Influence of acupuncture and moxibustion on postoperative gastrointestinal dysfunction among patients with gastrointestinal cancer: A network meta-analysis.

[OBJECTIVE] This study aims to evaluate and compare the relative efficacy and safety of acupuncture and moxibustion interventions for the recovery of gastrointestinal function and the incidence of adverse reactions after gastrointestinal cancer (GIC) surgery.

[METHODS] Eight databases were retrieved up to July 2025. The observation indicators included: time to first flatus, defecation, food intake, and bowel sound; incidence of postoperative adverse reactions (nausea and vomiting, abdominal distension and diarrhea, and ileus); and clinical efficacy rate. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Statistical analysis was conducted via Bayesian network meta-analysis implemented in R. Intervention efficacy was quantitatively ranked using the surface under the cumulative ranking curve (SUCRA), with relevant diagrams generated in Stata (version 18.0).

[RESULTS] In total, 43 randomized controlled trials (RCTs) were included in this study, involving 4019 patients, to evaluate the efficacy of 10 interventions of acupuncture and moxibustion. The network meta-analysis revealed that electroacupuncture was the most effective in shortening the time to first flatus after surgery (MD = -3.8, 95 % CI [-7.06, -0.61]) and the time to first defecation (MD = -4.97, 95 % CI [-9.61, -0.41]) (SUCRA = 75.1 %, SUCRA = 77.2 %). Parallel needling method (MD = -4.83, 95 % CI [-8.16, -1.45]) performed best in lessening the time to first postoperative bowel sound (SUCRA = 92.1 %). All interventions failed to significantly shorten the time to first food intake after surgery. In terms of clinical efficacy rate, moxibustion (MD = 1.54, 95 % CI [1.08, 2.3]) showed the best performance in ameliorating the overall clinical efficacy rate after surgery (SUCRA = 89.5 %). Thumbtack needle exerted the best effect in decreasing postoperative nausea and vomiting (RR = 6.7, 95 % CI [0.18, 269.63]) and abdominal distension and diarrhea (RR = 5.78, 95 % CI [1.07, 34.89]) (SUCRA = 76.1 %, SUCRA = 89.6 %).

[CONCLUSION] Acupuncture and moxibustion therapy, as an adjunctive therapy, has exhibited favorable efficacy and safety in treating POGD related to GICs. RCTs of high quality are warranted to further ascertain these findings in the future.

[PROSPERO REGISTRATION NUMBER] CRD42025111427.