Effects of prune consumption on the incidence of low anterior resection syndrome: a randomized controlled trial

Dae Hee Pyo; Jung Kyong Shin; Jung Wook Huh; Hee Cheol Kim; Seong Hyeon Yun; Woo Yong Lee; Yoonah Park; Yong Beom Cho

doi:10.3393/ac.2025.00514.0073

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Original Article Complications Effects of prune consumption on the incidence of low anterior resection syndrome: a randomized controlled trial: Dae Hee Pyo¹, Jung Kyong Shin², Jung Wook Huh², Hee Cheol Kim², Seong Hyeon Yun², Woo Yong Lee², Yoonah Park², Yong Beom Cho^2,3,4; Annals of Coloproctology 2025;41(6):510-518.
DOI: https://doi.org/10.3393/ac.2025.00514.0073
Published online: December 12, 2025

¹Department of Surgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea

²Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

³Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea

⁴Department of Biopharmaceutical Convergence, Sungkyunkwan University, Seoul, Korea

Correspondence to: Yong Beom Cho, MD, PhD Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Email: gscyb@skku.edu
Co-correspondence to: Yoonah Park, MD Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Email: yoonah.park@samsung.com

• Received: April 24, 2025 • Revised: June 24, 2025 • Accepted: July 16, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
Graphical abstract
INTRODUCTION
METHODS
RESULTS
DISCUSSION
ARTICLE INFORMATION
REFERENCES

Abstract

Purpose
Low anterior resection syndrome (LARS) is common and devastating complication for patients with rectal cancer who have undergone sphincter-sparing surgery. Prunes are a fiber-rich fruit being effective in treating chronic constipation. The aim of this study was to investigate the effect of prune consumption on the incidence of LARS.
Methods
A prospective, double-arm, parallel, nonblinded, randomized controlled trial was conducted from September 2019 to March 2021 at a single tertiary center for patients who underwent low anterior resection. Patients randomized to the prune group consumed prune daily for 2 weeks after surgery, while those in the no-prune group did not. The primary outcome was the incidence of major LARS at 3 weeks after surgery.
Results
A total of 130 patients were randomized and 118 completed the study (81 men, 37 women), including 55 patients (46.6%) in the prune group and 63 patients (53.4%) in the no-prune group. LARS was confirmed in 15 patients (27.3%) in the prune group and 47 patients (74.6%) in the no-prune group (P<0.001). The incidence of major LARS was also significantly lower in the prune group (18.2% vs. 61.9%, P<0.001). Multivariable analysis showed that the level of anastomosis and prune consumption were significantly associated with the incidence of LARS. The prune group had higher emotional scores and lower symptom scores for constipation, sleep disturbance, and loss of appetite in the quality-of-life questionnaire.
Conclusion
Prune consumption significantly reduced the incidence of LARS and improved quality of life after low anterior resection.
Trial registration
CRIS identifier: KCT0006085 (registered on September 1, 2019).
Keywords: Rectal neoplasms; Low anterior resection syndrome; Quality of life; Prune; Dried plum

Graphical abstract

INTRODUCTION

Total mesorectal excision is the mainstay of treatment for rectal cancer. Over the past decade, the rate of sphincter-sparing surgery has increased due to advances in surgical techniques and treatment strategies. It is considered superior to sphincter-sacrificing surgery, which leaves a permanent stoma, in terms of quality of life for patients. However, approximately 50% to 90% of patients who preserved anal sphincter experience varying degrees of bowel dysfunction and habit [1]. Symptoms include fecal incontinence, urgency, defecation difficulty, soiling and fragmentation, collectively referred to as low anterior resection syndrome (LARS), which drastically reduces quality of life. The pathophysiology of LARS remains largely unknown, although several hypotheses have been proposed, including denervation of the colon during dissection and reduction of the neorectal reservoir [2]. Unfortunately, there is no curative treatment for LARS. Current management is based primarily on symptom relief and supportive care, including dietary changes, constipation agents, enemas, transanal irrigation, and pelvic rehabilitation [3]. Dietary changes with the intake of fiber-rich foods as bulking agents are preferred to alleviate fragmentation symptoms and improve stool consistency.

Prunes (dried plums) are a widely consumed and nutrient-dense natural food. They contain several components that may have a positive effect on gastrointestinal function. In particular, prunes are high in fiber (6–7 g/100 g), including cellulose and pectin, which act as bulking agents to increase stool output [4]. Prunes also contain 12 g of sorbitol per 100 g. Sorbitol, a class of sugar alcohols, is poorly absorbed by the gut and acts a laxative by increasing the volume of water in the bowel. The mechanism of conservative symptom control, such as high-fiber diets, enemas, and transanal irrigation, is also to remove the neorectum due to the high stool content. Accordingly, it can be concluded that prune consumption has the potential to alleviate the symptoms of LARS.

Therefore, in this study, we hypothesized that prunes may have a beneficial effect on LARS symptoms. The aim of this randomized controlled clinical trial was to compare the incidence of LARS in patients who received prune after surgery with those who did not.

METHODS

Ethics statement

The study protocol was approved by the Institutional Review Board of Samsung Medical Center (No. 2019-06-104). Written informed consent was obtained from all participants. This study was registered at the Clinical Research Information Service of Korea (CRiS; identifier: KCT0006085, registered on September 1, 2019). This study followed the 2010 CONSORT (Consolidated Standards of Reporting Trials) statement and performed in accordance with the principles of the Declaration of Helsinki.

Study design

This was a single-center, parallel arm, open-label, randomized controlled trial to evaluate the effect of prune consumption in rectal cancer patients who underwent low anterior resection. Because an inert prune‑matched placebo is not technically feasible, we used an open‑label design with blinded outcome assessors; this pragmatic approach mirrors routine dietary counselling yet is acknowledged as a potential source of expectation bias.

Study population and randomization

The inclusion criteria were age >18 to 70 years, nonmetastatic primary rectal or rectosigmoid junction adenocarcinoma, and planned to undergo low anterior resection with double-stapled end-to-end anastomosis. Exclusion criteria were neoadjuvant chemoradiotherapy, diverting stoma, preoperative metallic stent placement, emergent or urgent surgery, food allergy, and diabetes mellitus. Patients who had received neoadjuvant chemoradiotherapy were excluded because the acute study window (first 3 weeks) precedes the consolidation of radiation‑induced neuromuscular injury; inclusion would therefore have introduced a heterogeneous pathophysiology and required a different sample‑size framework. All included patients signed a written consent form before initial data collection. All collected data were deidentified and each participant was coded as a unique study identifier.

Patients were allocated randomly to the prune group or no-prune control group on 1:1 ratio. In the randomization process, anonymized sealed envelopes were used with 6-size permuted blocks of 3:3 ratio. The questionnaire assessor was blinded for the participant’s group allocation. Blinding of the participants was not possible due to the nature of the intervention.

Surgical procedure and perioperative management

The surgery was performed by experienced colorectal surgeons according to the principles of total mesorectal excision. Transection of distal rectum was done using the linear stapler and end-to-end type anastomosis was done using the circular stapler. If the air leak test was positive, reinforcement suture was applied along the anastomosis line until the negative air leak test. The patients began taking solid food on postoperative day 2 or 3 according to the surgeon’s preference.

Prune consumption

The prune group started to take prunes from the first day of solid food diet postoperatively. For the first 3 days of prune consumption, they consumed a total of 60 g (6 prunes) per day, divided into 2 doses of 30 g (3 prunes) each in the morning (from 8 ᴀᴍ to 10 ᴀᴍ) and evening (from 5 ᴘᴍ to 7 ᴘᴍ). During the next 11 days, a total of 100 g (10 prunes) per day was consumed, divided into 2 doses of 50 g (5 prunes) each in the morning and evening. Overall, the patients consumed prunes for 14 days. The no-prune group consumed an unrestricted diet on any acceptability measure, except for a prune or prune-containing product, such as prune juice.

Outcomes

During the study period, all participants recorded a stool diary which provides information on the number of bowel movements and stool form. After 3 weeks from surgery, the incidence of LARS and patients’ quality of life was evaluated by self-reporting questionnaires. Impairment of bowel function was evaluated using the validated Korean LARS questionnaire that includes 5 questions (incontinence for flatus, incontinence for liquid stool, frequency, clustering, and urgency) [5]. Each item has 3 or 4 responses that are assigned with predefined scores. The patients were classified into the no LARS (score, 0–20), minor LARS (score, 21–29) and major LARS (score, 30–42) groups according to the total sum of scores generated by 5 items. The quality of life of the patients was evaluated using the Korean version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) containing 30 items [6]. It includes 9 multi-item scales: 1 global health status, 5 functional scales, 3 symptom scales, and 6 single items measuring dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties. A higher score on the summary score, global health status, and functional scales represents a better or higher quality of life and functioning. On the contrary, a greater score on the symptom scales and single items represents to worse and more severe symptoms. The primary outcome was the incidence of major LARS at 3 weeks after surgery. Secondary outcomes were the incidence of overall LARS, the LARS score itself, and stool diary. To reduce expectation bias, questionnaires were administered by research staff blinded to group allocation; the primary endpoint was a categorical definition of major LARS, and objective stool‑frequency data served as triangulation.

Statistical analysis

The expected proportion of patients with major LARS was 90% and 70% in the control and prune groups, respectively, according to expert opinion and review of the literature. The assumed 90 % baseline rate of early major LARS is consistent with prospective cohorts reporting 85% to 92 % within 1 month after resection [1, 6]. A 20‑point absolute reduction was selected a priori as the minimally important clinical difference for patient-centered interventions. The calculated sample size was 58 cases per group to provide a statistical power of 80% and a 2-sided α of 5%. To consider the dropout rate of 10% in the final analysis, 65 cases per group were required.

Descriptive variables were presented as mean (standard deviation) or median (interquartile range) based on the type and characteristics of variables. To test the differences between the groups, Chi-square test and Student t-test were performed for discrete and continuous variables, respectively. For example, to compare the mean scores of EORTC QLQ-C30, Student t-test was done. A per-protocol approach was used in statistical analysis. For primary and secondary outcomes, the α level was set at 0.05. All statistical analyses were performed using R ver. 4.0.1 (R Foundation for Statistical Computing).

RESULTS

A total of 136 patients were screened for eligibility and 130 (95.6%) were finally included. They were randomized into the intervention (prune) group (n=65) or the control (no prune) group (n=65) (Fig. 1). In the prune group, 7 patients (10.8%) withdrew from the study and 3 patients (4.6%) who did not adhere to the study were excluded, resulting in a per-protocol analysis of 55 patients. In the no-prune groups, 2 patients (3.1%) withdrew from the study, resulting in a per-protocol analysis of 63 patients. The baseline clinicopathological characteristics of the patients did not differ significantly between groups (Table 1).

The median length of hospital stay was 6 days. There were no significant differences in the perioperative outcomes between the 2 groups (Table 2). During the immediate postoperative recovery, 1 patient in the prune group experienced low abdominal pain and fever, which was diagnosed as a minor anastomotic leakage on computed tomography at postoperative day 4. The patient was treated conservatively with intravenous antibiotics and nil per oral with hydration and was discharged without symptoms. The patient was therefore not excluded from the study. Adverse events attributable to prune were limited to self‑limited bloating (5 of 55, 9.1%) and abdominal cramp (3 of 55, 5.5%); no events exceeded Clavien-Dindo grade I. Both recorded anastomotic leaks occurred prior to the first prune dose.

The median follow-up after surgery was 22 days in the prune group and 23 days in the no-prune group (P=0.659). The incidence of LARS was 15 (27.3%) in the prune group and 47 (74.6%) in the no-prune groups (P<0.001). The incidence of major LARS was also significantly lower in the prune group than in the no-prune group (18.2% [10 of 55] vs. 61.9% [39 of 63], P<0.001) (Table 3). Among the 5 items of the LARS questionnaire, the frequency, clustering, and urgency scores were significantly lower in the prune group (Table 4). In multivariable regression analysis, the level of anastomosis less than 5 cm from the anal verge and the prune group were significantly associated with the incidence of severe LARS (Table 5).

In quality-of-life analysis using the EORTC QLQ-C30 questionnaire, the prune group had significantly higher emotional function (P=0.047) on the functional scale, although global health status showed no statistical difference between the groups (Fig. 2A). On the symptom scales, the prune group had significantly lower scores for constipation, diarrhea, sleep disturbance, and loss of appetite (Fig. 2B). In the stool diary analysis, the number of bowel movements on study day 2 and 3 was significantly greater in the prune group than in the no-prune group (Fig. 3). However, from study day 9, the number of bowel movements per day was significantly lower in the prune group.

DISCUSSION

In the present study, we investigated the clinical efficacy of prune consumption during the early postoperative period in patients with rectal cancer who underwent low anterior resection. We found that prune consumption was significantly associated with a lower incidence of major LARS. The consumption of prunes alleviated the symptoms of LARS and had a positive effect on the patients’ quality of life. To date, this is the first randomized controlled trial to evaluate the clinical efficacy of natural foods, prunes, in improving gastrointestinal symptoms and quality of life in the early postoperative period in patients with rectal cancer. The incidence of LARS in the prune group was 27.3% and this was significantly lower than that in the no-prune group, 74.6%. In addition, patients who received prunes had significantly better emotional scores, although global health status was not significantly different between the groups. Considering that abdominal discomfort and emotional conflict are most severe in the early postoperative period, the main finding of this study was noteworthy. In multivariate regression analysis, level of anastomosis less than 5 cm was the significant risk factor and prune consumption was the only protective factor for the incidence of LARS.

Previous studies have shown that prunes, when consumed in moderation as part of a balanced diet, have several beneficial effects on the body. They include improving symptoms of chronic constipation [7], preserving bone mineral by providing vitamin K and boron [8], reducing the risk of chronic diseases such as cancer [9], cardiovascular disease [10], and lowering blood cholesterol levels [11], and boosting immunity by providing antioxidants such as vitamin C [12]. Because the effects of prune consumption on chronic constipation have been well studied, prunes are often recommended as a natural remedy for constipation [13]. In one study, participants who consumed 50 g of prunes per day for 3 weeks had increased stool frequency and consistency compared to those who consumed psyllium, a common fiber supplement [14]. Prunes are high in fiber, which can help promote regular bowel movements. Fiber helps bulk up the stools and soften them, making them easier to pass. A 100 g serving of prunes contains about 7 g of fiber. Prunes are also high in sorbitol, a natural sugar alcohol that has a mild laxative effect. Sorbitol is not fully digested in the small intestine and passes to the large intestine, where it draws water into the stool, making it softer and easier to pass. Although prunes contain sorbitol, which might theoretically increase luminal pressure, no prune‑related anastomotic complications were observed. The laxative threshold of sorbitol (>20 g/day) was not reached in our staged dosing regimen. Recent studies have shown that prunes also have prebiotic properties, which means they help promote the growth of healthy bacteria in the gut [15, 16]. A healthy gut microbiome is important for regular bowel movements. Finally, prunes also contain compounds that stimulate the muscles in the digestive tract, helping to move stools more efficiently [16].

For the cluster of LARS symptoms, we hypothesized that prune consumption could alleviate the clustering and improve stool consistency. Because the pathophysiology of LARS is not fully understood and may be multifactorial, no single modality could provide complete relief of LARS symptoms. In addition, each patient has different main symptoms. Nevertheless, taking prunes only in the early postoperative period was significantly associated with a low incidence of major LARS. For each item in the LARS questionnaire, frequency and clustering showed a significant association with prune consumption. These results support that prune consumption improves LARS symptoms through its role as a laxative. The stool diary showed that the first three days of prune consumption tended to increase stool frequency. However, after 4 or 5 days of prune consumption the stool frequency stabilized and was significantly less than that of patients in the control group. A previous study showed that not only the number of bowel movements but also the diurnal variation of stool frequency may have a negative effect on quality of life [17]. According to the results of the stool diary, prune consumption may help patients to predict when and how often to go to the toilet by stabilizing stool frequency.

A recent study showed that transanal irrigation significantly reduced symptoms of LARS and improved the quality of life [18]. The authors conducted a multicenter randomized clinical trial to evaluate the clinical efficacy of transanal irrigation with a long-term follow-up. Of the 45 patients, 22 in the transanal irrigation group had significantly lower LARS scores and higher quality-of-life scores at 12 months. They suggested that transanal irrigation may play a role as a mechanical laxative and in clearing the neorectum. Along with the results of our study, mechanical or physiological emptying of the rectum is an important part of improving LARS symptoms. While transanal irrigation mechanically clears the neorectum in a retrograde fashion, prune consumption may facilitate physiological antegrade evacuation by improving stool consistency through its bulk and fiber content.

A strength of the present study is the randomized clinical trial design and the new modality, prune as a natural food, to treat LARS symptoms. However, there are limitations to this study.

The first limitation of this study was that the dropout rate was higher in the prune group. It cannot be excluded that the results of the study would have been different if these patients had not dropped out. Four patients withdrew on the first day of taking plums. Three of them did not like the taste of prunes. Meanwhile, 2 anastomotic leaks occurred in the prune group. However, as the complications were diagnosed before the start of prune consumption, it is unlikely to be correlated with prune consumption. The participants who dropped out of the study withdrew their informed consent, making it impossible to collect questionnaire data from them. As a result, we were unable to conduct an intention-to-treat analysis and instead performed a per-protocol analysis. Secondly, we included patients in the early postoperative period. As LARS is a chronic disease, the pathophysiology may be different in the acute phase. In addition, LARS symptoms are often severe in the early postoperative period, so the results of this study may be exaggerated. A 12‑month follow-up analysis is underway, but durability of benefit must presently be regarded as unknown. Third, because the follow-up period was short, we could not draw any conclusions about the long-term effect of prune consumption on LARS. Future studies are warranted to investigate long-term adherence to prune consumption and its beneficial effects.

As the long-term survival of patients with rectal cancer improves, oncologists should pay attention to patients' quality of life and functional outcomes. Based on the results of this randomized clinical trial, prune consumption may reduce short‑term major LARS and improve early quality of life after low anterior resection. Therefore, colorectal surgeons may actively recommend prune consumption to patients at high risk of developing LARS while a larger multi‑center trials with long‑term follow‑up are warranted before routine recommendation.

ARTICLE INFORMATION

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Funding

This study was supported by SMC-Ottogi Research Fund (No. SMO1190221).

Author contributions

Conceptualization: YBC; Data curation: DHP; Formal analysis: DHP; Funding acquisition: YP, YBC; Investigation: JKS, JWH, HCK, SHY, WYL, YP, YBC; Methodology: DHP, YP, YBC; Project administration: YBC; Visualization: DHP; Writing–original draft: DHP; Writing–review & editing: DHP, YBC. All authors read and approved the final manuscript.

Fig. 1.

CONSORT (Consolidated Standards of Reporting Trials) flowchart.

Fig. 2.

European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) score. (A) Functional scale. (B) Symptom scale. ^*P<0.05; ^***P<0.001.

Fig. 3.

Stool diary representing the number of bowel movements during the study period. . *P<0.05; **P<0.01; ***P<0.001.

Table 1.

Baseline clinicopathologic characteristics (n=118)

Characteristic	Prune group (n=55)	No-prune group (n=63)	P-value
Age (yr)			0.496
≥65	7 (12.7)	12 (19.0)
<65	48 (87.3)	51 (81.0)
Male sex	40 (72.7)	41 (65.1)	0.487
Body mass index (kg/m²)			0.722
≥25	21 (38.2)	21 (33.3)
<25	34 (61.8)	42 (66.7)
CEA (ng/mL)			>0.999
≥5	3 (5.5)	4 (6.3)
<5	52 (94.5)	59 (93.7)
Tumor location			0.731
Rectosigmoid	28 (50.9)	29 (46.0)
Rectum	27 (49.1)	34 (54.0)
Surgery type			0.442
Laparoscopic	52 (94.5)	56 (88.9)
Robotic	3 (5.5)	7 (11.1)
Level of anastomosis			0.878
<5 cm	21 (38.2)	26 (41.3)
≥5 cm	34 (61.8)	37 (58.7)
Pathologic T category			0.964
pT1	6 (10.9)	7 (11.1)
pT2	21 (38.2)	26 (41.3)
pT3	28 (50.9)	30 (47.6)
Pathologic N category			0.454
pN0	49 (89.1)	52 (82.5)
pN1	6 (10.9)	11 (17.5)

Values are presented as number (%).

CEA, carcinoembryonic antigen.

Table 2.

Operative characteristics and postoperative outcomes (n=118)

Variable	Prune group (n=55)	No-prune group (n=63)	P-value
Operation time (min)	163 (135–200)	169 (138–210)	0.405
Estimated blood loss (mL)	50 (30–130)	50 (30–100)	0.614
Postoperative hospital stay (day)	6 (5–7)	6 (5–7)	>0.999
First bowel movement (day)	3 (3–4)	3 (3–5)	0.812
First solid diet (day)	3 (3–4)	3 (3–4)	0.912
Postoperative morbidity	6 (10.9)	6 (9.5)	>0.999
Wound infection	0 (0)	1 (1.6)	-
Ileus	4 (7.3)	5 (7.9)	>0.999
Anastomotic leakage	1 (1.8)	0 (0)	-

Values are presented as median (interquartile range) or number (%).

Table 3.

Comparison of the incidence of LARS

Category	Prune group (n=55)	No-prune group (n=63)	P-value
LARS	15 (27.3)	47 (74.6)	<0.001
Major LARS	10 (18.2)	39 (61.9)	<0.001
Minor LARS	5 (9.1)	8 (12.7)	0.369

Values are presented as number (%).

LARS, low anterior resection syndrome

Table 4.

Comparison of the component score of low anterior resection syndrome questionnaire between the prune group and no-prune group

Component	Prune group (n=55)	No-prune group (n=63)	P-value
Gas incontinence	5.1±0.4	5.4±0.9	0.325
Liquid incontinence	2.8±1.9	2.7±1.2	0.813
Frequency	2.5±0.5	4.2±1.8	<0.001
Clustering	6.3±2.5	9.3±3.8	<0.001
Urgency	8.2±6.9	13.2±7.0	0.014

Values are presented as mean±standard deviation.

Table 5.

Univariable and multivariable regression analysis for the incidence of major low anterior resection syndrome

Variable	Univariate analysis		Multivariate analysis
Variable	OR (95% CI)	P-value	OR (95% CI)	P-value
Age (≥65 yr vs. <65 yr)	1.21 (0.41–1.98)	0.751
Sex (male vs. female)	2.04 (1.15–4.23)	0.024^*	1.84 (0.79–3.32)	0.175
BMI (≥25 kg/m² vs. <25 kg/m²)	1.47 (0.69–2.16)	0.425
CEA (≥5 ng/mL vs. <5 ng/mL)	1.81 (0.65–2.15)	0.382
Level of anastomosis (<5 cm vs. ≥5 cm)	4.41 (2.65–8.00)	<0.001^*	3.91 (2.71–7.54)	<0.001
Surgery type (robotic vs. laparoscopic)	0.93 (0.81–1.13)	0.984
Pathologic T category
T2 vs. T1	1.25 (0.29–3.71)	0.913
T3 vs. T1	1.13 (0.33–3.88)	>0.999
Pathologic N category (N1 vs. N0)	1.34 (0.54–3.17)	0.809
Prune intake (no vs. yes)	0.65 (0.32–0.84)	<0.001^*	0.71 (0.48–0.85)	<0.001

OR, odds ratio; CI, confidence interval; BMI, body mass index; CEA, carcinoembryonic antigen.

^*P<0.05.

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Effects of prune consumption on the incidence of low anterior resection syndrome: a randomized controlled trial

Ann Coloproctol. 2025;41(6):510-518. Published online December 12, 2025

DOI: https://doi.org/10.3393/ac.2025.00514.0073

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Effects of prune consumption on the incidence of low anterior resection syndrome: a randomized controlled trial

Fig. 1. CONSORT (Consolidated Standards of Reporting Trials) flowchart.

Fig. 2. European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) score. (A) Functional scale. (B) Symptom scale. *P<0.05; ***P<0.001.

Fig. 3. Stool diary representing the number of bowel movements during the study period. . *P<0.05; **P<0.01; ***P<0.001.

Graphical abstract

Fig. 1.

Fig. 2.

Fig. 3.

Graphical abstract

Effects of prune consumption on the incidence of low anterior resection syndrome: a randomized controlled trial

Characteristic	Prune group (n=55)	No-prune group (n=63)	P-value
Age (yr)			0.496
≥65	7 (12.7)	12 (19.0)
<65	48 (87.3)	51 (81.0)
Male sex	40 (72.7)	41 (65.1)	0.487
Body mass index (kg/m²)			0.722
≥25	21 (38.2)	21 (33.3)
<25	34 (61.8)	42 (66.7)
CEA (ng/mL)			>0.999
≥5	3 (5.5)	4 (6.3)
<5	52 (94.5)	59 (93.7)
Tumor location			0.731
Rectosigmoid	28 (50.9)	29 (46.0)
Rectum	27 (49.1)	34 (54.0)
Surgery type			0.442
Laparoscopic	52 (94.5)	56 (88.9)
Robotic	3 (5.5)	7 (11.1)
Level of anastomosis			0.878
<5 cm	21 (38.2)	26 (41.3)
≥5 cm	34 (61.8)	37 (58.7)
Pathologic T category			0.964
pT1	6 (10.9)	7 (11.1)
pT2	21 (38.2)	26 (41.3)
pT3	28 (50.9)	30 (47.6)
Pathologic N category			0.454
pN0	49 (89.1)	52 (82.5)
pN1	6 (10.9)	11 (17.5)

Variable	Prune group (n=55)	No-prune group (n=63)	P-value
Operation time (min)	163 (135–200)	169 (138–210)	0.405
Estimated blood loss (mL)	50 (30–130)	50 (30–100)	0.614
Postoperative hospital stay (day)	6 (5–7)	6 (5–7)	>0.999
First bowel movement (day)	3 (3–4)	3 (3–5)	0.812
First solid diet (day)	3 (3–4)	3 (3–4)	0.912
Postoperative morbidity	6 (10.9)	6 (9.5)	>0.999
Wound infection	0 (0)	1 (1.6)	-
Ileus	4 (7.3)	5 (7.9)	>0.999
Anastomotic leakage	1 (1.8)	0 (0)	-

Category	Prune group (n=55)	No-prune group (n=63)	P-value
LARS	15 (27.3)	47 (74.6)	<0.001
Major LARS	10 (18.2)	39 (61.9)	<0.001
Minor LARS	5 (9.1)	8 (12.7)	0.369

Component	Prune group (n=55)	No-prune group (n=63)	P-value
Gas incontinence	5.1±0.4	5.4±0.9	0.325
Liquid incontinence	2.8±1.9	2.7±1.2	0.813
Frequency	2.5±0.5	4.2±1.8	<0.001
Clustering	6.3±2.5	9.3±3.8	<0.001
Urgency	8.2±6.9	13.2±7.0	0.014

Variable	Univariate analysis		Multivariate analysis
Variable	OR (95% CI)	P-value	OR (95% CI)	P-value
Age (≥65 yr vs. <65 yr)	1.21 (0.41–1.98)	0.751
Sex (male vs. female)	2.04 (1.15–4.23)	0.024^*	1.84 (0.79–3.32)	0.175
BMI (≥25 kg/m² vs. <25 kg/m²)	1.47 (0.69–2.16)	0.425
CEA (≥5 ng/mL vs. <5 ng/mL)	1.81 (0.65–2.15)	0.382
Level of anastomosis (<5 cm vs. ≥5 cm)	4.41 (2.65–8.00)	<0.001^*	3.91 (2.71–7.54)	<0.001
Surgery type (robotic vs. laparoscopic)	0.93 (0.81–1.13)	0.984
Pathologic T category
T2 vs. T1	1.25 (0.29–3.71)	0.913
T3 vs. T1	1.13 (0.33–3.88)	>0.999
Pathologic N category (N1 vs. N0)	1.34 (0.54–3.17)	0.809
Prune intake (no vs. yes)	0.65 (0.32–0.84)	<0.001^*	0.71 (0.48–0.85)	<0.001

Table 1. Baseline clinicopathologic characteristics (n=118)

Values are presented as number (%).

CEA, carcinoembryonic antigen.

Table 2. Operative characteristics and postoperative outcomes (n=118)

Values are presented as median (interquartile range) or number (%).

Table 3. Comparison of the incidence of LARS

Values are presented as number (%).

LARS, low anterior resection syndrome

Table 4. Comparison of the component score of low anterior resection syndrome questionnaire between the prune group and no-prune group

Values are presented as mean±standard deviation.

Table 5. Univariable and multivariable regression analysis for the incidence of major low anterior resection syndrome

OR, odds ratio; CI, confidence interval; BMI, body mass index; CEA, carcinoembryonic antigen.