Perioperative administration of daikenchuto, a traditional Japanese herbal medicine, ameliorates the occurrence of postoperative small bowel obstruction in patients undergoing surgery for gastrointestinal cancer: A meta-analysis

Background: Although it has been widely demonstrated that daikenchuto (DKT), a traditional Japanese herbal medicine, administration improves gastrointestinal (GI) motility in patients undergoing abdominal surgery, few studies have investigated the efficacy of perioperative DKT administration for amelioration of the occurrence of postoperative small bowel obstruction (PSBO) in patients undergoing surgery for GI cancer. Therefore, we aim to investigate whether perioperative administration of DKT ameliorates the occurrence of PSBO in patients with GI cancer. Methods: We performed a comprehensive electronic search of the literature (Cochrane Library, PubMed, the Web of Science and “ICHUSHI”) up to December 2016 to identify studies that had showed the efficacy of perioperative DKT administration for amelioration of the occurrence of PSBO in GI cancer patients. Paralytic ileus after surgery was included in PSBO. To integrate the individual effect of DKT, a meta-analysis was performed using random-effects models to calculate the risk ratio (RR) and 95% confidence interval (CI), and heterogeneity was analyzed using I2 statistics. Results: Seven studies involving a total of 1134 patients who had undergone GI cancer surgery were included in this meta-analysis. Among 588 patients who received DKT perioperatively, 67 (11.4%) had PSBO, whereas among 546 patients who did not receive DKT perioperatively, 87 (15.9%) had PSBO. Perioperative administration of DKT significantly ameliorates the occurrence of PSBO (RR, 0.58; 95% CI, 0.35-0.97; P = 0.04; I2 = 48%) in comparison to patients who did not receive DKT or received placebo. Conclusion: The results of this meta-analysis suggest that perioperative administration of DKT ameliorates the occurrence of PSBO in patients undergoing surgery for GI cancer.