh M, Alwahedi H, Elhamshary J, et al. The effect of chewing sugar-free gum to improve bowel movement after colorectal surgeries in patients with colorectal cancer. SAGE Open Nurs, 2023, 9: 23779608231170725. doi: 10.1177/23779608231170725.
31. Lim P, Morris OJ, Nolan G, et al. Sham feeding with chewing gum after elective colorectal resectional surgery: a randomized clinical trial. Ann Surg, 2013, 257(6): 1016-1024.
32. Zaghiyan K, Felder S, Ovsepyan G, et al. A prospective randomized controlled trial of sugared chewing gum on gastrointestinal recovery after major colorectal surgery in patients managed with early enteral feeding. Dis Colon Rectum, 2013, 56(3): 328-335.
33. Forrester DA, Doyle-Munoz J, McTigue T, et al. The efficacy of gum chewing in reducing postoperative ileus: a multisite randomized controlled trial. J Wound Ostomy Continence Nurs, 2014, 41(3): 227-232.
34. Kobayashi T, Masaki T, Kogawa K, et al. Efficacy of gum chewing on bowel movement after open colectomy for left-sided colorectal cancer: a randomized clinical trial. Dis Colon Rectum, 2015, 58(11): 1058-1063.
35. Atkinson C, Penfold CM, Ness AR, et al. Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection. Br J Surg, 2016, 103(8): 962-970.
36. Shum NF, Choi HK, Mak JC, et al. Randomized clinical trial of chewing gum after laparoscopic colorectal resection. Br J Surg, 2016, 103(11): 1447-1452.
37. Topcu SY, Oztekin SD. Effect of gum chewing on reducing postoperative ileus and recovery after colorectal surgery: A randomised controlled trial. Complement Ther Clin Pract, 2016, 23: 21-25.
38. Vergara-Fernandez O, Gonzalez-Vargas AP, Castellanos-Juarez JC, et al. Usefulness of gum chewing to decrease postoperative ileus in colorectal surgery with primary anastomosis: a randomized controlled trial. Rev Invest Clin, 2016, 68(6): 314-318.
39. Byrne CM, Zahid A, Young JM, et al. Gum chewing aids bowel function return and analgesic requirements after bowel surgery: a randomized controlled trial. Colorectal Dis, 2018, 20(5): 438-448.
40. Yang P, Long WJ, Wei L. Chewing Xylitol gum could accelerate bowel motility recovery after elective open proctectomy for rectal cancer. Rev Invest Clin, 2018, 70(1): 53-58.
41. Duluklu B, Senol Celik S. Effect of gum chewing on recovery after surgery for colorectal surgery patients: a randomized controlled trial. Gastroenterol Nurs, 2020, 43(6): 422-428.
42. Hsu YC, Szu SY. Effects of gum chewing on recovery from postoperative ileus: a randomized clinical trail. J Nurs Res, 2022, 30(5): e233. doi: 10.1097/jnr.0000000000000510.
43. Bragg D, El-Sharkawy AM, Psaltis E, et al. Postoperative ileus: Recent developments in pathophysiology and management. Clin Nutr, 2015, 34(3): 367-376.
44. 楊雪梅, 張正馨, 譚小義, 等. 術后早期咀嚼口香糖對結直腸癌術后胃腸道功能恢復效果的Meta分析. 中國循證醫學雜志, 2015, 15(5): 542-549.
45. 溫尊甲, 王文婷, 梅彬彬, 等. 咀嚼口香糖對結直腸癌術后腸道功能作用的Meta分析. 世界華人消化雜志, 2017, 25(2): 147-158.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of chewing gum on gastrointestinal function after colorectal cancer surgery: a meta-analysis

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