Effectiveness of comprehensive interventions including exercise and exercise-only interventions on postoperative ileus and recovery of intestinal function in patients with colorectal cancer: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Postoperative comprehensive interventions: SMD -1.38 (flatus), -1.56 (defecation); Preoperative exercise-only: OR 0.56 for POI prevention

• Primary Outcome: Time to first flatus and defecation; postoperative ileus incidence

• Nnt Or Sensitivity: Based on OR 0.56 for POI prevention, estimated NNT approximately 8-12 patients for preoperative exercise interventions

• Confidence Interval: Flatus: -1.87 to -0.89; Defecation: -2.20 to -0.92; POI prevention: 0.46 to 0.67

Clinical Application

Highly feasible in Australian hospitals with established physiotherapy services and enhanced recovery protocols Aligns with existing ERAS protocols in major Australian centres; physiotherapy interventions covered under public hospital services; supports TGA-approved enhanced recovery pathways Adult patients undergoing elective colorectal cancer surgery in hospital settings

Abstract

PURPOSE: This systematic review and meta-analysis aimed to evaluate the effectiveness of postoperative or preoperative comprehensive interventions including exercise and exercise-only interventions on postoperative ileus (POI) incidence and the recovery of intestinal function in patients with colorectal cancer (CRC). METHODS: Electronic searches were conducted in 6 databases. Cohort and randomized-controlled trial (RCT) studies investigating the effects of postoperative or preoperative comprehensive interventions including exercise or exercise-only interventions on POI and the recovery of intestinal function in patients with CRC were included. RESULTS: Thirty-eight studies involving 13,124 patients were included. Postoperative comprehensive interventions including exercise significantly shortened the time to first flatus (standardized mean difference [SMD] = -1.38, 95% confidence interval [CI]: -1.87 to -0.89) and time to first defecation (SMD = -1.56, 95% CI: -2.20 to -0.92), but did not reduce POI incidence (odds ratio [OR] = 1.38, 95% CI: 0.43 to 4.47). While, postoperative exercise-only interventions showed no significant effect on intestinal recovery (SMD = -0.31, 95% CI: -1.21 to 0.58). Preoperative comprehensive interventions including exercise shortened the time to first flatus (SMD = -0.41, 95% CI: -0.66 to -0.17). Also, preoperative exercise-only interventions significantly reduced the incidence of POI (OR = 0.56, 95% CI: 0.46 to 0.67). CONCLUSIONS: Postoperative comprehensive interventions effectively promote intestinal recovery; however, postoperative exercise-only interventions may not promote the recovery of intestinal function. On the other hand, preoperative comprehensive interventions or exercise-only interventions may promote the recovery of intestinal function and prevent POI onset; however, the limited number of included studies prevented definitive conclusions.

References

1. 1.Yanagisawa, T., Furuya, N., Tatematsu, N., & Hayashi, K. (2026). Effectiveness of comprehensive interventions including exercise and exercise-only interventions on postoperative ileus and recovery of intestinal function in patients with colorectal cancer: a systematic review and meta-analysis. Supportive Care in Cancer. https://doi.org/10.1111/ans.15659