The ACURE Trial: Acupuncture for Colorectal Recovery

Postoperative ileus (a temporary stop in bowel motility) is a common challenge following major abdominal surgery. This study, the ACURE trial, is a prospective, multi-center, randomized controlled trial designed to investigate the efficacy of electroacupuncture as an adjunctive therapy within an Enhanced Recovery After Surgery (ERAS) framework.

Intervention Protocol:

The intervention involves bilateral stimulation of five specific acupoints (ST36, ST37, SP6, LI4, and PC6) known in Traditional Chinese Medicine to regulate gastrointestinal motility and alleviate nausea. The sessions are administered once daily starting the day before surgery through postoperative day 3.

Objectives:

Primary: To measure the time (in hours) from the end of surgery to the patient's first spontaneous defecation.

Secondary: To evaluate the time to first flatus, tolerance of oral intake, postoperative pain levels (VAS scores), total analgesic consumption, and the overall length of hospital stay.

The study aims to enroll 240 participants across multiple centers to ensure statistical power. By using a three-arm design (True EA vs. Sham EA vs. Control), the trial seeks to distinguish the specific therapeutic effects of acupuncture from potential placebo effects or standard recovery improvements.

• Electroacupuncture (EA) (Device): A licensed practitioner will administer electroacupuncture at five bilateral acupoints: ST36 (Zusanli), ST37 (Shangjuxu), SP6 (Sanyinjiao), LI4 (Hegu), and PC6 (Neiguan). Sterile acupuncture needles will be inserted to a depth of 15-30 mm to elicit the "deqi" sensation. An electroacupuncture device will deliver a continuous wave at a frequency of 5 Hz, with intensity adjusted to individual tolerance. Each session lasts 30 minutes. A total of 4 sessions will be performed: one session the day before surgery and three sessions on postoperative days 1, 2, and 3.
• Sham Electroacupuncture (SA) (Device): Participants receive superficial needling (2-3 mm depth) at five non-acupoint locations, anatomically distinct from the true acupoints. To maintain blinding, visually identical needles and a sham electroacupuncture device will be used. While electrodes are attached to the needles, the internal wiring of the stimulator is disconnected, ensuring no electrical current is delivered. The treatment timing (30 minutes per session) and overall schedule (4 sessions total) are identical to the Electroacupuncture group.
• Enhanced Recovery After Surgery (ERAS) Protocol (Procedure): Standardized perioperative care including patient education, preoperative mechanical bowel preparation with oral antibiotics, minimally invasive surgical approach (laparoscopic or robotic), restrictive fluid management, early removal of nasogastric tube and urinary catheter, multimodal analgesia, and early postoperative mobilization and oral intake.

Primary outcomes

• Time to First Postoperative Defecation [From the end of surgery up to postoperative day 30.]: The time interval (measured in hours) from the completion of surgery to the first spontaneous passage of stool. Patients will record the exact time in the ACURE Trial Patient Diary.

Secondary outcomes

• I-FEED Score Assessment [At 24 hours and 72 hours post-surgery.]: The I-FEED (Intake, Feeling, Emesis, Exam, and Distention) scoring system will be used to evaluate gastrointestinal recovery. The total score ranges from 0 to 15, where higher scores indicate more severe gastrointestinal dysfunction or ileus.
• Time to First Postoperative Flatus [From the end of surgery up to postoperative day 30.]: The time interval (measured in hours) from the completion of surgery to the first passage of anal gas, as reported by the patient in the study diary.
• Length of Postoperative Hospital Stay [Up to postoperative day 30.]: The duration (measured in days) from the completion of the surgical procedure to the time of hospital discharge.
• Quality of Life Assessment (EORTC QLQ-C30) [At Postoperative Day 3 and Postoperative Day 28.]: Description: The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30. It includes functional scales, symptom scales, and a global health status. Scores are transformed to a 0-100 scale; higher scores for functional scales represent better functioning, while higher scores for symptoms represent more severe symptoms.

Sex: All, ages: 18 Years to 80 Years

Inclusion Criteria:

* Histologically confirmed colorectal cancer requiring scheduled curative-intent resection.
* Age between 18 and 79 years, inclusive.
* Ability to understand the study protocol and provide written informed consent.
* American Society of Anesthesiologists (ASA) physical status classification of I, II, or III.

Exclusion Criteria:

* Pregnant or breastfeeding women.
* History of major abdominal surgery within the past 4 weeks.
* Receipt of chemotherapy or radiotherapy within the past 6 months.
* History of organ transplantation with rejection episodes within the past 30 days.
* Presence of active infection (e.g., tuberculosis, sepsis, peritonitis).
* Positive for hepatitis B, hepatitis C, or HIV with an uncontrolled viral load.
* Severe malnutrition, defined as a Nutritional Risk Screening (NRS 2002) score ≥ 3.
* History of total colectomy or requirement for ileorectal anastomosis.
* Requirement for multivisceral resection due to tumor invasion.
* Scheduled for prophylactic stoma creation.
* Moderate to severe cognitive impairment, epilepsy, or uncontrolled neurological disorders.
* Active psychiatric illness (e.g., bipolar disorder, schizophrenia) that may interfere with study compliance.
* Severe cardiopulmonary insufficiency (e.g., New York Heart Association \[NYHA\] class IV heart failure or requirement for long-term oxygen therapy).
* Presence of open wounds, skin infections, or known allergies at or near the designated acupuncture sites.

History of adverse reactions to acupuncture, including syncope (fainting) or needle phobia.

Participation in another clinical trial within the past 6 months.

Anticipated inability to complete the study protocol due to physical, psychological, or logistical reasons.