Long-term (≥ 5 Years) Low Anterior Resection Syndrome and Health Related Quality of Life in Rectal Cancer Patients: A Systematic Review

BACKGROUND: Up to 80% of patients who undergo rectal resection suffer from low anterior resection syndrome, with approximately half continuing to experience symptoms more than 10 years after surgery. While short-term outcomes are well documented, evidence on long-term functional and health-related quality of life trajectories remains fragmented. There is some improvement over time, but symptoms often persist. OBJECTIVE: To systematically review the prevalence, severity, and long-term trajectory of low anterior resection syndrome, and its association with health-related quality of life, in rectal cancer survivors followed for at least five years after sphincter-preserving surgery. DATA SOURCES: A systematic search of PubMed, Scopus, and the Cochrane Library from inception through September 2025. STUDY SELECTION: Eligible studies reported low anterior resection syndrome scores in patients at ≥5 years following sphincter-preserving rectal cancer resection. Studies lacking long-term functional assessment or not reporting low anterior resection syndrome were excluded. INTERVENTIONS: None; all included studies comprised observational cohort data assessing long-term functional outcomes. MAIN OUTCOME MEASURES: Prevalence of major and minor Low Anterior Resection Syndrome, distribution of long-term low anterior resection syndrome severity categories, and associations between low anterior resection syndrome severity and health-related quality of life measures. RESULTS: Six studies comprising 1,000 patients were included, with median follow-up ranging from 6.9 to 14.6 years. Across cohorts, major low anterior resection syndrome was reported in 20.5-53.0% of patients and minor low anterior resection syndrome in 14.6-27.0%. Overall, 39.3% of patients experienced major low anterior resection syndrome, 21.5% minor low anterior resection syndrome, and 39.2% reported no low anterior resection syndrome at long-term follow-up. Major low anterior resection syndrome was consistently associated with significant health-related quality of life impairment across multiple domains. Neoadjuvant radiotherapy emerged as the most consistent risk factor for persistent bowel dysfunction. LIMITATIONS: Heterogeneity in neoadjuvant radiotherapy, tumor height, and exclusion of patients with permanent or secondary stomas; observational designs. CONCLUSION: Nearly half of rectal cancer survivors experience major Low Anterior Resection Syndrome ≥5 years postoperatively, highlighting the persistence of bowel dysfunction and its lasting impact on health-related quality of life. These findings underscore the need for long-term survivorship care and functional outcome monitoring.