Early evaluation of the low anterior resection syndrome after sphincter sparing rectal cancer surgery and prompt treatment: a cohort study protocol

Introduction. Low anterior resection syndrome (LARS) is a common complication following sphincter-sparing rectal cancer surgery, affecting 30–80% of patients and significantly reducing quality of life. Treatment options such as pelvic floor physiotherapy, transanal irrigation, and sacral neuromodulation are available, yet the optimal treatment sequence and their overall efficacy remain uncertain. This study aims to assess the effectiveness of an integrative management pathway, including preoperative physiotherapy, for the prevention and treatment of LARS at our institution. Methods. This cohort study will include patients undergoing low anterior resection for rectal cancer at Fribourg Cantonal Hospital over 24 months; patient’s inclusion will start on February 2026. Preoperative assessment includes LARS and EQ-5D questionnaires, and anal manometry to establish baseline functional status. Postoperative LARS and EQ-5D scores will be collected at six weeks. Based on LARS severity, patients will follow a progressive treatment pathway consisting of physiotherapy, transanal irrigation, and sacral neuromodulation. Questionnaires will be repeated after each treatment stage to assess symptom progression and quality of life. Statistical analysis will include Wilcoxon Mann-Whitney tests for score comparisons and logistic regression for identifying risk factors such as neoadjuvant therapy, tumor location, and anastomotic technique. Results. We hypothesize that this integrative approach will lead to a significant reduction in LARS severity and improvement in quality of life compared to retrospective data collected in 2022. Conclusions. This study protocole aims to refine postoperative management of LARS through a structured, evidence-based protocol, to identify modifiable risk factors, and to enhance overall patient outcomes following rectal cancer surgery.