Development and external validation of a nomogram and online tool to predict bowel dysfunction following restorative rectal cancer resection: the POLARS score

Battersby, Nick; Bouliotis, George; Emmertsen, Katrine Jøssing; Juul, Therese; Glynne‐Jones, Rob; Branagan, Graham; Christensen, Peter; Laurberg, Søren; Moran, Brendan

doi:10.1136/gutjnl-2016-312695

Cited by 144 publications

(200 citation statements)

References 62 publications

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“…Several non-controlled studies 20,23,26 have shown an association between use of a temporary ileostomy and LARS. Only one-quarter of participants received radiotherapy, all tumours were above 5 cm and half were more than 10 cm above the anal verge.…”

Section: Discussionmentioning

confidence: 99%

“…59-75) and 63 (60-70) respectively; P = 0⋅207) or the frequency (22 (21)(22)(23)(24)(25) versus 22 (20)(21)(22)(23)(24); P = 0⋅437) and dietary (16 (13-18) versus 16 (12)(13)(14)(15)(16)(17)(18); P = 0⋅939) subscales (Fig. 59-75) and 63 (60-70) respectively; P = 0⋅207) or the frequency (22 (21)(22)(23)(24)(25) versus 22 (20)(21)(22)(23)(24); P = 0⋅437) and dietary (16 (13-18) versus 16 (12)(13)(14)(15)(16)(17)(18); P = 0⋅939) subscales (Fig.…”

Section: Memorial Sloan Ketting Cancer Center Bowel Function Instrumentmentioning

confidence: 97%

“…59-75) and 63 (60-70) respectively; P = 0⋅207) or the frequency (22 (21)(22)(23)(24)(25) versus 22 (20)(21)(22)(23)(24); P = 0⋅437) and dietary (16 (13-18) versus 16 (12)(13)(14)(15)(16)(17)(18); P = 0⋅939) subscales (Fig. However, patients undergoing late closure had worse scores on the urgency/soiling subscale than those in the early closure group (14 (6-18) versus 17 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20); P = 0⋅017). However, patients undergoing late closure had worse scores on the urgency/soiling subscale than those in the early closure group (14 (6-18) versus 17 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20); P = 0⋅017).…”

Section: Memorial Sloan Ketting Cancer Center Bowel Function Instrumentmentioning

confidence: 97%

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Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer

Keane

Park

Öberg

et al. 2019

British Journal of Surgery

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Background Low anterior resection syndrome (LARS) has a significant impact on postoperative quality of life. Although early closure of an ileostomy is safe in selected patients, functional outcomes have not been investigated. The aim was to compare bowel function and the prevalence of LARS in patients who underwent early or late closure of an ileostomy after rectal resection for cancer. Methods Early closure (8–13 days) was compared with late closure (after 12 weeks) of the ileostomy following rectal cancer surgery in a multicentre RCT. Exclusion criteria were: signs of anastomotic leakage, diabetes mellitus, steroid treatment and postoperative complications. Bowel function was evaluated using the LARS score and the Memorial Sloan Kettering Cancer Center Bowel Function Instrument (BFI). Results Following index surgery, 112 participants were randomized (55 early closure, 57 late closure). Bowel function was evaluated at a median of 49 months after stoma closure. Eighty‐two of 93 eligible participants responded (12 had died and 7 had a permanent stoma). Rates of bowel dysfunction were higher in the late closure group, but this did not reach statistical significance (major LARS in 29 of 40 participants in late group and 25 of 42 in early group, P = 0·250; median BFI score 63 versus 71 respectively, P = 0·207). Participants in the late closure group had worse scores on the urgency/soiling subscale of the BFI (14 versus 17; P = 0·017). One participant in the early group and six in the late group had a permanent stoma ( P = 0·054). Conclusion Patients undergoing early stoma closure had fewer problems with soiling and fewer had a permanent stoma, although reduced LARS was not demonstrated in this cohort. Dedicated prospective studies are required to evaluate definitively the association between temporary ileostomy, LARS and timing of closure.

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Section: Discussionmentioning

confidence: 99%

Section: Memorial Sloan Ketting Cancer Center Bowel Function Instrumentmentioning

confidence: 97%

“…59-75) and 63 (60-70) respectively; P = 0⋅207) or the frequency (22 (21)(22)(23)(24)(25) versus 22 (20)(21)(22)(23)(24); P = 0⋅437) and dietary (16 (13-18) versus 16 (12)(13)(14)(15)(16)(17)(18); P = 0⋅939) subscales (Fig. However, patients undergoing late closure had worse scores on the urgency/soiling subscale than those in the early closure group (14 (6-18) versus 17 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20); P = 0⋅017). However, patients undergoing late closure had worse scores on the urgency/soiling subscale than those in the early closure group (14 (6-18) versus 17 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20); P = 0⋅017).…”

Section: Memorial Sloan Ketting Cancer Center Bowel Function Instrumentmentioning

confidence: 97%

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Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer

Keane

Park

Öberg

et al. 2019

British Journal of Surgery

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“…The nomogram is a graphical statistical instrument that incorporates some variables to develop a continuous scoring system, which reflects the individual and precise risk probability. Nomograms are an important part of modern medical decision making, which has been established and validated in extensive medical applications including surgery, cancer, and myocardial infarction [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

A COACHS Nomogram to Predict the Probability of Three-Month Unfavorable Outcome after Acute Ischemic Stroke in Chinese Patients

et al. 2019

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Background: Accurate prognostication of unfavorable outcome made at the early onset of stroke is important to both the clinician and the patient management. This study was aimed to develop a nomogram based on the integration of parameters to predict the probability of 3-month unfavorable functional outcome in Chinese acute ischemic stroke patients. Methods: We retrospectively collected patients who underwent acute ischemic stroke at Stroke Center of the Nanjing First Hospital (China) between May 2013 and May 2018. After exclusion, the study population includes 1,025 patients for nomogram development. The main outcome measure was 3-month unfavorable outcome (modified Rankin Scale > 2). Multivariable logistic regression analysis was used to develop the predicting model, and stepwise logistic regression with the Akaike information criterion was utilized to find best-fit nomogram model. We incorporated the creatinine, fast blood glucose, age, previous cerebral hemorrhage, previous valvular heart disease, and NHISS score (COACHS), and these factors were presented with a nomogram. We assessed the discriminative performance by using the area under curve (AUC) of receiver-operating characteristic (ROC) and calibration of risk prediction model by using the Hosmer-Lemeshow test. Results: Multivariate analysis of the 1,025 patients for logistic regression helped identify the independent factors as National Institutes of Health Stroke Scale score on admission, age, previous valvular heart disease, fasting blood glucose, creatinine, and previous cerebral hemorrhage, which were included in the COACHS nomogram. The AUC-ROC of nomogram was 0.799. Calibration was good (p = 0.1376 for the Hosmer-Lemeshow test). Conclusions: The COACHS nomogram may be used to predict unfavorable outcome at 3 months after acute ischemic stroke in Chinese population. It may be also a reliable tool that is effective in its clinical utilization to risk-stratify acute stroke patients.

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“…Indeed, a recent international collaboration of UK and Danish surgeons has sought to develop a tool to predict bowel dysfunction severity prior to anterior resection. The Pre-operative LARS (POLARS) score purports to help patients understand their risk of bowel dysfunction and to preoperatively highlight patients who may require additional postoperative support [24].…”

Section: Resultsmentioning

confidence: 99%

Neuromodulation for low-anterior resection syndrome

McCawley

O’Connell

2017

Colorect. Cancer

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Development and external validation of a nomogram and online tool to predict bowel dysfunction following restorative rectal cancer resection: the POLARS score

Cited by 144 publications

References 62 publications

Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer

Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer

A COACHS Nomogram to Predict the Probability of Three-Month Unfavorable Outcome after Acute Ischemic Stroke in Chinese Patients

Neuromodulation for low-anterior resection syndrome

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