Systematic Review of Acupuncture and Moxibustion in Colorectal Cancer Care: A Synthesis of the Evidence

Abstract Purpose The object of this article was to assess the efficacy and safety of acupuncture and moxibustion therapy for patients recovering after surgical resection of Colorectal Cancer (CRC).Methods We systematically searched eight databases from the establishment of the database to October 2021 for randomized clinical trials (RCTs). We used the Cochrane risk of bias (ROB) tool to assess the ROB and the RevMan 5.3 for data analysis. The certainty of outcomes was summarized using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).Results Twenty-seven studies involving the recovery of GI function met the inclusion criteria. There was significant variability and a high or unknown ROB. For certain outcomes reflecting physiological recovery, in comparison to sham acupuncture or usual care, acupuncture had a clear therapeutic effect, as measured by the time to first flatus [MD=−13.87, 95% CI (−17.82, −9.93), I2 =94%, p<0.00001], time to first defecation [MD=−15.25, 95% CI (−19.76, −10.75), I2 =94%, p<0.00001] and time to first bowel sounds [MD=−8.56, 95% CI (10.9, −6.23) I2 =91%, p<0.00001). Five studies reported possible adverse events of acupuncture and moxibustion, while the other studies did not premeditate adverse events.Conclusion Acupuncture and moxibustion are appropriate adjunctive treatments for postoperative GI function and they improve other symptoms, such as postoperative pain, to a certain extent for patients with CRC. For other symptoms, the efficacy remains uncertain due to a high ROB among studies. Future research should focus on not only more rigorous, well-designed and larger RCTs but also on assessing the biological mechanisms.