Pharmacological therapies for bowel dysfunction after colorectal cancer surgery: a systematic review

Purpose: Bowel dysfunction frequently occurs in colorectal cancer (CRC) patients following sphincter-preserving surgeries. This review systematically evaluated the evidence on pharmacological therapies for this complication. Methods: A systematic search was conducted in PubMed, Web of Science, and Scopus in November 2024. Experimental or quasi-experimental studies examining the effects of conventional pharmacological therapies and herbal medicine on stable CRC patients with post-surgical bowel dysfunction were included. Results: Among 8,989 retrieved records, eight studies were eligible. These investigated the effects of serotonin type 3 receptor antagonists (n=3), herbal medicines (n=2, specifically Daikenchuto and modified Baizhu Shaoyao San), diazepam (n=1), Botulinum A toxin injection (n=1), and topical phenylephrine (n=1). Except for phenylephrine, interventions showed varying improvements in stool frequency, incontinence, urgency, or quality of life. Most of the included studies exhibited a high risk of bias. Conclusion: Some interventions appear promising; however, the current evidence is insufficient to guide clinical practice. This review highlights a significant evidence gap and underscores the urgent need for large-scale, rigorous randomized controlled trials to establish definitive therapeutic strategies for this debilitating condition.