Narrative therapy and resilience training improve recovery and survival after intersphincteric resection for low rectal cancer: a randomized trial.

Abstract

Patients undergoing intersphincteric resection (ISR) for low rectal cancer often experience persistent bowel dysfunction, psychological distress, and compromised quality of life, especially in the context of preventive stoma creation. These challenges can negatively affect recovery, immune function, and long-term prognosis. Psychosocial interventions, such as narrative therapy and resilience training, may mitigate these effects, yet their integrated application in ISR populations remains unexplored. In this single-center randomized controlled trial, 178 patients with stage I-III low rectal cancer who underwent ISR between October 2019 and October 2021 at the First Affiliated Hospital of Soochow University were randomized to receive either standard care or a structured 6-month intervention combining narrative therapy and resilience training. Primary outcomes included psychological resilience (CD-RISC), emotional well-being (HADS), sleep quality (PSQI), and nutritional recovery (serum albumin, prealbumin, BMI). Secondary endpoints encompassed postoperative complications, systemic inflammation (CRP, IL-6, TNF-α), and 2-year disease-free survival (DFS) and overall survival (OS). All analyses followed the intention-to-treat principle. The intervention group demonstrated significantly greater improvements in psychological and nutritional parameters (all P < .01), fewer complications (12.4% vs. 23.6%, P = .035), and reduced inflammatory markers on postoperative day 7. At 24 months, both DFS (89.2% vs. 75.3%, P = .028) and OS (93.1% vs. 81.6%, P = .031) were significantly higher in the intervention group. Effect sizes (Cohen's d) and minimal clinically important differences (MCIDs) were assessed to support the interpretation of clinical relevance. An integrated psychosocial intervention significantly enhanced functional recovery and long-term oncologic outcomes following ISR. These findings underscore the value of incorporating structured psychological support into postoperative care for low rectal cancer.