Gastroenterology Research and Practice / 2017 / Article / Tab 1

Review Article

Chewing Gum for Intestinal Function Recovery after Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis

Table 1

The characteristics of included studies.

Author (year)Patient populationNumber of patients (GC/NGC)GC interventionOutcomesResults

Asao 2002 [16]Elective laparoscopic colectomy for colorectal cancer19 (10/9)Patients chewed gum three times a day from the first postoperative AM until the day they began oral intake.①②⑤⑦Gum chewing aids early recovery from postoperative ileus and is an inexpensive and physiologic method for stimulating bowel motility.
Atkinson 2016 [17]Elective colorectal resection402 (199/203)Patients chewed gum for at least 10 min, four times a day for 5 consecutive days (or until discharge, if less than 5 days) from the first postoperative morning.①③⑥⑦⑧⑩⑪Chewing gum did not alter the return of bowel function or LOS after colorectal resection.
Fernandez 2016 [18]Elective colorectal surgery64 (32/32)Chewing gum within the first 24 h after surgery, for 15 minutes every four hours throughout their hospital stay, with six resting hours at night.①⑤⑥⑦⑧The use of chewing gum after colorectal surgery was associated with less postoperative ileus and vomiting, and with an increased passage of flatus within the first 48 hours after surgery.
Forrester 2014 [19]Open colon resection or a laparoscopic sigmoid colectomy31 (13/18)Gum chewing began on the morning of the first postoperative day or after removal of the nasogastric tube, and the times of gum chewing corresponded with routine medication administration times.①③④⑦⑨Postoperative gum chewing was not more effective than standard postoperative care or attention-control intervention in reducing the duration of postoperative ileus symptoms, length of stay, or complications among patients following open laparoscopic sigmoid colectomy.
Heijkant 2015 [20]Elective colorectal surgery120 (58/62)Patients started chewing gum 3 h before and after surgery. The frequency and duration of gum chewing were not standardized.①②⑤⑦⑧⑫Gum chewing is a safe and simple treatment to reduce POI and is associated with a reduction in systemic inflammatory markers and complications.
Hirayama 2006 [21]Elective open surgery for colorectal cancer24 (10/14)Patients chewed gum three times daily for 30 minutes every time.①②⑥Gum-chewing provides a simple and effective method to improve the postoperative state of patients.
Hwang 2013 [22]Laparoscopic colorectal cancer surgery132 (65/67)Patients started to chew gum on the first postoperative day, 3 times a day, approximately 10–20 minutes at a time, until normal feeding was resumed.①⑦Gum chewing is an easy and cost-effective method to reduce the length of the postoperative hospital stay for laparoscopic colorectal cancer surgery.
Kobayashi 2015 [23]Left-sided resection for colorectal cancer43 (21/22)Patients chewed gum three times daily for ≥5 minutes (morning, noon, and evening) until the first day of regular oral dietary intake.①③⑦⑬Gum chewing changed the serum levels of des-acyl ghrelin and gastrin, but we were unable to demonstrate an effect on the recovery of bowel function.
Lim 2013 [24]Colorectal resection157 (77/80)Chewing gum for 15 minutes 4 times a day (8 AM, 12 PM,4 PM, and 8 PM).①③⑥⑦⑧Chewing gum is safe, but does not hasten the return of gastrointestinal function in patients who receive accelerated postoperative feeding.
Matros 2006 [25]Elective partial colectomy for colorectal cancer43 (22/21)Chewing gum for 45 minutes three times daily at 9 AM, 4 PM, and 8 PM.①③⑦Gum chewing, although safe, does not reduce duration of post colectomy ileus.
McCormick 2005 [26]Elective colon resection88 (53/35)Gum chewing 4 times a day for 15 min.①③⑦Chewing gum in the postoperative period may be an inexpensive intervention to facilitate recovery and decrease hospital cost.
Quah 2006 [27]Open surgery for left-sided colorectal cancer38 (19/19)The patients chewed gum for at least 5 min, three times daily from the first postoperative morning until the intake of a solid diet orally.①②⑦⑧⑭The addition of gum chewing to a standardized postoperative regimen did not reduce the period of postoperative ileus or shorten length of stay following open surgery for left-sided colorectal cancer.
Schuster 2006 [28]Elective open sigmoid resections34 (17/17)Chewing gum 3 times daily for 1 hour each time until discharge.①③⑦⑨Gum chewing speeds recovery after elective open sigmoid resection by stimulating bowel motility.
Shum 2016 [29]Laparoscopic colorectal resection82 (41/41)Chewing gum three times daily for 30 min each time from day 1 until discharge.①③⑦⑨Chewing gum is a simple intervention that speeds intestinal transit in patients managed with a recovery programme after laparoscopic colorectal resection
Topcu 2016 [30]Planned open colorectal surgery60 (30/30)Patients chewed gum three times a day after meals for a period of 15 min from the first morning after the operation until the time of their discharge.①②④⑦Chewing gum is a simple intervention for reducing postoperative ileus after colorectal surgery.
Yang 2017 [31]Open or laparoscopic resection394 (197/197)Chewing gum three times daily for at least 10 min, starting on postoperative day 1 and continuing for 5 consecutive days or until flatus.①③⑥⑦⑧Chewing gum does not appear to affect recovery of bowel function or hospital stay, though it may benefit patients who undergo open resection.
Zaghiyan 2013 [32]Major colorectal surgery114 (54/60)Chewing gum for 45 minutes, 3 times daily on postoperative days 1 to 7.①③⑥⑦There does not appear to be any benefit to sugared chewing gum in comparison with no gum in patients undergoing major colorectal surgery

Note: ① the time to first passage of flatus; ② the time to first defecation; ③ the time to first bowel movement; ④ time to start feeding; ⑤ postoperative ileus (POI); ⑥ clinical complications such as nausea, vomiting, abdominal distension, pain, pneumonia, wound infection, bleeding, and others; ⑦ the length of postoperative hospital stay; ⑧ mortality; ⑨ time to first hunger; ⑩ first day of auscultated bowel sounds; ⑪ solid food consumption and tolerance; ⑫ local and systemic inflammation and gastric emptying; ⑬ gut hormones; ⑭ tolerance and satisfaction of gum chewing.