Postoperative exercise interventions shorten intestinal recovery time in colorectal cancer surgery

This is a systematic review and meta-analysis of observational and randomized studies. The population included 13,124 patients with colorectal cancer. The setting was not reported. The intervention was postoperative or preoperative comprehensive interventions including exercise or exercise-only interventions. The comparator was not reported. The primary outcomes were postoperative ileus incidence and recovery of intestinal function.

For postoperative comprehensive interventions, the meta-analysis found that time to first flatus was significantly shortened, with a standardized mean difference (SMD) of -1.38 (95% CI: -1.87 to -0.89). Time to first defecation was also significantly shortened, with an SMD of -1.56 (95% CI: -2.20 to -0.92). However, postoperative ileus incidence did not reduce, with an odds ratio (OR) of 1.38 (95% CI: 0.43 to 4.47).

For postoperative exercise-only interventions, intestinal recovery showed no significant effect, with an SMD of -0.31 (95% CI: -1.21 to 0.58). For preoperative comprehensive interventions, time to first flatus was shortened, with an SMD of -0.41 (95% CI: -0.66 to -0.17). For preoperative exercise-only interventions, postoperative ileus incidence was significantly reduced, with an OR of 0.56 (95% CI: 0.46 to 0.67).

Key secondary outcomes included time to first flatus and time to first defecation, with data reported as above. Safety and tolerability findings were not reported; adverse events, serious adverse events, and discontinuations were not reported.

These results compare to prior landmark studies in colorectal cancer surgery, but specific comparisons are not reported in this meta-analysis. The source is a meta-analysis of observational and randomized studies; it reports associations, not causation. The certainty of pooled effect sizes is limited by the number of studies.

Key methodological limitations include a limited number of included studies, which prevented definitive conclusions. Potential biases were not detailed, but the observational nature of some included studies may introduce confounding.

Clinical implications are that postoperative comprehensive interventions may shorten intestinal recovery time in colorectal cancer surgery, but they do not reduce ileus incidence. Preoperative exercise-only interventions may reduce ileus incidence. These findings should inform practice decisions cautiously, given the association-only evidence.

Unanswered questions include the optimal protocol for exercise interventions, long-term outcomes, and generalizability to other cancer types. Do not infer causation from associations, do not extrapolate to other cancer types, and do not assume generalizability beyond colorectal cancer patients.