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. 2025 Mar 20:16:1460900.
doi: 10.3389/fphar.2025.1460900. eCollection 2025.

Effects of Chinese herbal medicine on colorectal adenoma recurrence following polypectomy: a systematic review and meta-analysis

Yi Cheng  1   2 , Yuan Ming Di  1 , Brian May  1 , Anthony Lin Zhang  1 , Charlie Changli Xue  1   2 , Beiping Zhang  2   3
Affiliations

Effects of Chinese herbal medicine on colorectal adenoma recurrence following polypectomy: a systematic review and meta-analysis

Yi Cheng et al. Front Pharmacol. .

Abstract

Objective: Preventing colorectal adenoma (CRA) recurrence after polypectomy is essential. However, the current evidence of Chinese herbal medicine (CHM) for CRA recurrence is still limited. This study aims to synthesize the effects of CHM as a prevention method for CRA recurrence.

Methods: Nine databases were searched up to May 2024. Randomised controlled trials identifying the preventive effects of CHM among people with CRA post-polypectomy were included. spreadsheets were used to collect and extract data. RevMan and STATA were used for data analysis. We performed subgroup and sensitivity analyses to explore potentially influencing variables.

Results: Twenty trials (2,325 participants) were included. The commonly used botanical drugs belonged to the categories of strengthening the spleen and anti-tumour metabolites. Compared to routine care (RC) alone, oral CHM plus RC significantly reduced the CRA recurrence rate at 12 months (RR 0.51, 95% CI [0.39, 0.67], I2 = 42%), 6 months (RR 0.44, 95% CI [0.36, 0.55], I2 = 0%), and 3 months (RR 0.46, 95% CI [0.22, 0.96], I2 = 0%) post-polypectomy. Compared to CHM placebo plus RC, San zi granule combined with RC significantly reduced CRA recurrence at 12 months post-polypectomy (RR 0.39, 95% CI [0.16, 0.93], I2 = 0%) and during the 2-year follow-up (RR 0.73, 95% CI [0.58, 0.90]). There were no significant differences between groups for treatment duration and syndromes. Additional analysis showed that oral CHM containing the botanical drugs of Si jun zi decoction plus RC reduced CRA recurrence at 12 months post-polypectomy with a low heterogeneity, compared to RC alone (RR 0.26, 95% CI [0.13, 0.54], I2 = 0%). Adverse events were similar in the above two comparisons.

Conclusion: Oral CHM combined with RC may reduce CRA recurrence and be well-tolerated. San zi granule and Si jun zi decoction may be representative prescriptions Experimental studies of the frequent botanical drugs have found anti-cancer effects that may account for the clinical findings. Future rigorous clinical trials are needed due to low-to-moderate certainty of evidence.

Systematic review registration: PROSPERO (CRD42023324197), https://www.crd.york.ac.uk/PROSPERO/view/CRD42023324197.

Keywords: Chinese herbal medicine; San zi granule; Si jun zi decoction; colorectal adenoma recurrence; colorectal cancer; colorectal polyp; meta-analysis; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Study selection process.
FIGURE 2
FIGURE 2
Risk of bias assessment for the primary outcome: CRA recurrence rate.
FIGURE 3
FIGURE 3
Forest plot of the CRA recurrence rate at 12 months after polypectomy.
FIGURE 4
FIGURE 4
Forest plot of the CRA recurrence rate at 6 months after polypectomy.
FIGURE 5
FIGURE 5
Potential anti-tumour mechanisms of Si jun zi decoction and its modified forms.
FIGURE 6
FIGURE 6
Potential mechanisms of Bai zhu and Dang shen to contribute to colorectal adenoma recurrence. Note: CRA, colorectal adenoma.
See this image and copyright information in PMC

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