International consensus definition of low anterior resection syndrome
International consensus definition of low anterior resection syndrome
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.
consensus definition, low anterior resection syndrome, patient reported, rectal resection
300-307
Keane, Celia
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Fearnhead, Nicola S
39468f9f-bb98-4c77-ae75-315bdbad27f7
Bordeianou, Liliana G
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Christensen, Peter
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Espin Basany, Eloy
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Laurberg, Søren
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Mellgren, Anders
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Messick, Craig
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Orangio, Guy R
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Verjee, Azmina
a8f9ab8c-63e5-42cc-bc74-58c4bf8eb2e8
Wing, Kirsty
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Bissett, Ian P
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Nugent, Karen
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LARS International Collaborative Group
1 March 2020
Keane, Celia
6929845f-f722-4aaa-ac74-bc87db06133b
Fearnhead, Nicola S
39468f9f-bb98-4c77-ae75-315bdbad27f7
Bordeianou, Liliana G
8c5472a4-1372-48e7-bb78-9bfc702e9481
Christensen, Peter
742561eb-dc9b-475e-9faa-3e81a23a2dd6
Espin Basany, Eloy
8dd2b1f9-6407-4661-b20b-36b5121a419e
Laurberg, Søren
8ccc6192-751f-425e-97b3-8a6fe71f81f1
Mellgren, Anders
e35466d2-eff9-41e8-ad9b-e54f09d5eb47
Messick, Craig
29cd31de-2f19-459c-9ce4-abda51970512
Orangio, Guy R
c4c01c8d-fc19-412b-a378-13ae2abe1d53
Verjee, Azmina
a8f9ab8c-63e5-42cc-bc74-58c4bf8eb2e8
Wing, Kirsty
4c7aa7f8-1b9c-4b9b-a240-0898f3f2ce77
Bissett, Ian P
9efac23f-7b5e-42c1-9d8b-4919e84e4316
Nugent, Karen
79fcb89d-6ff2-47b8-ac2c-2afb24954456
Keane, Celia, Fearnhead, Nicola S, Bordeianou, Liliana G, Christensen, Peter, Espin Basany, Eloy, Laurberg, Søren, Mellgren, Anders, Messick, Craig, Orangio, Guy R, Verjee, Azmina, Wing, Kirsty and Bissett, Ian P
,
LARS International Collaborative Group
(2020)
International consensus definition of low anterior resection syndrome.
ANZ Journal of Surgery, 90 (3), .
(doi:10.1111/ans.15421).
Abstract
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.
Text
ans.15421
- Version of Record
More information
Accepted/In Press date: 28 July 2019
e-pub ahead of print date: 10 February 2020
Published date: 1 March 2020
Additional Information:
Funding Information:
As a Tripartite 2020 Vision collaborative study, we acknowledge the support of the following societies: The Association of Coloproctology of Great Britain and Ireland (ACPGBI), the Royal Society of Medicine (RSM) Section of Coloproctology, the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) and/or the Colon and Rectal Surgery Section of the Royal Australasian College of Surgeons (RACS), the European Society of Coloproctology (ESCP), the American Society of Colon and Rectal Surgeons (ASCRS). The Bowel Disease Research Foundation (BDRF) hosted and funded the UK patient meeting including travelling expenses for all patient, nursing and trainee participants as well as meeting and administration costs. ESCP generously hosted the final consensus meeting in Nice. The Auckland Medical Research Foundation and the Danish Cancer Society funded participant attendance at the final consensus meeting.
Funding Information:
Bowel Cancer UK, Bowel Cancer NZ, Fight Colorectal Cancer assisted with advertising the study to allow for patient participant recruitment. CK is funded by the Auckland Medical Research Foundation Ruth Spencer Fellowship. The authors would also like to acknowledge Ethan Hermanson for transcription of the North American patient consultation meeting.
Publisher Copyright:
© 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.
Keywords:
consensus definition, low anterior resection syndrome, patient reported, rectal resection
Identifiers
Local EPrints ID: 443419
URI: http://eprints.soton.ac.uk/id/eprint/443419
ISSN: 1445-2197
PURE UUID: 32ae751a-7c6b-47a9-abbc-adc334145998
Catalogue record
Date deposited: 24 Aug 2020 16:37
Last modified: 16 Mar 2024 09:00
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Contributors
Author:
Celia Keane
Author:
Nicola S Fearnhead
Author:
Liliana G Bordeianou
Author:
Peter Christensen
Author:
Eloy Espin Basany
Author:
Søren Laurberg
Author:
Anders Mellgren
Author:
Craig Messick
Author:
Guy R Orangio
Author:
Azmina Verjee
Author:
Kirsty Wing
Author:
Ian P Bissett
Corporate Author: LARS International Collaborative Group
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