Acupuncture for Quality of Life of Patients with Defecation Dysfunction after Sphincter Preserving Surgery for Rectal Cancer: A Systematic Review

PURPOSE: To evaluate the effectiveness and safety of acupuncture for quality of life of patients with defecation dysfunction (DD) after sphincter preserving surgery for rectal cancer. METHODS: We searched nine online databases from inception to July 1, 2021, and did not restrict the type of language. Then, studies were independently selected by two research team members with screening criteria and risk bias assessment, and the data were extracted. The primary outcome was Quality of Life Questionnaire-Core 29 (QLQ-CR29). The data were then synthesized using the RevMan V.5.2 by random-effects model. Also, we used the standardized mean differences with 95% credible interval (CI) to describe the outcome of the analysis. RESULTS: A total of 6 randomized controlled trials (RCTs) (with 439 patients) were included in the systematic review, and data from 2 RCTs (with 200 patients) were used in the meta-analysis. Five studies (83%) were judged to have a medium risk of bias, and one was at high risk of bias. For synthesis, data from two medium-risk studies found that acupuncture or electropuncture may improve the QLQ-CR29 with urination (mean difference, −0.39 points; 95%CI, −0.46 to −0.32; I(2) = 34%), abdominal pain (mean difference, −0.71 points; 95%CI, −0.89 to −0.54; I(2) = 9%), stool (mean difference, −0.49 points; 95%CI, −0.77 to −0.20; I(2) = 57%), defecation (mean difference, −0.59 points; 95% CI, −0.85 to −0.33; I(2) = 51%), sexual function (mean difference, 0.93 points; 95% CI, 0.48 to 1.38; I(2) = 90%), and self-feelings (mean difference, 1.04 points; 95% CI, 0.36 to 1.73; I(2) = 94%). CONCLUSION: Findings in this study indicate that acupuncture or electropuncture may be effective and safe for DD, but the quality of included studies was very low. So, more large-scale, multicenter, long-term, and high-quality original research is still expected in the future.