Bidirectional longitudinal associations between low anterior resection syndrome and stigma in patients with postoperative LARS: a cross-lagged panel study.

OBJECTIVE: To investigate the bidirectional longitudinal associations between low anterior resection syndrome (LARS) and stigma among patients with postoperative LARS following sphincter-preserving surgery for rectal cancer. METHODS: A total of 201 patients with LARS after sphincter-preserving surgery for rectal cancer were recruited using convenience sampling between March 2024 and June 2025. Follow-up was completed in December 2025. Data were collected at 1 month (T1), 3 months (T2), and 6 months (T3) after discharge using the Low Anterior Resection Syndrome Score (LARS) and the Social Impact Scale (SIS). Of the enrolled participants, 181 with complete data across all follow-up assessments were included in the final cross-lagged panel model analysis. RESULTS: LARS scores decreased from 37.28 ± 1.61 at T1 to 28.64 ± 2.86 at T2 and 27.52 ± 2.38 at T3. Stigma scores declined from 67.47 ± 4.06 at T1 to 60.52 ± 3.96 at T2 and 53.40 ± 4.22 at T3 (P < 0.05). Cross-lagged analysis revealed significant reciprocal longitudinal associations between LARS and stigma. Higher LARS scores were associated with higher subsequent stigma scores, while higher stigma scores were associated with higher subsequent LARS scores (all P < 0.05). Bidirectional longitudinal associations were observed between LARS and stigma. CONCLUSION: LARS and stigma were longitudinally associated among patients with postoperative LARS following sphincter-preserving surgery for rectal cancer. These findings suggest that both symptom burden and psychosocial adaptation should be considered during postoperative follow-up.