International consensus definition of low anterior resection syndrome

C Keane¹, N S Fearnhead², L Bordeianou³, P Christensen⁴, E Espin Basany⁵, S Laurberg⁴, A Mellgren⁶, C Messick⁷, G R Orangio⁸, A Verjee⁹, K Wing¹⁰, I Bissett¹¹; LARS International Collaborative Group

Collaborators, Affiliations

Collaborators

LARS International Collaborative Group:
V An, A Bryant, C Byrne, T Chen, D Clark, S Croft, P Dinning, M Gladman, A Heriot, S Kariappa, J Keck, D Lubowski, A Khera, K Kirkwood, D Petersen, K Sloots, B Totten, M Weston, P Andersen, C Bachmann, H Barht, K Emmertsen, P Faaborg, I Gögenur, P Ingerslev, D Isaksen, H Iversen, L Iversen, K Jacobsen, T Jansen, I Jocobsen, T Juul, D Kjaer, K Krogh, M Majgaard, A Mynster, A Neuenschwander, C Nielsen, M Nielsen, R Nielsen, T Nielsen, J Olsen, B Poulsen, H Rahr, B Snedker, G Sørensen, T Stolzenburg, P Vaabengaard, A Acheson, J Andreyev, S Bach, N Battersby, J Bradbury, S Brown, T Cecil, M Chapman, S Chapman, H Chave, T Cook, L Cuffy, J Davies, C Dawson, J Dixon, S Duff, C Edwards, I Geh, C Hamilton, L Hancock, D Harji, J Hill, S Holtham, J Jenkins, R Johnston, S Kapur, C Maxwell-Armstrong, D McArthur, B Moran, C Norton, K Nugent, L Pateman, Y Perston, T Rockall, P Sagar, M Saunders, D Sebag-Montefiore, A Senapati, B Singh, P Skaife, N Smart, H Sykes, C Taylor, G Thorpe, G Tierney, S Voyce, C Walsh, O Warren, J Wheeler, A Woodward, D Winter, S Abbott, V Beban, M Bennett, T Chadwick, R Collinson, S Corbett, E Dennett, T Eglinton, A Fraser, J Glue, D Hohaia, E Menzi, M O'Connor, D Stevenson, C Wells, S Wolyncewicz, J Woodfield, K Bence, M Boutros, M Brueseke, J DeKorte, C Floruta, T Francone, F Frederick, J Grasso, B Gurland, K Higgins, T Hull, D Keller, A Laffan, S Lovett, J Marlatt, D McAdams, C McCarthy, H Milch, S Natale, E Pappou, I Paquette, S Pulskamp, M Rich, L Savitt, M Shafi, S Steele, S Stein, M Tolbert, M Varma, S Vogler, T Vuong, K Wells, S Wexner, J Wo, J Wright, C Wunderlich, K Campbell, M Lim, S Moug, R Oliphant, M Araujo-Ferreiro, C Ballester, A Belen-Bueno, R Blanco-Colino, J Carrillo-Moreno, J Castillo, A Codina-Cazador, J M Enriquez-Navascuez, M Gallego-García, J Jerez, L M Jimenez, I Labaka-Aretaga, M Martin-Fernández, C Martinez-Sanchez, A Muñoz, G Paniagua-Cayetano, M Pascual-Damieta, F de la Portilla, L Ramirez, C Sanchez-García, G Vaquer-Casas, E Vico-García, V Vigorita, R Adams, J Cornish, M Davies, M Evans, J Torkington, J Turner

Affiliations

¹ Department of Surgery, University of Auckland, Auckland, New Zealand.
² Department of Colorectal Surgery, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
³ Colorectal Surgery Centre/Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁴ Danish Cancer Society National Research Centre for Survivorship and Late Side Effect to Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
⁵ Colon and Recto Unit, Department of General Surgery, Vall de Hebron Hospital, Universitat Autonoma de Barcelona, Spain.
⁶ Division of Colon and Rectal Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.
⁷ Department of Surgical Oncology, Section of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁸ Department of Surgery/School of Medicine, Louisiana State University, New Orleans, Louisiana, USA.
⁹ Bowel Disease Research Foundation, London, UK.
¹⁰ Otago Community Hospice, Dunedin, New Zealand.
¹¹ Department of Surgery, Auckland City Hospital, Auckland, New Zealand.

PMID: 32037685
DOI: 10.1111/codi.14957

Free article

International consensus definition of low anterior resection syndrome

C Keane et al. Colorectal Dis. 2020 Mar.

Free article

. 2020 Mar;22(3):331-341.

doi: 10.1111/codi.14957. Epub 2020 Feb 10.

Authors

Collaborators

LARS International Collaborative Group:
V An, A Bryant, C Byrne, T Chen, D Clark, S Croft, P Dinning, M Gladman, A Heriot, S Kariappa, J Keck, D Lubowski, A Khera, K Kirkwood, D Petersen, K Sloots, B Totten, M Weston, P Andersen, C Bachmann, H Barht, K Emmertsen, P Faaborg, I Gögenur, P Ingerslev, D Isaksen, H Iversen, L Iversen, K Jacobsen, T Jansen, I Jocobsen, T Juul, D Kjaer, K Krogh, M Majgaard, A Mynster, A Neuenschwander, C Nielsen, M Nielsen, R Nielsen, T Nielsen, J Olsen, B Poulsen, H Rahr, B Snedker, G Sørensen, T Stolzenburg, P Vaabengaard, A Acheson, J Andreyev, S Bach, N Battersby, J Bradbury, S Brown, T Cecil, M Chapman, S Chapman, H Chave, T Cook, L Cuffy, J Davies, C Dawson, J Dixon, S Duff, C Edwards, I Geh, C Hamilton, L Hancock, D Harji, J Hill, S Holtham, J Jenkins, R Johnston, S Kapur, C Maxwell-Armstrong, D McArthur, B Moran, C Norton, K Nugent, L Pateman, Y Perston, T Rockall, P Sagar, M Saunders, D Sebag-Montefiore, A Senapati, B Singh, P Skaife, N Smart, H Sykes, C Taylor, G Thorpe, G Tierney, S Voyce, C Walsh, O Warren, J Wheeler, A Woodward, D Winter, S Abbott, V Beban, M Bennett, T Chadwick, R Collinson, S Corbett, E Dennett, T Eglinton, A Fraser, J Glue, D Hohaia, E Menzi, M O'Connor, D Stevenson, C Wells, S Wolyncewicz, J Woodfield, K Bence, M Boutros, M Brueseke, J DeKorte, C Floruta, T Francone, F Frederick, J Grasso, B Gurland, K Higgins, T Hull, D Keller, A Laffan, S Lovett, J Marlatt, D McAdams, C McCarthy, H Milch, S Natale, E Pappou, I Paquette, S Pulskamp, M Rich, L Savitt, M Shafi, S Steele, S Stein, M Tolbert, M Varma, S Vogler, T Vuong, K Wells, S Wexner, J Wo, J Wright, C Wunderlich, K Campbell, M Lim, S Moug, R Oliphant, M Araujo-Ferreiro, C Ballester, A Belen-Bueno, R Blanco-Colino, J Carrillo-Moreno, J Castillo, A Codina-Cazador, J M Enriquez-Navascuez, M Gallego-García, J Jerez, L M Jimenez, I Labaka-Aretaga, M Martin-Fernández, C Martinez-Sanchez, A Muñoz, G Paniagua-Cayetano, M Pascual-Damieta, F de la Portilla, L Ramirez, C Sanchez-García, G Vaquer-Casas, E Vico-García, V Vigorita, R Adams, J Cornish, M Davies, M Evans, J Torkington, J Turner

Affiliations

¹ Department of Surgery, University of Auckland, Auckland, New Zealand.
² Department of Colorectal Surgery, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
³ Colorectal Surgery Centre/Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁴ Danish Cancer Society National Research Centre for Survivorship and Late Side Effect to Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
⁵ Colon and Recto Unit, Department of General Surgery, Vall de Hebron Hospital, Universitat Autonoma de Barcelona, Spain.
⁶ Division of Colon and Rectal Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.
⁷ Department of Surgical Oncology, Section of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁸ Department of Surgery/School of Medicine, Louisiana State University, New Orleans, Louisiana, USA.
⁹ Bowel Disease Research Foundation, London, UK.
¹⁰ Otago Community Hospice, Dunedin, New Zealand.
¹¹ Department of Surgery, Auckland City Hospital, Auckland, New Zealand.

PMID: 32037685
DOI: 10.1111/codi.14957

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.

Keywords: Consensus definition; low anterior resection syndrome; patient-reported; rectal resection.

© 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Colon and Rectal Surgeons, by John Wiley & Sons Limited on behalf of the Association of Coloproctology of Great Britain and Ireland and by John Wiley & Sons Australia on behalf of the Royal Australasian College of Surgeons. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in anyway or used commercially without permission from the journal.

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Comment in

Do we have enough Foreknowledge to predict the low anterior resection syndrome (LARS) score preoperatively?
Essangri H, Majbar MA, Benkabbou A, Belkhadir Z, Amrani L, Mohsine R, Souadka A. Essangri H, et al. Colorectal Dis. 2020 Oct;22(10):1445. doi: 10.1111/codi.15062. Epub 2020 May 12. Colorectal Dis. 2020. PMID: 32270539 No abstract available.

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International consensus definition of low anterior resection syndrome

Collaborators

Affiliations

International consensus definition of low anterior resection syndrome

Authors

Collaborators

Affiliations

Abstract

Comment in

References

MeSH terms

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Medical