Temporal patterns and influencing factors associated with low anterior resection syndrome after rectal cancer surgery: A scoping review
Shihui He, Yuan Chang, Linlin Gao, Fuyun Zhao, Jiyuan Shi, Jianwen Ma, Changshuo Zhang, Shujin YueObjectives
To map the existing evidence on the evolution of low anterior resection syndrome, including factors associated with stage-specific low anterior resection syndrome outcomes and longitudinal changes in symptoms.
Methods
This scoping review was conducted in accordance with the Joanna Briggs Institute methodology and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline. Seven databases were searched through 31 December 2025, with English databases searched from 1 January 2012 and Chinese databases from 1 January 2013. Eligible studies included adults aged ≥18 years who underwent sphincter-preserving anterior resection for rectal cancer and were diagnosed with low anterior resection syndrome at least twice postoperatively.
Results
Twenty-three studies were included. Major low anterior resection syndrome was most prevalent during the early follow-up period, particularly at approximately 1–3 months. Symptom improvement was most evident between 6 and 18 months, whereas overall symptom patterns tended to stabilize after approximately 18–24 months, with relatively limited changes subsequently up to 36 months. Tumor and anastomotic location, surgical approach, radiotherapy and/or chemotherapy, and stoma-related factors were associated with low anterior resection syndrome at different follow-up stages or with longitudinal symptom changes. However, only a few studies directly examined longitudinal changes or trajectory-related factors.
Conclusion
Low anterior resection syndrome is a dynamic condition with stage-specific patterns and substantial inter-individual variability. Understanding its temporal evolution and associated factors may help identify high-risk patients, optimize the timing of assessment, and tailor supportive care and rehabilitation across recovery stages. However, heterogeneity in study design, follow-up schedules, and outcome measures limits comparability. Future research should adopt standardized longitudinal designs, harmonized follow-up protocols, larger samples, and more comprehensive assessment tools to strengthen evidence for individualized low anterior resection syndrome management.