Effectiveness of digital health interventions for the management of Low Anterior Resection Syndrome (LARS) after sphincter-preserving surgery for rectal cancer: a systematic review and meta-analysis.

Abstract

Background: Low anterior resection syndrome (LARS) frequently occurs following sphincter-preserving rectal cancer surgery. Although recent studies have reported the effects of digital health interventions for LARS management, no systematic review and meta-analysis has been conducted.

Methods: We searched five English databases and three Chinese databases from inception to 18 December 2025, supplemented by gray literature sources and reference checking. Randomized and non-randomized controlled studies involving adults who had undergone sphincter-preserving rectal surgery were eligible. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for non-randomized studies. When at least two studies reported similar outcomes, meta-analysis was performed using mean difference or standardized mean difference with 95% confidence intervals, with the I² statistic used to measure heterogeneity. Narrative synthesis was used when pooling was not appropriate. Certainty of evidence was assessed using GRADE. The protocol was registered in PROSPERO.

Results: Eight studies published between 2021 and 2025 were included, and seven contributed to the meta-analysis. Digital health interventions were associated with reductions in LARS scores compared with usual care (MD = - 3.00, 95% CI - 4.17 to - 1.83; P < 0.00001; I² = 28%) and with improvements in health-related quality of life, although heterogeneity for this outcome was substantial (SMD = 0.75, 95% CI 0.17 to 1.34; P = 0.01; I² = 89%). No statistically significant between-group effect was observed for self-efficacy, with substantial heterogeneity (SMD = 0.43, 95% CI - 0.15 to 1.01; P = 0.15; I² = 79%). Anxiety and depression outcomes, assessed in a small number of trials, did not show meaningful between-group differences. Evidence for self-management, activation, satisfaction, feasibility, and other implementation outcomes was suggestive but inconsistently reported and often study-specific.

Conclusions: Digital health interventions show promising potential to reduce LARS symptom burden and may improve quality of life after sphincter-preserving rectal surgery. Nonetheless, confidence in these findings is limited by the small number of available trials, clinical and methodological heterogeneity, and inconsistent outcome measurement and reporting, particularly for psychological and intermediate pathway outcomes. Further well-designed, adequately powered studies are needed to confirm effectiveness and inform implementation in routine care.

Trial registration: PROSPERO Registration: CRD420251250663.