Validation of the low anterior resection syndrome score in finnish patients: preliminary results on quality of life in different lars severity groups

Carpelan, Anu; Elamo, Eeva; Karvonen, Jukka; Varpe, Pirita; Elamo, Sami; Vahlberg, Tero; Grönroos, Juha; Huhtinen, Heikki

doi:10.1177/1457496920930142

Cited by 5 publications

(6 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…found that patients with major LARS had a significantly lower quality of life and more defecatory symptoms than those with no low anterior resection syndrome. Significant differences in the global quality of life between those with no or minor LARS could not be detected, even in cases where a progression of defecatory symptoms was noted 13 . Thus, the patients in this study were categorized into a group with major LARS and a group with minor or no LARS.…”

Section: Methodsmentioning

confidence: 90%

See 1 more Smart Citation

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

Yan

Lin

et al. 2022

ANZ Journal of Surgery

View full text Add to dashboard Cite

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.

show abstract

Section: Methodsmentioning

confidence: 90%

“…Significant differences in the global quality of life between those with no or minor LARS could not be detected, even in cases where a progression of defecatory symptoms was noted. 13 Thus, the patients in this study were categorized into a group with major LARS and a group with minor or no LARS.…”

Section: Diagnosis and Classification Of Larsmentioning

confidence: 99%

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

Yan

Lin

et al. 2022

ANZ Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…This definition is too broad to clearly identify the diagnostic criteria because the symptoms of LARS are highly variable. Therefore, in clinical practice and in academic studies, the LARS score is used instead of the previous definition to diagnose LARS and estimate the severity of the disease [38].…”

Section: Diagnostic Criteria For Larsmentioning

confidence: 99%

Clinical Management of Low Anterior Resection Syndrome: Review of the Current Diagnosis and Treatment

Zhang,

Luo,

Qiu

et al. 2023

Cancers

View full text Add to dashboard Cite

Background: Low anterior resection syndrome (LARS) is a series of bowel dysfunction symptoms, including altered bowel frequency, irregular bowel rhythms, fecal incontinence, and constipation. LARS occurs in 80% of patients undergoing sphincter-preserving surgery, affecting patients’ quality of life along with social avoidance. Different measurements and treatments have been raised to deal with LARS, but no systematic standard has been developed. Objective and Methods: To promote the standardization of clinical trials and clinical management of LARS, this review summarizes the latest findings up until 2023 regarding the diagnostic criteria, assessment protocols, and treatment modalities for postoperative LARS in rectal cancer. Results: The diagnostic criteria for LARS need to be updated to the definition proposed by the LARS International Collaborative Group, replacing the current application of the LARS score. In both clinical trials and clinical treatment, the severity of LARS should be assessed using at least one symptom assessment questionnaire, the LARS score or MSKCC BFI, and at least one scale related to quality of life. Anorectal manometry, fecoflowmetry, endoscopic ultrasonography, and pelvic floor muscle strength testing are recommended to be adopted only in clinical trials. After analysis of the latest literature on LARS treatment, a stepwise classification model is established for the standardized clinical management of LARS. Patients with minor LARS can start with first-line treatment, including management of self-behavior with an emphasis on diet modification and medication. Lamosetron, colesevelam hydrochloride, and loperamide are common antidiarrheal agents. Second-line management indicates multi-mode pelvic floor rehabilitation and transanal irrigation. Patients with major LARS should select single or several treatments in second-line management. Refractory LARS can choose antegrade enema, neuromodulation, or colostomy. Conclusions: In clinical trials of LARS treatment between 2020 and 2022, the eligibility criteria and evaluation system have been variable. Therefore, it is urgent to create a standard for the diagnosis, assessment, and treatment of LARS. Failure to set placebos and differentiate subgroups are limitations of many current LARS studies. Randomized controlled trials comparing diverse therapies and long-term outcomes are absent, as well. Moreover, a new scale needs to be developed to incorporate the patient’s perspective and facilitate outpatient follow-up. Though the establishment of a stepwise classification model for LARS treatment here is indispensable, the refinement of the guidelines may be improved by more standardized studies.

show abstract

“…Clinically validated standard 25 EORTC QLQ-C30 18 3 6 min walk test 19 3 Breast-Q Score 20 2 Quality of Recovery Score 21 2 COPD assessment test 22 1 Duchenne muscular dystrophy tests 23 1 Low Anterior Resection Syndrome Score 24 1 Wexner Incontinence Score 25 1 MRC Breathlessness Scale 26 1 Numerical Pain Rating Scale 27 1 Medical Outcomes Study SF-36 28 1 Oswestry Disability Index 29 1 Female Sexual Function Index 30 1 State-Trait Anxiety Inventory 31 1 MD Anderson Dysphagia Inventory 32 1 Expanded Prostate Cancer Index Composite 33 1 Functional Assessment of Cancer Therapy 34 1 Colorectal Functional Outcome Questionnaire 35 1 Hospital Anxiety and Depression Scale 36 1 Subjectively 1…”

Section: Methods Nmentioning

confidence: 99%

Distinguishing Clinical from Statistical Significances in Contemporary Comparative Effectiveness Research

Gikandi,

Hallet,

Koerkamp

et al. 2024

Annals of Surgery

View full text Add to dashboard Cite

Objective: To determine the prevalence of clinical significance reporting in contemporary comparative effectiveness research (CER). Background: In CER, a statistically significant difference between study groups may or may not be clinically significant. Misinterpreting statistically significant results could lead to inappropriate recommendations that increase healthcare costs and treatment toxicity. Methods: CER studies from 2022 issues of Annals of Surgery, Journal of the American Medical Association, Journal of Clinical Oncology, Journal of Surgical Research, and Journal of the American College of Surgeons were systematically reviewed by two different investigators. The primary outcome of interest was whether authors specified what they considered to be a clinically significant difference in the Methods. Results: Of 307 reviewed studies, 162 were clinical trials and 145 were observational studies. Authors specified what they considered to be a clinically significant difference in 26 studies (8.5%). Clinical significance was defined using clinically validated standards in 25 studies and subjectively in 1 study. Seven studies (2.3%) recommended a change in clinical decision-making, all with primary outcomes achieving statistical significance. Five (71.4%) of these studies did not have clinical significance defined in their methods. In randomized controlled trials with statistically significant results, sample size was inversely correlated with effect size (r=−0.30, P=0.038). Conclusion: In contemporary CER, most authors do not specify what they consider to be a clinically significant difference in study outcome. Most studies recommending a change in clinical-decision making did so based on statistical significance alone, and clinical significance was usually defined with clinically validated standards.

show abstract

Validation of the low anterior resection syndrome score in finnish patients: preliminary results on quality of life in different lars severity groups

Cited by 5 publications

References 39 publications

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

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

Clinical Management of Low Anterior Resection Syndrome: Review of the Current Diagnosis and Treatment

Distinguishing Clinical from Statistical Significances in Contemporary Comparative Effectiveness Research

Contact Info

Product

Resources

About