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

TY - JOUR

T1 - Development and external validation of a nomogram and online tool to predict bowel dysfunction following restorative rectal cancer resection

T2 - the POLARS score

AU - Battersby, Nick J

AU - Bouliotis, George

AU - Emmertsen, Katrine J

AU - Juul, Therese

AU - Glynne-Jones, Rob

AU - Branagan, Graham

AU - Christensen, Peter

AU - Laurberg, Søren

AU - Moran, Brendan J

AU - UK and Danish LARS Study Groups

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

PY - 2018/4

Y1 - 2018/4

N2 - OBJECTIVE: Bowel dysfunction is common following a restorative rectal cancer resection, but symptom severity and the degree of quality of life impairment is highly variable. An internationally validated patient-reported outcome measure, Low Anterior Resection Syndrome (LARS) score, now enables these symptoms to be measured. The study purpose was: (1) to develop a model that predicts postoperative bowel function; (2) externally validate the model and (3) incorporate these findings into a nomogram and online tool in order to individualise patient counselling and aid preoperative consent.DESIGN: Patients more than 1 year after curative restorative anterior resection (UK, median 54 months; Denmark (DK), 56 months since surgery) were invited to complete The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 version3 (EORTC QLQ-C30 v3), LARS and Wexner incontinence scores. Demographics, tumour characteristics, preoperative/postoperative treatment and surgical procedures were recorded. Using transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) guidelines, risk factors for bowel dysfunction were independently assessed by advanced linear regression shrinkage techniques for each dataset (UK:DK).RESULTS: Patients in the development (UK, n=463) and validation (DK, n=938) datasets reported mean (SD) LARS scores of 26 (11) and 24 (11), respectively. Key predictive factors for LARS were: age (at surgery); tumour height, total versus partial mesorectal excision, stoma and preoperative radiotherapy, with satisfactory model calibration and a Mallow's Cp of 7.5 and 5.5, respectively.CONCLUSIONS: The Pre-Operative LARS score (POLARS) is the first nomogram and online tool to predict bowel dysfunction severity prior to anterior resection. Colorectal surgeons, gastroenterologist and nurse specialists may use POLARS to help patients understand their risk of bowel dysfunction and to preoperatively highlight patients who may require additional postoperative support.

AB - OBJECTIVE: Bowel dysfunction is common following a restorative rectal cancer resection, but symptom severity and the degree of quality of life impairment is highly variable. An internationally validated patient-reported outcome measure, Low Anterior Resection Syndrome (LARS) score, now enables these symptoms to be measured. The study purpose was: (1) to develop a model that predicts postoperative bowel function; (2) externally validate the model and (3) incorporate these findings into a nomogram and online tool in order to individualise patient counselling and aid preoperative consent.DESIGN: Patients more than 1 year after curative restorative anterior resection (UK, median 54 months; Denmark (DK), 56 months since surgery) were invited to complete The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 version3 (EORTC QLQ-C30 v3), LARS and Wexner incontinence scores. Demographics, tumour characteristics, preoperative/postoperative treatment and surgical procedures were recorded. Using transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) guidelines, risk factors for bowel dysfunction were independently assessed by advanced linear regression shrinkage techniques for each dataset (UK:DK).RESULTS: Patients in the development (UK, n=463) and validation (DK, n=938) datasets reported mean (SD) LARS scores of 26 (11) and 24 (11), respectively. Key predictive factors for LARS were: age (at surgery); tumour height, total versus partial mesorectal excision, stoma and preoperative radiotherapy, with satisfactory model calibration and a Mallow's Cp of 7.5 and 5.5, respectively.CONCLUSIONS: The Pre-Operative LARS score (POLARS) is the first nomogram and online tool to predict bowel dysfunction severity prior to anterior resection. Colorectal surgeons, gastroenterologist and nurse specialists may use POLARS to help patients understand their risk of bowel dysfunction and to preoperatively highlight patients who may require additional postoperative support.

KW - ABDOMINOPERINEAL EXCISION

KW - COLORECTAL-CANCER

KW - DIVERSION COLITIS

KW - FECAL INCONTINENCE

KW - INTERSPHINCTERIC RESECTION

KW - LOW ANTERIOR RESECTION

KW - QUALITY-OF-LIFE

KW - SACRAL NERVE-STIMULATION

KW - SURGERY

KW - TERM OUTCOMES

KW - Humans

KW - Middle Aged

KW - Male

KW - Colectomy/methods

KW - Online Systems

KW - Recovery of Function

KW - Nomograms

KW - Aged, 80 and over

KW - Adult

KW - Female

KW - Surveys and Questionnaires

KW - Retrospective Studies

KW - Defecation

KW - Rectal Neoplasms/pathology

KW - Reproducibility of Results

KW - Treatment Outcome

KW - United Kingdom

KW - Denmark

KW - Quality of Life

KW - Aged

U2 - 10.1136/gutjnl-2016-312695

DO - 10.1136/gutjnl-2016-312695

M3 - Journal article

C2 - 28115491

SN - 0017-5749

VL - 67

SP - 688

EP - 696

JO - Gut

JF - Gut

IS - 4

ER -