International consensus definition of low anterior resection syndrome

Celia Keane; Nicola S. Fearnhead; Liliana G. Bordeianou; Peter Christensen; Eloy Espin Basany; Søren Laurberg; Anders Mellgren; Craig Messick; Guy R. Orangio; Azmina Verjee; Kirsty Wing; Ian Bissett; LARS International Collaborative Group; T. Chen; D. Clark; P. Dinning; S. Brown; C. Edwards; C. Walsh; S. Abbott; M. Bennett; T. Vuong; J. Wright

doi:10.1111/codi.14957

International consensus definition of low anterior resection syndrome

Celia Keane, Nicola S. Fearnhead, Liliana G. Bordeianou, Peter Christensen, Eloy Espin Basany, Søren Laurberg, Anders Mellgren, Craig Messick, Guy R. Orangio, Azmina Verjee, Kirsty Wing, Ian Bissett, LARS International Collaborative Group, T. Chen, D. Clark, P. Dinning, S. Brown, C. Edwards, C. Walsh, S. AbbottM. Bennett, T. Vuong, J. Wright

College of Medicine and Public Health

Research output: Contribution to journal › Article › peer-review

23 Citations (Scopus)

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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.

Original language	English
Pages (from-to)	331-341
Number of pages	11
Journal	Colorectal Disease
Volume	22
Issue number	3
DOIs	https://doi.org/10.1111/codi.14957
Publication status	Published - 1 Mar 2020

Bibliographical note

This article is being published concurrently in Diseases of the Colon & Rectum, Colorectal Disease and ANZ Journal of Surgery. The articles are identical exceptfor minor stylistic and spelling differences in keeping with each journal’s style. Citation from any of the three journals can be used when citing this article.

Keywords

Consensus definition
low anterior resection syndrome
patient-reported
rectal resection

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10.1111/codi.14957Licence: CC BY-NC-ND

Published versionFinal published version, 1.11 MBLicence: CC BY-NC-ND

Cite this

Keane, C., Fearnhead, N. S., Bordeianou, L. G., Christensen, P., Basany, E. E., Laurberg, S., Mellgren, A., Messick, C., Orangio, G. R., Verjee, A., Wing, K., Bissett, I., LARS International Collaborative Group, Chen, T., Clark, D., Dinning, P., Brown, S., Edwards, C., Walsh, C., ... Wright, J. (2020). International consensus definition of low anterior resection syndrome. Colorectal Disease, 22(3), 331-341. https://doi.org/10.1111/codi.14957

@article{566fc9f163684f39af1fbfe24fae4e63,

title = "International consensus definition of low anterior resection syndrome",

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",

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

note = "This article is being published concurrently in Diseases of the Colon & Rectum, Colorectal Disease and ANZ Journal of Surgery. The articles are identical exceptfor minor stylistic and spelling differences in keeping with each journal{\textquoteright}s style. Citation from any of the three journals can be used when citing this article.",

year = "2020",

month = mar,

day = "1",

doi = "10.1111/codi.14957",

language = "English",

volume = "22",

pages = "331--341",

journal = "Colorectal Disease",

issn = "1462-8910",

publisher = "BLACKWELL PUBLISHERS INC",

number = "3",

}

Keane, C, Fearnhead, NS, Bordeianou, LG, Christensen, P, Basany, EE, Laurberg, S, Mellgren, A, Messick, C, Orangio, GR, Verjee, A, Wing, K, Bissett, I, LARS International Collaborative Group, Chen, T, Clark, D, Dinning, P, Brown, S, Edwards, C, Walsh, C, Abbott, S, Bennett, M, Vuong, T & Wright, J 2020, 'International consensus definition of low anterior resection syndrome', Colorectal Disease, vol. 22, no. 3, pp. 331-341. https://doi.org/10.1111/codi.14957

TY - JOUR

T1 - International consensus definition of low anterior resection syndrome

AU - Keane, Celia

AU - Fearnhead, Nicola S.

AU - Bordeianou, Liliana G.

AU - Christensen, Peter

AU - Basany, Eloy Espin

AU - Laurberg, Søren

AU - Mellgren, Anders

AU - Messick, Craig

AU - Orangio, Guy R.

AU - Verjee, Azmina

AU - Wing, Kirsty

AU - Bissett, Ian

AU - LARS International Collaborative Group

AU - An, V.

AU - Bryant, A.

AU - Byrne, C.

AU - Chen, T.

AU - Croft, S.

AU - Clark, D.

AU - Gladman, M.

AU - Heriot, A.

AU - Kariappa, S.

AU - Keck, J.

AU - Lubowski, D.

AU - Dinning, P.

AU - Khera, A.

AU - Kirkwood, K.

AU - Petersen, D.

AU - Sloots, K.

AU - Totten, B.

AU - Weston, M.

AU - Andersen, P.

AU - Bachmann, C.

AU - Barht, H.

AU - Emmertsen, K.

AU - Faaborg, P.

AU - Gögenur, I.

AU - Ingerslev, P.

AU - Isaksen, D.

AU - Iversen, H.

AU - Iversen, L.

AU - Jacobsen, K.

AU - Jansen, T.

AU - Jocobsen, I.

AU - Juul, T.

AU - Kjar, D.

AU - Krogh, K.

AU - Majgaard, M.

AU - Mynster, A.

AU - Neuenschwander, A.

AU - Nielsen, C.

AU - Nielsen, R.

AU - Nielsen, M.

AU - Nielsen, T.

AU - Olsen, J.

AU - Poulsen, B.

AU - Rahr, H.

AU - Snedker, B.

AU - Sørensen, G.

AU - Stolzenburg, T.

AU - Vaabengaard, P.

AU - Acheson, A.

AU - Andreyev, J.

AU - Bach, S.

AU - Battersby, N.

AU - Bradbury, J.

AU - Brown, S.

AU - Cecil, T.

AU - Chapman, S.

AU - Chapman, M.

AU - Chave, H.

AU - Cook, T.

AU - Cuffy, L.

AU - Davies, J.

AU - Dawson, C.

AU - Dixon, J.

AU - Duff, S.

AU - Edwards, C.

AU - Geh, I.

AU - Hamilton, C.

AU - Hancock, L.

AU - Harji, D.

AU - Hill, J.

AU - Holtham, S.

AU - Jenkins, J.

AU - Johnston, R.

AU - Kapur, S.

AU - Maxwell-Armstrong, C.

AU - McArthur, D.

AU - Moran, B.

AU - Norton, C.

AU - Nugent, K.

AU - Pateman, L.

AU - Perston, Y.

AU - Rockall, T.

AU - Sagar, P.

AU - Saunders, M.

AU - Sebag-Montefiore, D.

AU - Senapati, A.

AU - Singh, B.

AU - Skaife, P.

AU - Sykes, H.

AU - Smart, N.

AU - Taylor, C.

AU - Thorpe, G.

AU - Tierney, G.

AU - Voyce, S.

AU - Walsh, C.

AU - Warren, O.

AU - Wheeler, J.

AU - Woodward, A.

AU - Winter, D.

AU - Abbott, S.

AU - Beban, V.

AU - Bennett, M.

AU - Chadwick, T.

AU - Collinson, R.

AU - Corbett, S.

AU - Dennett, E.

AU - Eglinton, T.

AU - Fraser, A.

AU - Glue, J.

AU - Hohaia, D.

AU - Menzi, E.

AU - O'Connor, M.

AU - Stevenson, D.

AU - Wells, C.

AU - Wolyncewicz, S.

AU - Woodfield, J.

AU - Bence, K.

AU - Boutros, M.

AU - Brueseke, M.

AU - DeKorte, J.

AU - Floruta, C.

AU - Francone, T.

AU - Frederick, F.

AU - Grasso, J.

AU - Gurland, B.

AU - Higgins, K.

AU - Hull, T.

AU - Keller, D.

AU - Laffan, A.

AU - Lovett, S.

AU - Marlatt, J.

AU - McAdams, D.

AU - McCarthy, C.

AU - Milch, H.

AU - Natale, S.

AU - Pappou, E.

AU - Paquette, I.

AU - Pulskamp, S.

AU - Rich, M.

AU - Savitt, L.

AU - Shafi, M.

AU - Steele, S.

AU - Stein, S.

AU - Tolbert, M.

AU - Varma, M.

AU - Vogler, S.

AU - Vuong, T.

AU - Wells, K.

AU - Wexner, S.

AU - Wo, J.

AU - Wright, J.

AU - Wunderlich, C.

AU - Campbell, K.

AU - Lim, M.

AU - Moug, S.

AU - Oliphant, R.

AU - Labaka-Aretaga, I.

AU - Ballester, C.

AU - Belen-Bueno, A.

AU - Vaquer-Casas, G.

AU - Jerez, J.

AU - Castillo, J.

AU - Paniagua-Cayetano, G.

AU - Codina-Cazador, A.

AU - Blanco-Colino, R.

AU - de la Portilla, F.

AU - Pascual-Damieta, M.

AU - Enriquez-Navascuez, J. M.

AU - Martin-Fernández, M.

AU - Araujo-Ferreiro, M.

AU - Sanchez-García, C.

AU - Vico-García, E.

AU - Gallego-García, M.

AU - Jimenez, L. M.

AU - Martinez-Sanchez, C.

AU - Carrillo-Moreno, J.

AU - Muñoz, A.

AU - Ramirez, L.

AU - Vigorita, V.

AU - Adams, R.

AU - Cornish, J.

AU - Davies, M.

AU - Evans, M.

AU - Torkington, J.

AU - Turner, J.

N1 - This article is being published concurrently in Diseases of the Colon & Rectum, Colorectal Disease and ANZ Journal of Surgery. The articles are identical exceptfor minor stylistic and spelling differences in keeping with each journal’s style. Citation from any of the three journals can be used when citing this article.

PY - 2020/3/1

Y1 - 2020/3/1

N2 - 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.

AB - 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.

KW - Consensus definition

KW - low anterior resection syndrome

KW - patient-reported

KW - rectal resection

UR - http://www.scopus.com/inward/record.url?scp=85079525806&partnerID=8YFLogxK

U2 - 10.1111/codi.14957

DO - 10.1111/codi.14957

M3 - Article

C2 - 32032141

AN - SCOPUS:85079525806

VL - 22

SP - 331

EP - 341

JO - Colorectal Disease

JF - Colorectal Disease

SN - 1462-8910

IS - 3

ER -

International consensus definition of low anterior resection syndrome

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