Defining low anterior resection syndrome: a systematic review of the literature

Keane, Celia; Wells, Cameron I.; O’Grady, Gregory; Bissett, Ian P.

doi:10.1111/codi.13767

Cited by 169 publications

(152 citation statements)

References 43 publications

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“…Systematic review of literature published between 1986 and 2016 that reported functional outcomes after sphincter preserving rectal resection was undertaken to produce a comprehensive list of bowel function outcomes which were then tested in a pilot study. The results of this review have been published and were used in round 1 of the Delphi survey. Participants were invited to add novel items during round 1.…”

Section: Methodsmentioning

confidence: 99%

“…Whilst pragmatic, this definition can incorporate a vast array of symptoms from faecal incontinence and urgency, to evacuation difficulties. Consequent heterogeneity in reporting makes it impossible to accurately identify the prevalence of LARS . Development of a validated patient‐reported outcome measure, the LARS score, has improved standardization of reporting .…”

Section: Introductionmentioning

confidence: 99%

“…Consequent heterogeneity in reporting makes it impossible to accurately identify the prevalence of LARS. [9][10][11] Development of a validated patient-reported outcome measure, the LARS score, has improved standardization of reporting. 12 Prevalence of LARS using this tool is reported to be 41% (95% confidence interval 34-48%).…”

Section: Introductionmentioning

confidence: 99%

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International consensus definition of low anterior resection syndrome

Keane

Fearnhead

Bordeianou

et al. 2020

ANZ Journal of Surgery

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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International consensus definition of low anterior resection syndrome

Keane

Fearnhead

Bordeianou

et al. 2020

ANZ Journal of Surgery

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“…Patient representatives sent newsletters to maintain participant engagement and highlight the focus on the patient perspective. In each survey, participants were asked to rank each item on a 1-9 point Likert scale from 'Not important' (1) to 'Essential' (9) for the definition of LARS, with an additional response option 'Unable to comment' (0) (see Appendix S1 for the format of a question, http:// links.lww.com/DCR/B127). Likert rankings of 7-9 in any round were considered to indicate high-priority items, ratings of 4-6 indicated moderate-priority items that were important but not critical for the definition and rankings of 1-3 were low priority.…”

Section: Phase 1: Online Delphi Surveymentioning

confidence: 99%

International consensus definition of low anterior resection syndrome

et al. 2020

Self Cite

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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.

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“…In a multicenter cross-sectional study by the UK Low Anterior Resection Syndrome Study Group, Battersby et al showed that 85% of patients following curative restorative anterior resection reported bowel-related quality-of-life impairment, with 40% reporting major impairment [3]. A thorough assessment of LARS is complex employing 18 instruments and over 30 symptoms as reported by Keane et al [2] but most studies employ much simpler questionnaires. The most frequently reported outcomes were incontinence (97%), stool frequency (80%), urgency (67%), evacuatory dysfunction (47%), gas-stool discrimination (34%) and a general measure of quality of life (80%).…”

mentioning

confidence: 99%

PROMS and LARS – will functional outcomes trump cancer survival?

Aigner

2018

Colorectal Disease

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Defining low anterior resection syndrome: a systematic review of the literature

Cited by 169 publications

References 43 publications

International consensus definition of low anterior resection syndrome

International consensus definition of low anterior resection syndrome

International consensus definition of low anterior resection syndrome

PROMS and LARS – will functional outcomes trump cancer survival?

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