International consensus definition of low anterior resection syndrome

Abstract

Background Low anterior resection syndrome (LARS) is pragmatically defined as disordered bowel function after rectal resection leading to a detriment in quality of life. This broad characterization does not allow for precise estimates of prevalence. The LARS score was designed as a simple tool for clinical evaluation of LARS. Although the LARS score has good clinical utility, it may not capture all important aspects that patients may experience. The aim of this collaboration was to develop an international consensus definition of LARS that encompasses all aspects of the condition and is informed by all stakeholders. Methods This international patient‐provider initiative used an online Delphi survey, regional patient consultation meetings and an international consensus meeting. Three expert groups participated: patients, surgeons and other health professionals from five regions (Australasia, Denmark, Spain, Great Britain and Ireland, and North America) and in three languages (English, Spanish and Danish). The primary outcome measured was the priorities for the definition of LARS. Results Three hundred and twenty‐five participants (156 patients) registered. The response rates for successive rounds of the Delphi survey were 86%, 96% and 99%. Eighteen priorities emerged from the Delphi survey. Patient consultation and consensus meetings refined these priorities to eight symptoms and eight consequences that capture essential aspects of the syndrome. Sampling bias may have been present, in particular, in the patient panel because social media was used extensively in recruitment. There was also dominance of the surgical panel at the final consensus meeting despite attempts to mitigate this. Conclusions This is the first definition of LARS developed with direct input from a large international patient panel. The involvement of patients in all phases has ensured that the definition presented encompasses the vital aspects of the patient experience of LARS. The novel separation of symptoms and consequences may enable greater sensitivity to detect changes in LARS over time and with intervention.

The risk factors of low anterior resection syndrome after colorectal cancer surgery: A retrospective study of 566 patients in a single institution in China

“…The resection of the rectum, division of the coccygeus muscle, and/or damage to the nerve supply can impair rectal function. The remaining rectum is small and does not function properly, and the hypermotility of the remnant colon can affect the manifestation of urge fecal incontinence (7,16,17).…”

“…It can be described as a "disordered bowel function after rectal resection, leading to a detriment in quality of life." (14)(15)(16)(17). The etiology of LARS is poorly understood, and it seems that the anatomical components and physiological functions of normal defecation, which may be damaged during surgery, are not well established (9,18).…”

Preoperative short-course radiation therapy with PROtons compared to photons in high-risk RECTal cancer (PRORECT): Initial dosimetric experience

“…OAR for patients with rectal cancer include bladder, bowel, pelvic bone marrow, nervous tissue, skin, and genitalia. Acquired radiation dose to these OAR can result in adverse events which can affect survival and quality of life [16] , [17] , [18] , [19] . As demonstrated in the RAPIDO trial, considerable toxicity was observed in the preoperative period with 48 % of patients in the SCRT arm experiencing grade 3+ toxicity [20] .…”

Low anterior resection syndrome: An unavoidable price to pay to preserve the rectum?

“…Dysfunction translates into impairment of patients' daily activities that end up in "toilet-dependence" and deterioration of their quality of life, even in the long-term (9, 10). These concerns have motivated the development of a new LARS Patient-Reported Outcome Measure tool that includes symptoms and consequences (11).…”