Effect of modified Da-Cheng-Qi decoction on stoma reversal and postoperative ileus after laparoscopic anterior resection

Abstract

BACKGROUND

Laparoscopic anterior resection for colorectal cancer often necessitates a temporary protective stoma to mitigate anastomotic-leak risk, yet stoma reversal is frequently delayed by postoperative ileus. Western medicine offers limited pro-motility options, while traditional Chinese medicine (TCM) has shown promise within enhanced-recovery protocols. Modified Da-Cheng-Qi decoction (mDCQD), a purgative- and qi-moving formula, has demonstrated intestinal motility benefits, but its specific impact on stoma-reversal timing remains unexamined. We undertook a retrospective study to determine whether mDCQD accelerates stoma closure and reduces postoperative ileus after laparoscopic colorectal resection with protective stoma.

AIM

To investigate the effect of mDCQD on stoma reversal time and incidence of postoperative ileus after laparoscopic anterior resection for colorectal cancer.

METHODS

A retrospective analysis was conducted on 283 patients who underwent laparoscopic anterior resection for colorectal cancer with prophylactic stoma at our hospital from January 2022 to August 2024. According to whether mDCQD was used postoperatively, patients were divided into observation group (132 cases) and control group (151 cases). The control group received conventional treatment postoperatively, while the observation group received oral mDCQD (raw rhubarb 12 g, mirabilite 10 g, immature bitter orange 15 g, magnolia bark 15 g, radish seed 15 g, aucklandia root 10 g, areca seed 10 g, cannabis seed 15 g) starting from postoperative day 2-3 (the day of gastric tube removal) in addition to conventional treatment, twice daily, 150 mL each time, continued until anal gas passage and defecation. Observation indicators included stoma reversal time, incidence of postoperative ileus, time to first anal gas passage, time to first defecation, time to bowel sound recovery, TCM symptom scores, quality of life scores European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30), gastrointestinal hormone levels [motilin (MTL), gastrin (GAS), vasoactive intestinal peptide (VIP)], and inflammatory and nutritional indicators [C-reactive protein (CRP), procalcitonin (PCT), albumin (ALB), prealbumin (PA)]. Kaplan-Meier method and Cox proportional hazards regression model were used to analyze factors affecting stoma reversal time.

RESULTS

The stoma reversal time in the observation group was 118.5 ± 23.7 days, shorter than 142.8 ± 28.4 days in the control group (t = 7.623, P < 0.001). The incidence of postoperative ileus in the observation group was 6.1% (8/132), lower than 18.5% (28/151) in the control group (χ² = 10.245, P = 0.001). The time to first anal gas passage (52.3 ± 10.8 hours vs 68.7 ± 14.2 hours), time to first defecation (78.6 ± 15.3 hours vs 96.4 ± 18.7 hours), and time to bowel sound recovery (38.2 ± 8.5 hours vs 51.6 ± 11.3 hours) in the observation group were all shorter than those in the control group (P < 0.001). On postoperative days 5 and 7, TCM symptom scores in the observation group were lower than those in the control group (P < 0.001). At 3 months after stoma surgery, the EORTC QLQ-C30 overall health status score in the observation group was 68.5 ± 11.7 points, higher than 62.3 ± 13.2 points in the control group (t = 4.19, P < 0.001). On postoperative days 5 and 7, MTL and GAS levels in the observation group were higher than those in the control group, while VIP levels were lower (P < 0.001); CRP and PCT levels in the observation group were lower than those in the control group, while ALB and PA levels were higher (P < 0.05). Multivariate Cox regression analysis showed that the use of mDCQD was an independent factor for shortening stoma reversal time (hazard ratio = 2.147, 95% confidence interval: 1.658-2.781, P < 0.001).

CONCLUSION

mDCQD can shorten stoma reversal time after laparoscopic anterior resection for colorectal cancer, reduce the incidence of postoperative ileus, promote intestinal function recovery, and improve patients’ quality of life. It is a safe and effective integrated traditional Chinese and Western medicine treatment method.

Keywords: Colorectal cancer; Laparoscopic anterior resection; Da-Cheng-Qi decoction; Stoma reversal; Postoperative ileus; Integration of traditional Chinese and Western medicine; Enhanced recovery after surgery

Core Tip: This study demonstrates that modified Da-Cheng-Qi decoction significantly shortens stoma reversal time and reduces postoperative ileus after laparoscopic anterior resection for colorectal cancer. By promoting gastrointestinal motility, regulating gastrointestinal hormones, and attenuating postoperative inflammation, the modified formula accelerates bowel recovery and improves patients’ nutritional status and quality of life. The study highlights the value of integrating traditional Chinese medicine with enhanced recovery pathways and identifies the decoction as an independent factor associated with earlier stoma closure.