International consensus definition of low anterior resection syndrome

Abstract

Aim 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. Method 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 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. Conclusion 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.

Low anterior resection syndrome in a Scandinavian population of patients with rectal cancer: a longitudinal follow‐up within the QoLiRECT study

“…However, there is considerable variability in the literature due to inconsistent terminology and lack of an international validated scoring system. To enable clinical evaluation of LARS, the LARS questionnaire was developed in 2012 as a scoring tool taking into account the impact of bowel dysfunction on overall quality of life (QoL) [6]; recently, work has begun to reach an international consensus definition of LARS [7].…”

Long-term bowel dysfunction following low anterior resection

“…Recently Delphi consensus on LARS description was published. To meet the definition, a patient must have had an anterior resection (sphincter-preserving rectal resection) and experience at least 1 of suggested 8 symptoms that result in at least one of suggested 8 consequences 9 . The advantaged of the Delphi approach is that unlike most patient-reported outcome measures that were initially produced by expert clinician researchers who then consulted patient populations, the Delphi definition of LARS actively involved all major stakeholders, especially patients, early in the construction to ensure that the resulting tool was fit for purpose.…”

Management guidelines for low anterior resection syndrome – the MANUEL project

“…Recently, a large international consensus trilingual Delphi process with patients as the major stakeholders defined LARS as having at least one of eight symptoms resulting in at least one of eight consequences (Figure 2) after anterior resection [6].…”

“…International consensus definition of low anterior resection syndrome (LARS). LARS is defined as one or more symptoms with one or more consequences following anterior resection [6]…”