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Bowel dysfunction is common following a restorative rectal cancer resection, but symptom severity and the degree of quality of life impairment is highly variable.
Dr Brendan Moran and colleagues from the United Kingdom found that an internationally validated patient-reported outcome measure, Low Anterior Resection Syndrome score, now enables these symptoms to be measured.
The team developed a model that predicts postoperative bowel function. The researchers externally validated the model and incorporate these findings into a nomogram and online tool in order to individualize patient counselling and aid preoperative consent.
Patients more than 1 year after curative restorative anterior resection were invited to complete The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 version3, Low Anterior Resection Syndrome and Wexner incontinence scores.
Demographics, tumor characteristics, preoperative/postoperative treatment and surgical procedures were recorded.
Using transparent reporting of a multivariable prediction model for individual prognosis or diagnosis guidelines, risk factors for bowel dysfunction were independently assessed by advanced linear regression shrinkage techniques for each dataset.
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| Age was a key predictive factor for Low Anterior Resection Syndrome |
| Gut |
The team found that patients in the development and validation datasets reported mean, Low Anterior Resection Syndrome scores of 26 and 24, respectively.
Key predictive factors for Low Anterior Resection Syndrome were: age; tumor 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.
Dr Moran's team concluded, "The Pre-Operative Low Anterior Resection Syndrome score is the first nomogram and online tool to predict bowel dysfunction severity prior to anterior resection."
"Colorectal surgeons, gastroenterologist and nurse specialists may use the Pre-Operative Low Anterior Resection Syndrome score to help patients understand their risk of bowel dysfunction and to preoperatively highlight patients who may require additional postoperative support."
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