Tibial nerve stimulation for low anterior resection syndrome after rectal cancer surgery: current evidence, patient-tailored clinical positioning, and future directions

Low anterior resection syndrome (LARS) is a common long-term bowel dysfunction following rectal cancer sphincter-preserving surgery, mainly manifested as defecation urgency, frequency, clustered defecation, fecal incontinence, and a feeling of incomplete evacuation, significantly impacting patients' quality of life. Current treatments largely follow symptom-oriented and stepwise management principles, including dietary and behavioral adjustments, medication, pelvic floor rehabilitation, biofeedback, and transanal irrigation. However, efficacy remains unsatisfactory for patients with persistent major LARS or refractory symptoms. Tibial nerve stimulation (TNS), as a minimally invasive or non-invasive neuromodulation method, has gradually gained attention in recent years. Direct LARS-specific studies of percutaneous tibial nerve stimulation (PTNS) suggest a potential therapeutic signal. However, the small sample sizes, inconsistent stimulation protocols, inconsistent comparative findings, and limited follow-up preclude considering PTNS an established escalation treatment. Transcutaneous tibial nerve stimulation (TTNS) offers advantages such as being non-invasive, repeatable, and potentially suitable for home maintenance therapy. However, direct evidence for its use in LARS remains limited, and it cannot currently be recommended as equivalent to PTNS. This article reviews the clinical characteristics of LARS, the basis of TNS's role, research evidence for PTNS and TTNS, their clinical positioning, and future research directions, aiming to provide a reference for individualized treatment and subsequent clinical research of LARS.