A predictive nomogram model for low anterior resection syndrome after rectal cancer resection

Abstract

Background: The aim of this study was to identify risk factors associated with the low anterior resection syndrome (LARS) and to construct a nomogram capable of predicting the risk of LARS in patients who undergo rectal cancer resection. Methods: About 538 patients who had undergone anterior resection were recruited as a development set. In addition, 114 patients with rectal cancer were analysed as a validation set to test the new nomogram. Patients in the development set were grouped into two separate cohorts: those with major LARS and those with minor or no LARS. Multiple logistic regression was conducted to detect risk factors for major LARS. Results: The prevalence of major LARS was 40.7%, of minor LARS was 28.6% and the proportion with no LARS was 30.7% in the development set. In multivariate analysis, female gender, preoperative chemoradiation, low tumour height, diverting ileostomy, postoperative anastomotic leakage were shown to be independently associated with major LARS occurring in patients after rectal cancer resection. The area under the curve (AUC) values of the nomogram were 0.726 (95% CI: 0.682-0.769) and 0.750 (95% CI: 0.655-0.845) in the development and validation sets, respectively. The calibration curves and Hosmer-Lemeshow goodness of fit tests showed that the model was acceptably accurate. Conclusion: A nomogram model based on risk factors could be valuable as a predictor of the probability of major LARS after rectal cancer surgery, and provides a guide that clinical staff can use to take preventive measures for high-risk patients.

Validity assessment of the POLARS score tool in the prediction of post rectal cancer surgery LARS score in a population-based Swedish cohort

“…Similarly, as in the POLARS score, all variables are weighted differently in the calculations. These different strategies illustrate the difficulties in selecting the ‘right’ variables for a predictive nomogram of postoperative LARS 9 24 25…”

“…The total LARS score adds up to 42 points and is divided into three groups: no LARS (0–20), minor LARS21–29 and major LARS (30–42). One analysis was done with the comparison across these three groups and a further analysis with only two groups, no/minor LARS and major LARS.…”

“…These were the following: males should be coded as 1 instead of 0, PME needed to be coded as 1 instead of TME and a missing minus sign in front of the regression estimate for tumour height. 9 The JAVA script used an age range between The total LARS score adds up to 42 points and is divided into three groups: no LARS (0-20), minor LARS [21][22][23][24][25][26][27][28][29] and major LARS (30-42). One analysis was done with the comparison across these three groups and a further Open access analysis with only two groups, no/minor LARS and major LARS.…”

Low Anterior Resection Syndrome (LARS) after Surgery for Rectal Cancer: An Inevitable Price to Pay for Survival, or a Preventable Complication?

“…Thus, the goal must be to identify these patients to properly stratify risk and subject them to close functional follow-up. In this light, Yan et al have developed a nomogram to stratify patients according to the risk of developing LARS that will require further data to be validated but may be a good starting point [ 26 ].…”

Improving Outcomes in Laparoscopic Anterior Rectal Resection: The Benefits of REAL Score in Preoperative Risk Assessment for Anastomotic Leak

“…As a result, ARR with TME represents the colorectal surgical procedure with the greatest risk of developing postoperative AL [16]. AL was also shown to be independently associated with major low anterior resection syndrome, resulting in a decreased quality of life [17]. The ISREC-International Study Group of Rectal Cancer has de ned AL as a defect in intestinal wall integrity localized at the colorectal or colo-anal anastomotic site -including manual, mechanical or neorectal reservoir suture lines -responsible for the formation of a communication between the intraluminal and the extraluminal spaces.…”