Introduction

Colorectal cancer (CRC) is a common malignant tumor of the digestive system that is associated with high mortality and morbidity.1 Globally, CRC is the third most common malignant tumor and the second deadliest cancer. In 2020, about 1.9 million cases of morbidity and 900,000 deaths globally were attributed to CRC. The prevalence of CRC is higher in developed countries and on the rise in low- and middle-income countries and regions.2 It is projected that by 2035, the prevalence of CRC will increase to 2.5 million people, posing a serious healthcare challenge.3 In China, the number of new cases of CRC was approximately 608,000 in 2019.4 The total economic burden on patients was estimated to be RMB 202,990, with a per capita hospitalization cost of RMB 56,714.5

Therefore, laparoscopic colorectal cancer surgery is currently the most important operation in the treatment of CRC patients. However, as an invasive operation, the incidence of postoperative immune and gastrointestinal disorders in patients reached 12.5%.6 The clinical manifestations of patients were stoppage of anal exhaust and defecation, abdominal pain, abdominal distension, continuous nausea and vomiting, and reduction or disappearance of intestinal sounds.7–9 At the same time, studies have shown that the recovery of gastrointestinal function after colorectal cancer resection is slow and prone to mucosal barrier damage, intestinal flora imbalance and postoperative malnutrition, which affect the postoperative recovery of patients.10–14 In addition, gastrointestinal dysfunction will also increase the occurrence of postoperative intestinal obstruction, anastomotic fistula and other serious complications, and lead to an infection rate of 9.38%,6 seriously threatening the life of patients.7 Existing guidelines on postoperative measures to accelerate the recovery of gastrointestinal function in patients are uneven, and patient compliance is low. Moreover, these guidelines do not have clear instructions on the specific surgical procedures, and the interpretation and execution are also vague, and the clinical nursing situation is not optimistic, resulting in a long postoperative bed time for patients, and it is difficult to recover to the preoperative level of function. The incidence of postoperative complications was 19.4%.7,8,11–14 Therefore, in this study, we sought to summarize the best evidence for accelerating the postoperative recovery of gastrointestinal function in patients with CRC to offer a scientific, standardized, and reliable evidence basis for clinical practice.

Materials and Methods Formulation of the Research Question

Based on the question development tool of the Center for Evidence-Based Nursing at Fudan University,15 we formulated the research question using the PIPOST model. PIPOST is used for constructing a specific problem. Here, “P” (population) refers to the target population of evidence use, ie, in our case, patients with CRC identified as needing surgical treatment; “I” (intervention) refers to measures that can promote the enhanced recovery of gastrointestinal function of postoperative patients, and includes the five facets, namely, organizational management, preoperative risk assessment, preoperative education, intraoperative monitoring, and postoperative management; “P” (professional) denotes the personnel using the evidence, including nurses, doctors, patients, and family members; “O” (outcome) refers to the outcome indicators, including bowel sounds, the first postoperative exhaust, the first bowel movement, anxiety, nausea and vomiting, pain, and so on; “S” (setting) refers to the place where the evidence is used, including general surgery, gastrointestinal surgery, and surgical oncology settings, among others; and “T” (type of evidence) refers to the type of evidence, such as clinical decision-making, best practices, guidelines, evidence summaries, systematic reviews, expert consensus statements, and randomized controlled trials. This study was registered at the Fudan University Evidence-Based Nursing Center, China (registration number: ES20231504).

Literature Search Strategy

We performed a computerized search of the following using the top-down approach, following the “6S” pyramid model of evidence: (1) BMJ Best Practice, a computerized clinical decision support system; (2) guideline websites, including the US National Guideline Clearinghouse (NGC), the National Institute for Health and Care Excellence (NICE), the Guidelines International Network (GIN), the New Zealand Guidelines Group (NZGG), the Registered Nurses’ Association of Ontario (RNAO), the Australian Clinical Practice Guidelines (ACPG), the Scottish Intercollegiate Guidelines Network (SIGN), the Ding Xiang Yuan (DXY), the Medlive, and other guideline networks; (3) databases included the following: PubMed, Cochrane library, OVID, Web of Science, Embase, CINAHL, and other foreign databases. We also performed a search in Chinese databases such as the China Biology Medicine disc, China National Knowledge Infrastructure, Wanfang Data, and the VIP Database.

We used the following English search terms: Colorectal Neoplasms/Ne-oplasm, Colorectal/Neoplasms, Colorectal/Colorectal Tumors/Colorectal Tumor/Tumor, Colorectal/T-umors, Colorectal/Colorectal Cancer/Cancer, Colorectal/Cancers, Colorectal/Colorectal Cancers/Color-ectal Carcinoma/Carcinoma, Colorectal/Carcinomas, Colorectal/Colorectal Carcinomas/Colonic Neopla-sms/Rectal Neoplasms GeneralSurgery/Postoperative, surgery /operative treatment /operation/p-ostoperation/after operation/radical resection/Radical surgery/radical operation/Modified radical corre-ction Gastrointestinal Motility/Gastrointestinal Motilities/Motilities, Gastrointestina/Motility, Gast-rointestinal/Intestinal Motility/Intestinal Motilities/Motilities, Intestinal/Motility, Intestinal/Gastroint-estinal Motilities/Motilities, Gastrointestinal/Motility, Gastrointestinal/Intestinal Motility/Intestinal Mot-ilities/Motilities, Intestinal/Motility, Intestinal/Gastrointestinal Tracts “Nursing Care/nurse/nursing/care”.

The Chinese search terms we used were as follows: “Colorectal Tumor/Colon Tumor/Colorectal Cancer/Colon Cancer/Rectal Cancer/Rectal Tumor” “Post-Operative Period/Post-Operative/Surgery/Radical Surgery/Rectomy” “Gastrointestinal Activity/Gastrointestinal Function/Gastrointestinal Tracts/Gastrointestinal activity/intestinal peristalsis” and “Nursing/Nursing Management”.

The search keywords were modified for each database. The search strategy for PubMed, as an example, is shown in Supplementary Materials. The search time frame for clinical decision-making, guidelines, best practices, evidence summaries, systematic reviews, and expert consensus statements was from the inception of the database until January 2023.

Inclusion and Exclusion Criteria Literature Inclusion Criteria

(1) The study population was patients after surgery for CRC, involving enhanced recovery of gastrointestinal function; (2) The type of literature was Chinese and international clinical practice guidelines, evidence summaries, systematic reviews, original studies, and so on; (3) The languages were Chinese and English.

Literature Exclusion Criteria

(1) Research that pertained to patients with postoperative enterostomy after CRC; (2) literature with limited information in the text that could not be utilized; (3) literature where the full text could not be obtained through various channels but only abstracts were available; (4) conference reports and conference papers; (5) guidelines published by individual treatises; and (6) non-evidence-based guidelines.

Criteria for Evaluating the Quality of Literature

We evaluated the guidelines quantitatively using the 2012 version of the Appraisal of Guidelines for Research and Evaluation II (AGREE II).16 The scale consists of 23 items, each of which is rated on a scale of 1 to 7, with 7 being “strongly agree” and 1 being “strongly disagree”. Recommendations are made for the guidelines based on the number of standardized percentages for each domain and the appraiser’s judgment. We evaluated expert consensus statements using the 2016 version of the Australian Joanna Briggs Institute (JBI) Evidence-Based Health Care Centre criteria,17 which consists of six items with the evaluation options “not applicable”, “unclear”, “no”, and “yes” for each item. For evaluating randomized controlled trials, we utilized the 2016 version of the Australian JBI evaluation tool, which consists of 13 items with the choices “not applicable”, “unclear”, “no”, and “yes” for each item. We evaluated systematic reviews using AMSTAR (A MeaSurement Tool to Assess systematic Reviews),18 which consists of 11 items with the options of “not applicable”, “unclear”, “no”, and “yes” for each item. For evaluating evidence summaries, recommended practices, and best practice information booklets, we traced the original literature on which the evidence was based and selected the appropriate evaluation criteria for quality assessment depending on the type of literature.19

Process of Literature Quality Evaluation

Two appraisers with a research background in evidence-based nursing independently conducted the quality evaluation of the selected literature. In cases where the two raters came to different conclusions about a piece of literature, a third professional was invited to rate the piece and collaboratively decide on its inclusion or exclusion. When there were conflicting conclusions from different sources of evidence, the appraisers followed the rule of prioritizing evidence-based evidence, prioritizing high-quality evidence, and prioritizing the most recent published evidence. Guidelines were evaluated by at least four professionals, and other literature was evaluated independently by two researchers with evidence-based training, and in case of disagreements, a third researcher with a background in evidence-based medicine made the decision.20

Criteria for Extracting Evidence, Summarizing Findings, and Determining Recommendation Levels

In this study, we evaluated the extracted evidence using the JBI system for evidence pre-grading and evidence recommendation level21 and the evidence was classified from levels 1 to 5 according to the type of study design: level 1 for randomized controlled trials/experimental studies, level 2 for quasi-randomized controlled trials, level 3 for observational-analytical studies, level 4 for observational-descriptive studies, and level 5 for expert opinion/basic studies.

We organized an expert meeting in March 2023 to evaluate the feasibility, appropriateness, clinical significance, and effectiveness of each item in the intervention program. The discussion included six experts (two specialists in evidence-based nursing methodology, one chief physician of general surgery, one deputy chief physician, one head nurse of general surgery, and one charge nurse), two staff members at the senior level, three at the deputy senior level, and one at the intermediate level. All of them had been working in their related field for more than 10 years and had rich work experience. Thus, the opinions discussed by the experts in this meeting had a certain degree of reliability and representativeness.

Results General Overview of the Included Literature

We identified 1,454 articles in the preliminary literature search. There were 1,179 articles after removing duplicates. We excluded articles whose content was not relevant to the topic, reviews, 939 case reports, publications where we could not access the full text, those with incomplete data, and 55 articles in languages other than Chinese or English. After this re-screening, we had 185 articles. Additionally, we excluded articles with low-quality literature, literature that was not relevant to the practical work of nursing staff, and those with inconsistencies in outcome indicators. Finally, we included a total of 21 articles in the review, comprising 6 guidelines,22–27 6 systematic reviews,28–33 3 expert consensus,34–36 4 randomized controlled trials,37–40 and 2 evidence summaries.7,41 The flowchart of literature screening is shown in Figure 1.

Figure 1 The flowchart of literature screening.

Basic Details of the Included Literature

Literature extraction and evidence grading results: We extracted the following details from the included literature: title of the article, year of publication, country, source, type, and topic. These details are shown in Table 1.

Table 1 Basic Details of the Literature Included in the Review (n = 21)

Results of Literature Quality Evaluation Results of Quality Evaluation of Guidelines

We included six guidelines22–27 in this review, and their methodological quality evaluation results are shown in Table 2.

Table 2 Results of the Quality Evaluation of Guidelines

Quality Evaluation Results of Systematic Reviews

There were a total of six systematic reviews28–33 in the final review, and the results of their methodological quality evaluations are shown in Table 3.

Table 3 Results of the Quality Evaluation of Systematic Reviews

Quality Evaluation Results of Expert Consensus Statements

Three articles pertaining to expert consensus statements34–36 were included in this study, and the results of their methodological quality evaluation are shown in Table 4.

Table 4 Quality Evaluation Results of Expert Consensus Statements

Quality Evaluation Results of Randomized Controlled Trials

The review consisted of six randomized controlled trials,37–42 and their methodological quality evaluation results are shown in Table 5.

Table 5 Quality Evaluation Results of Randomized Controlled Trials

Results of Quality Evaluation of Evidence Summaries

Two evidence summaries7,41 were included in our review, and the results of their methodological quality evaluation are shown in Table 6.

Table 6 Results of Quality Evaluation of Evidence Summaries

Best Evidence Summaries

After extracting and summarizing the evidence of enhanced postoperative recovery of gastrointestinal function in patients with CRC, we identified 58 best evidence practices in five areas: organizational management of postoperative CRC patients, preoperative risk assessment, preoperative teaching, intraoperative monitoring, and postoperative management, as shown in Table 7.43,44

Table 7 Summary of Evidence on Enhanced Recovery of Gastrointestinal Function After CRC Surgery

Discussion Organizational Management

Evidence 1 emphasizes a multidisciplinary collaborative approach. Currently, a multidisciplinary team consisting of personnel from nursing, surgery, traditional Chinese medicine, anesthesia, nutrition, rehabilitation, and other disciplines is involved in promoting enhanced postoperative recovery in patients. Relying solely on nursing staff is inadequate to comprehensively promote the enhanced postoperative recovery of gastrointestinal function in patients. As emphasized in the Clinical Practice Guidelines for Enhanced Recovery after Surgery in China (2021),22 a multidisciplinary collaboration can enhance the safety of patients during the perioperative period, reduce postoperative complications, shorten hospitalization time, and improve patient satisfaction. The negative impact on patients is mainly an increase in costs.

Preoperative Risk Assessment

Evidences 2 to 6 refer to preoperative risk assessment. Preoperative risk assessment is an important link to promote the enhanced recovery of patients after surgery. At present, hospitals routinely use the Hamilton Anxiety Scale (HAM-A) to evaluate the psychological status of patients; medication or specialized treatment has been recommended for moderate to severe anxiety that can increase postoperative pain. The severity of pain is assessed preoperatively by scoring the visual analog scale (VAS). Nutritional risk is screened with the Nutrition Risk Screening (NRS) 2002 nutritional scoring tool, and nutritional support is actively implemented. The 6-Minute Walk Test (6MWT) is used to assess the patients’ motor ability, while the Pittsburgh Sleep Quality Index (PSQI) is used to evaluate overall sleep quality.22

Preoperative Education Evidence 7 Summarizes Preoperative Education

Evidence 7 highlights the significance of preoperative education in order to promote better patient mastery and performance of perioperative tasks and thus accelerate the recovery of postoperative gastrointestinal function. There are various methods employed for imparting preoperative education, and the guidelines22 point out that clear and interesting preoperative education content disseminated through the use of cards, manuals, multimedia, display boards, and other forms can effectively elicit the active cooperation of patients as well as improve their mastery of such information.

Evidences 8 to 10 emphasize Preoperative Fluid Intake

At present, there is growing evidence in favor of preoperative energy supplementation. This, on the one hand, can reduce patients’ preoperative hunger, thirst, and irritability and significantly attenuate postoperative insulin resistance. On the other hand, it can stabilize the patient’s blood glucose and metabolism and significantly decrease complications. Guidelines in China and internationally, expert consensus statements, and evidence summaries7,24,26,36 all recommend that patients should consume 800 mL of liquid 10 hours before the procedure and 400 mL of carbohydrate drinks 2 hours before the procedure, but not ethanol-based drinks 10 hours before surgery. Patients should also fast for six hours before surgery, during which they can consume light and easy-to-digest food. Oral carbohydrate-rich isotonic fluids are not recommended for patients with diabetes. Patients with gastric emptying disorders can be left with a deep vein catheter (internal jugular vein or subclavian vein) to receive intravenous supplementation before surgery.

Evidences 11 to 13 Summarize Preoperative Bowel Preparation Protocols

Preoperative bowel preparation is determined based on the type of surgical modality. The guidelines22 clearly state that routine preoperative mechanical bowel preparation is not recommended for patients undergoing elective right hemicolectomy and combined abdominal perineal resection; for patients undergoing left hemicolectomy and anterior rectal resection, bowel preparation is based on an oral laxative combined with a small amount of sodium phosphate enema; and for patients undergoing anus-preserving surgery for low to intermediate rectal cancer who have severe constipation or require intraoperative colonoscopic localization, the following two protocols are recommended: (1) for patients with preoperative colonoscopy indicating incomplete obstruction, oral laxatives such as lactulose can be combined with enema laxatives; (2) for patients with colonoscopy indicating complete obstruction, enemas can be performed alone; for both of the above cases, oral antibiotics can be given three days before the operation. Additionally, antibiotics can be administered intravenously 30 minutes before the operation, followed by another dose for two hours during the intraoperative period.

Evidences 15 to 17 Highlight Preoperative Exercising

The Chinese and international guidelines23 indicate preoperative exercise to help reduce the risk of postoperative complications. These guidelines recommend preoperative aerobic and resistance exercise for at least two weeks prior to surgery, with a frequency of ≥ 3 times per week, for 40–60 minutes per session, including exercises such as ankle pumps, fist exercises, training to strengthen abdominal muscles, breath and sputum expectoration exercises, chest expansion exercises, deep breathing, and hip and anus lifting training, 1–2 times per day, 5–10 minutes per session while holding for 5–10 seconds each time, can improve organ function. In addition, guidelines and van Rooijen et al23,38 found that preoperative cessation of smoking and alcohol for ≥ 4 weeks can increase tissue oxygenation and reduce complications such as incision and lung infection.

Intraoperative Monitoring Evidences 20, 21 clarify the Importance of Maintaining a Constant Body Temperature in Intraoperative Patients

Maintaining a constant body temperature, one of the five vital signs, is necessary to ensure that the body can carry out metabolism and other essential functions. Unexpected inadvertent perioperative hypothermia (IPH) can lead to serious complications such as postoperative infections, an increased risk of transfusion therapy, and a lower rate of anesthetic drug metabolism in patients.42 The incidence of IPH in all types of surgeries ranges from 7% to 90%.45 It interferes with the rapid postoperative recovery of patients. Expert consensus statements35,36 have highlighted strategies for preventing IPH that include increasing the ambient temperature, shortening the intraoperative temperature monitoring time, and pharmacological interventions. Temperature monitoring should be started one hour before induction of anesthesia and monitored every 15–30 minutes. Additionally, warm saline or warm distilled water should be used when rinsing the abdominal cavity during the operation. The temperature in the operating room should be maintained at ≥ 21°C for surgeries on adults and ≥ 24°C for surgeries on pediatric patients.46

Evidences 22–25 Summarize the Choice of Perioperative Indwelling Tubes

A randomized controlled clinical trial of 494 patients with rectal cancer47 found that the use of pelvic drainage after rectal resection did not provide any benefit to patients. In another study,48–50 there was no significant difference between postoperative indwelling and non-indwelling gastrostomy tubes on patients’ recovery of bowel function or length of hospitalization. As per Chinese and international guidelines,22,25 routine placement of abdominal drains is not recommended for patients undergoing elective abdominal surgery. However, when risk factors for anastomotic leakage are present, it is recommended that abdominal drains be left in place to facilitate the early detection of gastrointestinal fistulas and timely treatment. If a urinary catheter is left in place during surgery, it is recommended that it be removed 24 hours postoperatively and that catheters be left in place for about 2 days in patients who have undergone transabdominal low anterior rectal resections or who have had suprapubic cystocentesis. If gas enters the stomach during tracheal intubation, the stomach can be pressed to reduce gastrointestinal insufflation before tracheal intubation, and a nasogastric tube can be left in place during the operation to expel the gas, but it should be removed before the patient regains consciousness from anesthesia.

Postoperative Management Evidences 14, 18, 19, and 26 to 30 Focus on Perioperative Medications

Postoperative recovery of gastrointestinal function is delayed by the patient’s reluctance to get out of bed early due to pain and fear of wound dehiscence. Delayed gastrointestinal function recovery (GIFR)may increase patients’ discomfort, length of hospital stay, and treatment costs. GIFR could lead to accumulation of gas and effusion in the gastrointestinal tract lumen and increases the likelihood of intestinal obstruction and dysregulation of the gastrointestinal flora. The main clinical manifestations of delayed GIFR are delayed flatus or defecation, abdominal pain, abdominal distension, nausea, vomiting, and postoperative intestinal obstruction which often require nasogastric tube intubation.51–53 Delayed GIFR also affects the time for early oral nutrition, leading to insufficient nutritional supply and time for adjuvant treatment, thus, influencing treatment outcomes and patients’ survival.54 Therefore, medical personnel should take a series of positive measures to help patients recover early, shorten the length of hospital stay, reduce medical costs and save medical resources. Several studies3,39 have shown that combining epidural block with parecoxib enhances recovery and reduces pain in patients with CRC. Additionally, assessing the degree of pain in patients using the VAS scale can be helpful. Also, guidelines22 recommend the use of a multimodal analgesic regimen postoperatively, in which, while epidural analgesia (EA) or thoracic epidural analgesia (TEA) are not beneficial for patients undergoing laparoscopic colorectal surgery, these have a positive effect on open colorectal surgery. The guidelines23 recommend that patients without contraindications should be advised to use non-steroidal anti-inflammatory drugs (NSAIDs) 30 minutes before the commencement of surgery and in the early postoperative period to improve the recovery of intestinal function; however, NSAIDs should not be used for more than three days. Furthermore, intraoperative intravenous infusions of lidocaine and dexmedetomidine can also help to enhance the analgesic and anti-stress effects, and these modalities can reduce the postoperative pain of the patients to a certain extent.

Morphine is used for prolonging the analgesic effect to deal with bouts of postoperative pain; however, the expert consensus statement35 points out that the amount of morphine should be controlled intraoperatively. Thoracic epidural anesthesia does not require the use of morphine, but there is a lack of evidence supporting its use in rectal surgery, and this needs to be clinically verified. Another meta-analysis30 found that perioperative administration of probiotics is less expensive, has fewer side effects, and is beneficial to patients when compared to alternative medications in alleviating gastrointestinal symptoms and postoperative complications in CRC; additionally, acetylcholinesterase inhibitors, as well as cholinesterase agonists, have a positive effect on the recovery of gastrointestinal paresthesia and can be an option for patients.

Evidences 31–39 Emphasize Early Postoperative Functional Exercises and the Content of Such Exercise Regimens

The evidence includes maintaining activity diaries and detailed records after surgery, adjusting the patient’s lying position to a semi-recumbent position when awake, and engaging in moderate activity while in bed. The guidelines7 recommend that on postoperative day 1, the patient should be out of bed for 1–2 hours, and from day 2 until discharge, 4–6 hours of activity per day is appropriate. The expert consensus statement36 recommends blowing exercises as they are simple and easy for patients to master. This postoperative functional exercise takes 3–5 minutes per session and is done 3–5 times per day.

Jin et al40 conducted a randomized controlled trial to investigate the effects of a three-step gradual early rehabilitation exercise on patients’ initial defecation time. They found that the intervention group experienced a significant reduction in initial defecation time, from 94.85 hours to 64.68.10 hours compared to the control group, leading to a significant reduction in both defecation and hospitalization time for the patients.

In addition, a meta-analysis and a randomized controlled trial19,21,26 found that in the postoperative period of 6–12 hours, having the patients chew gum for 5–10 minutes three times per day when they were awake had the potential to effectively enhance the restoration of intestinal function. However, another meta-analysis32 pointed out that chewing gum had no significant effect on intestinal obstruction. Therefore, it is imperative to consider these aspects in clinical practice.

Evidences 40–46 Summarize Dietary Guidance

A meta-analysis published by Yang et al,28 which included a total of 2,307 patients, found that early enteral nutrition increased serum albumin and prealbumin, promoted recovery of gastrointestinal function, and reduced postoperative hospitalization. Another study55 also found that early postoperative oral intake of water promotes the faster recovery of intestinal function, contributes to maintenance of the intestinal mucosal barrier, and reduces the incidence of postoperative infections. At the same time, the guidelines22,29 clearly point out that detailed preoperative and perioperative dietary health education should be provided to patients. Patients can drink water within two hours after surgery if they do not experience any significant gastrointestinal reactions. Their liquid diet can be gradually increased based on their recovery. Blood glucose levels should be monitored every two hours in the postoperative period and should be maintained in the target range of 6–10 mmol/L.

Evidences –49 Summarize the Specific Retention Options for Drains

Currently, the use of nasogastric tubes is not a standard practice, and this helps to reduce postoperative pulmonary atelectasis and pneumonia. According to the guidelines,22,26 in cases where gas enters the stomach during endotracheal intubation, it is recommended to keep a nasogastric tube in place intraoperatively to facilitate the expulsion of the gas. The tube should be removed prior to the patient’s waking from anesthesia. Additionally, it is recommended to remove the urinary catheter within 24 hours after the surgical procedure.

Suprapubic vesicourethral drainage is a viable option for patients who have undergone transabdominal low anterior resection of the rectum or have had an indwelling urinary catheter for approximately two days. Postoperative prophylactic abdominal drainage has been found to have no significant impact on the rate of anastomotic leakage and complications. Therefore, it is not recommended to routinely place abdominal drainage tubes for elective abdominal surgery. However, using indwelling abdominal drainage tubes is recommended for patients who have risk factors such as anastomotic leakage.56

Evidences 50–51 Refer to the Use of Acupressure

Acupressure is a noninvasive, safe, and easy-to-learn technique that can be performed by nurses, caregivers, family members, and even patients themselves under the guidance of a traditional Chinese medicine (TCM) practitioner. A randomized controlled trial37 found that patients who were given Zusanli point acupressure within five days of surgery had a significantly shorter time to recovery of bowel function.

Limitations

First, only 21 literatures were included in the study, which was too small, which affected the credibility of the study. Second, literature in English and Chinese is only included in the study, and literature in other languages is not included, which further affects the scope of application of the study.

Conclusion

Using an evidence-based approach, we conducted a thorough and systematic review of Chinese and international literature in order to summarize a significant amount of high-quality evidence. The process of evidence-based method is rigorous, and the established protocol is of high quality, which can promote the recovery of postoperative gastrointestinal function in patients relatively perfect. Through “organizational management”, “preoperative risk assessment”, “preoperative education”, “intraoperative monitoring” and “postoperative management” were analyzed in five aspects. Among them, acupressure, chewing gum, early imported eating, early exercise, and other measures are crucial to promote the recovery of postoperative gastrointestinal tract The function. Stop smoking and drinking, timely functional exercise, etc. before and after surgery will be beneficial to the rehabilitation of patients. The review provides healthcare professionals and other stakeholders with the most dependable evidence regarding enhanced recovery interventions for gastrointestinal function following surgery for CRC. It is essential for healthcare professionals to have a comprehensive understanding of the requirements for enhanced postoperative gastrointestinal recovery. They should also strive to increase the rate of implementing evidence-based practices and accurately utilize each piece of evidence in order to promote enhanced post-surgical gastrointestinal recovery for patients with CRC. In recent years, studies have shown that Chinese medicine acupuncture and moxibustion and other treatment methods have a good effect on promoting postoperative gastrointestinal function recovery.57,58 However, there is no evidence based medical research on acupuncture and moxibustion treatment for gastrointestinal function recovery after CRC surgery, which can be further explored in future research.

Abbreviations

CRC, Colorectal Cancer; PIPOST, Population, intervention, professional, outcome, setting, type of evidence; NGC, National Guideline Clearing-house; NICE, National lnstitute for Health and Clinical Excellence; GIN, Guidelines International Network; NZGG, New Zealand Guidelines Group; RNAO, Registered Nurses’Association of Ontario; ACPG, Australian Clinical Practice Guidelines; SIGN, ScottishIntercollegiate Guidelines Network; AGREE III, appraisal of guidelines for research and evaluation instrument II; HAMA, Hamilton II Anxiety Scale; VAS, VisualAnalogueScale; NRS2002, nutritional risk screening 2002; 6MWT, 6-minute walking test; IPH, inadvertent perioperative hypothermia; EA, epidural analgesia; TEA, thoracic epidural analgesia; NSAIDs, Nonsteroidal Antiinflammatory Drugs.

Data Sharing Statement

The datasets used and analysed during the current study available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

This study was conducted in accordance with the declaration of Helsinki. This study was conducted with approval from the Ethics Committee of Third People’s Hospital of Yunnan Province(2023KY015).

Acknowledgments

We are particularly grateful to all the people who have given us help on our article

Disclosure

None of the authors have any financial disclosure or conflicts of interest to report for this work.

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