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Background <p>Intersphincteric resection (ISR) is an important sphincter-preserving option for low and ultralow rectal cancer. However, postoperative bowel dysfunction remains a major concern. This systematic review and meta-analysis evaluated the prevalence and severity distribution of Low Anterior Resection Syndrome (LARS) after ISR and summarized reported factors potentially associated with major LARS.</p> Methods <p>Clinical studies reporting ISR-specific LARS score data after surgery for low or ultralow rectal cancer were included. The primary outcome was the pooled prevalence of LARS severity (major, minor, no). Random-effects models were used to estimate pooled prevalence. Reported factors potentially associated with major LARS were synthesized narratively because of heterogeneous reporting. Risk of bias was assessed using the JBI checklist and QUIPS.</p> Results <p>Eighteen studies including 1,337 ISR patients were included, of whom 1,141 had postoperative LARS score data. The pooled prevalence (18 studies) of major LARS was 46% (95%CI, 33%–60%; I²= 97.05%). The pooled prevalence (13 studies) of minor LARS was 25% (95%CI, 17%–33%; I²= 87.20%), and the pooled prevalence (13 studies) of no LARS was 37% (95%CI, 24%–49%; I²=9 4.71%). Narrative synthesis identified several reported factors associated with LARS burden, including distal tumor location, low anastomotic level, chemoradiotherapy, reconstruction/anastomotic technique, and timing of functional assessment.</p> Conclusion <p>Major LARS was estimated to affect nearly half of patients after ISR for low and ultralow rectal cancer. Reported associated factors were inconsistent and should be considered hypothesis-generating. Standardized ISR-specific LARS score reporting and prospective studies evaluating predictors of postoperative bowel dysfunction are needed.</p>

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Low anterior resection syndrome after intersphincteric resection for low and ultralow rectal cancer: a systematic review and meta-analysis with narrative synthesis of reported factors

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月31日

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  • Mohammadsadra Shamohammadi,
  • Sana Ehsan Ullah,
  • Marina Yiasemidou,
  • Mansour Bahrdoust,
  • Armaghan Abbasi Garavand,
  • Danyal Yarahmadi,
  • Fabio Carbone

摘要

Background

Intersphincteric resection (ISR) is an important sphincter-preserving option for low and ultralow rectal cancer. However, postoperative bowel dysfunction remains a major concern. This systematic review and meta-analysis evaluated the prevalence and severity distribution of Low Anterior Resection Syndrome (LARS) after ISR and summarized reported factors potentially associated with major LARS.

Methods

Clinical studies reporting ISR-specific LARS score data after surgery for low or ultralow rectal cancer were included. The primary outcome was the pooled prevalence of LARS severity (major, minor, no). Random-effects models were used to estimate pooled prevalence. Reported factors potentially associated with major LARS were synthesized narratively because of heterogeneous reporting. Risk of bias was assessed using the JBI checklist and QUIPS.

Results

Eighteen studies including 1,337 ISR patients were included, of whom 1,141 had postoperative LARS score data. The pooled prevalence (18 studies) of major LARS was 46% (95%CI, 33%–60%; I²= 97.05%). The pooled prevalence (13 studies) of minor LARS was 25% (95%CI, 17%–33%; I²= 87.20%), and the pooled prevalence (13 studies) of no LARS was 37% (95%CI, 24%–49%; I²=9 4.71%). Narrative synthesis identified several reported factors associated with LARS burden, including distal tumor location, low anastomotic level, chemoradiotherapy, reconstruction/anastomotic technique, and timing of functional assessment.

Conclusion

Major LARS was estimated to affect nearly half of patients after ISR for low and ultralow rectal cancer. Reported associated factors were inconsistent and should be considered hypothesis-generating. Standardized ISR-specific LARS score reporting and prospective studies evaluating predictors of postoperative bowel dysfunction are needed.