Risk prediction models for the occurrence of low anterior resection syndrome in patients with rectal cancer after surgery: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

HU Jinrui ¹ , ZHAO Hong ² , PENG Yuqi ¹ , HE Yiqing ¹ ,  XIE Lunfang ¹

1. School of Nursing, Anhui Medical University, Hefei 230601, P. R. China;
2. Department of Outpatient, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, P. R. China;

Corresponding?author：

XIE Lunfang, Email: 527548725@qq.com

Keywords：

Rectal neoplasms; Low anterior resection syndrome; Risk; Prediction model; Systematic review

DOI：

10.7507/1672-2531.202306144

Video：

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Objective To systematically review the risk prediction models for the occurrence of low anterior resection syndrome in patients with rectal cancer after surgery. Methods The PubMed, Web of Science, Embase, Cochrane Library, Scopus, CINHAL, CNKI, CBM, WanFang Data and VIP databases were electronically searched to collect studies related to the objectives from inception to June 13, 2023. Two reviewers independently screened the literature, extracted data using the critical appraisal and data extraction for systematic reviews of prediction modelling studies (CHARMS) checklist, and assessed quality of the included studies using prediction model risk of bias assessment tool (PROBAST). Results A total of 14 studies were included, all studies reported model discrimination, and 10 studies reported calibration. The models were internally validated in 8 studies, externally validated in 5 studies. The most common predictors included in the models were tumour distance from the anal verge, neoadjuvant therapy, anastomotic leak and BMI. Only 5 studies had good overall applicability, and all studies had a high risk of bias, with the risk of bias mainly stemming from the field of participants, outcomes and analysis. Conclusion There are still many shortcomings in the risk prediction models for the occurrence of low anterior resection syndrome in patients with rectal cancer after surgery. Future studies may consider external validation and recalibration of existing models. New prediction models should be built and validated according to methodological guidelines.

Citation： HU Jinrui, ZHAO Hong, PENG Yuqi, HE Yiqing, XIE Lunfang. Risk prediction models for the occurrence of low anterior resection syndrome in patients with rectal cancer after surgery: a systematic review. Chinese Journal of Evidence-Based Medicine, 2024, 24(3): 295-302. doi: 10.7507/1672-2531.202306144 Copy

1.	Keane C, Fearnhead NS, Bordeianou L, et al. International consensus definition of low anterior resection syndrome. Colorectal Dis, 2020, 22(3): 331-341.
2.	Croese AD, Lonie JM, Trollope AF, et al. A meta-analysis of the prevalence of low anterior resection syndrome and systematic review of risk factors. Int J Surg, 2018, 56: 234-241.
3.	Garfinkle R, Boutros M. Low anterior resection syndrome: predisposing factors and treatment. Surg Oncol, 2022, 43: 101691.
4.	夏賓松. 老年患者腹腔鏡低位直腸癌根治術行回腸末端預防性造口的安全性和有效性分析. 南昌: 南昌大學, 2022.
5.	Pape E, Pattyn P, Van Hecke A, et al. Impact of low anterior resection syndrome (LARS) on the quality of life and treatment options of LARS - a cross sectional study. Eur J Oncol Nurs, 2021, 50: 101878.
6.	Christensen P, Im Baeten C, Espín-Basany E, et al. Management guidelines for low anterior resection syndrome - the MANUEL project. Colorectal Dis, 2021, 23(2): 461-475.
7.	張蕊, 鄭黎強, 潘國偉. 疾病發病風險預測模型的應用與建立. 中國衛生統計, 2015, 32(4): 724-726.
8.	Moons KG, de Groot JA, Bouwmeester W, et al. Critical appraisal and data extraction for systematic reviews of prediction modelling studies: the CHARMS checklist. PLoS Med, 2014, 11(10): e1001744.
9.	Wolff RF, Moons KGM, Riley RD, et al. PROBAST: a tool to assess the risk of bias and applicability of prediction model studies. Ann Intern Med, 2019, 170(1): 51-58.
10.	Battersby NJ, Bouliotis G, Emmertsen KJ, et al. Development and external validation of a nomogram and online tool to predict bowel dysfunction following restorative rectal cancer resection: the POLARS score. Gut, 2018, 67(4): 688-696.
11.	趙海蓉, 張連香, 張志琴. 直腸癌保肛術后低位前切除綜合征風險的危險因素研究. 結直腸肛門外科, 2018, 24(5): 441-445.
12.	王珂, 張波, 楊瑩, 等. 低位直腸癌保肛術后LARS風險的預測模型建立及分析. 現代消化及介入診療, 2019, 24(12): 1449-1452.
13.	鄭利. 老年直腸癌保肛術后出現低位前切除綜合征風險預測模型的建立. 中國療養醫學, 2020, 29(11): 1131-1133.
14.	岳中屹, 李秀庚, 張敏, 等. 建立預測直腸癌術后前切除綜合征的列線圖模型. 現代腫瘤醫學, 2021, 29(23): 4141-4145.
15.	張峻嶺, 董潔晶, 吳濤, 等. 直腸癌保肛根治術后低位前切除綜合征危險因素的列線圖分析. 中華普通外科雜志, 2021, 36(2): 81-85.
16.	卜旻淳, 曹先東, 周波. 直腸癌保肛根治術后低位前切除綜合征危險因素分析及列線圖預測模型構建. 安徽醫科大學學報, 2021, 56(10): 1632-1636.
17.	張登云, 高玉熙, 張凱, 等. 直腸LARS危險因素分析及風險預測模型構建. 青島大學學報(醫學版), 2022, 58(6): 812-817.
18.	Yan M, Lin Z, Wu Z, et al. A predictive nomogram model for low anterior resection syndrome after rectal cancer resection. ANZ J Surg, 2022, 92(12): 3224-3231.
19.	Paku M, Miyoshi N, Fujino S, et al. Development and evaluation of a Japanese prediction model for low anterior resection syndrome after rectal cancer surgery. BMC Gastroenterol, 2022, 22(1): 239.
20.	Zhang XY, Liu XZ, Li XT, et al. MRI measurements predict major low anterior resection syndrome in rectal cancer patients. Int J Colorectal Dis, 2022, 37(6): 1239-1249.
21.	龐雪瀅, 胡少華, 李慧, 等. 直腸癌患者保肛術1年后發生重度低位前切除綜合征列線圖預測模型的構建. 護理學報, 2022, 29(11): 5-10.
22.	Xia F, Zou Y, Zhang Q, et al. A novel nomogram to predict low anterior resection syndrome (LARS) after ileostomy reversal for rectal cancer patients. Eur J Surg Oncol, 2023, 49(2): 452-460.
23.	Wang Z, Shao SL, Liu L, et al. Machine learning model for prediction of low anterior resection syndrome following laparoscopic anterior resection of rectal cancer: a multicenter study. World J Gastroenterol, 2023, 29(19): 2979-2991.
24.	Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg, 2012, 255(5): 922-928.
25.	Moons KGM, Wolff RF, Riley RD, et al. PROBAST: a tool to assess risk of bias and applicability of prediction model studies: explanation and elaboration. Ann Intern Med, 2019, 170(1): W1-W33.
26.	Keane C, Wells C, O'Grady G, et al. Defining low anterior resection syndrome: a systematic review of the literature. Colorectal Dis, 2017, 19(8): 713-722.
27.	Collins GS, Ogundimu EO, Cook JA, et al. Quantifying the impact of different approaches for handling continuous predictors on the performance of a prognostic model. Stat Med, 2016, 35(23): 4124-4135.
28.	Sterne JA, White IR, Carlin JB, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ, 2009, 338: b2393.
29.	谷鴻秋, 王俊峰, 章仲恒, 等. 臨床預測模型: 模型的建立. 中國循證心血管醫學雜志, 2019, 11(1): 14-16, 23.
30.	王俊峰, 章仲恒, 周支瑞, 等. 臨床預測模型: 模型的驗證. 中國循證心血管醫學雜志, 2019, 11(2): 141-144.
31.	Royston P, Moons KG, Altman DG, et al. Prognosis and prognostic research: developing a prognostic model. BMJ, 2009, 338: b604.
32.	Collins GS, Reitsma JB, Altman DG, et al. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BMJ, 2015, 350: g7594.
33.	葛欣, 王錫山. 低位前切除綜合征研究進展. 中華胃腸外科雜志, 2011, 14(12): 994-998.
34.	Hain E, Manceau G, Maggiori L, et al. Bowel dysfunction after anastomotic leakage in laparoscopic sphincter-saving operative intervention for rectal cancer: a case-matched study in 46 patients using the low anterior resection score. Surgery, 2017, 161(4): 1028-1039.
35.	Bolton WS, Chapman SJ, Corrigan N, et al. The incidence of low anterior resection syndrome as assessed in an international randomized controlled trial (MRC/NIHR ROLARR). Ann Surg, 2021, 274(6): e1223-e1229.
36.	Rosen H, Sebesta CG, Sebesta C. Management of low anterior resection syndrome (LARS) following resection for rectal cancer. Cancers (Basel), 2023, 15(3): 778.

1. Keane C, Fearnhead NS, Bordeianou L, et al. International consensus definition of low anterior resection syndrome. Colorectal Dis, 2020, 22(3): 331-341.
2. Croese AD, Lonie JM, Trollope AF, et al. A meta-analysis of the prevalence of low anterior resection syndrome and systematic review of risk factors. Int J Surg, 2018, 56: 234-241.
3. Garfinkle R, Boutros M. Low anterior resection syndrome: predisposing factors and treatment. Surg Oncol, 2022, 43: 101691.
4. 夏賓松. 老年患者腹腔鏡低位直腸癌根治術行回腸末端預防性造口的安全性和有效性分析. 南昌: 南昌大學, 2022.
5. Pape E, Pattyn P, Van Hecke A, et al. Impact of low anterior resection syndrome (LARS) on the quality of life and treatment options of LARS - a cross sectional study. Eur J Oncol Nurs, 2021, 50: 101878.
6. Christensen P, Im Baeten C, Espín-Basany E, et al. Management guidelines for low anterior resection syndrome - the MANUEL project. Colorectal Dis, 2021, 23(2): 461-475.
7. 張蕊, 鄭黎強, 潘國偉. 疾病發病風險預測模型的應用與建立. 中國衛生統計, 2015, 32(4): 724-726.
8. Moons KG, de Groot JA, Bouwmeester W, et al. Critical appraisal and data extraction for systematic reviews of prediction modelling studies: the CHARMS checklist. PLoS Med, 2014, 11(10): e1001744.
9. Wolff RF, Moons KGM, Riley RD, et al. PROBAST: a tool to assess the risk of bias and applicability of prediction model studies. Ann Intern Med, 2019, 170(1): 51-58.
10. Battersby NJ, Bouliotis G, Emmertsen KJ, et al. Development and external validation of a nomogram and online tool to predict bowel dysfunction following restorative rectal cancer resection: the POLARS score. Gut, 2018, 67(4): 688-696.
11. 趙海蓉, 張連香, 張志琴. 直腸癌保肛術后低位前切除綜合征風險的危險因素研究. 結直腸肛門外科, 2018, 24(5): 441-445.
12. 王珂, 張波, 楊瑩, 等. 低位直腸癌保肛術后LARS風險的預測模型建立及分析. 現代消化及介入診療, 2019, 24(12): 1449-1452.
13. 鄭利. 老年直腸癌保肛術后出現低位前切除綜合征風險預測模型的建立. 中國療養醫學, 2020, 29(11): 1131-1133.
14. 岳中屹, 李秀庚, 張敏, 等. 建立預測直腸癌術后前切除綜合征的列線圖模型. 現代腫瘤醫學, 2021, 29(23): 4141-4145.
15. 張峻嶺, 董潔晶, 吳濤, 等. 直腸癌保肛根治術后低位前切除綜合征危險因素的列線圖分析. 中華普通外科雜志, 2021, 36(2): 81-85.
16. 卜旻淳, 曹先東, 周波. 直腸癌保肛根治術后低位前切除綜合征危險因素分析及列線圖預測模型構建. 安徽醫科大學學報, 2021, 56(10): 1632-1636.
17. 張登云, 高玉熙, 張凱, 等. 直腸LARS危險因素分析及風險預測模型構建. 青島大學學報(醫學版), 2022, 58(6): 812-817.
18. Yan M, Lin Z, Wu Z, et al. A predictive nomogram model for low anterior resection syndrome after rectal cancer resection. ANZ J Surg, 2022, 92(12): 3224-3231.
19. Paku M, Miyoshi N, Fujino S, et al. Development and evaluation of a Japanese prediction model for low anterior resection syndrome after rectal cancer surgery. BMC Gastroenterol, 2022, 22(1): 239.
20. Zhang XY, Liu XZ, Li XT, et al. MRI measurements predict major low anterior resection syndrome in rectal cancer patients. Int J Colorectal Dis, 2022, 37(6): 1239-1249.
21. 龐雪瀅, 胡少華, 李慧, 等. 直腸癌患者保肛術1年后發生重度低位前切除綜合征列線圖預測模型的構建. 護理學報, 2022, 29(11): 5-10.
22. Xia F, Zou Y, Zhang Q, et al. A novel nomogram to predict low anterior resection syndrome (LARS) after ileostomy reversal for rectal cancer patients. Eur J Surg Oncol, 2023, 49(2): 452-460.
23. Wang Z, Shao SL, Liu L, et al. Machine learning model for prediction of low anterior resection syndrome following laparoscopic anterior resection of rectal cancer: a multicenter study. World J Gastroenterol, 2023, 29(19): 2979-2991.
24. Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg, 2012, 255(5): 922-928.
25. Moons KGM, Wolff RF, Riley RD, et al. PROBAST: a tool to assess risk of bias and applicability of prediction model studies: explanation and elaboration. Ann Intern Med, 2019, 170(1): W1-W33.
26. Keane C, Wells C, O'Grady G, et al. Defining low anterior resection syndrome: a systematic review of the literature. Colorectal Dis, 2017, 19(8): 713-722.
27. Collins GS, Ogundimu EO, Cook JA, et al. Quantifying the impact of different approaches for handling continuous predictors on the performance of a prognostic model. Stat Med, 2016, 35(23): 4124-4135.
28. Sterne JA, White IR, Carlin JB, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ, 2009, 338: b2393.
29. 谷鴻秋, 王俊峰, 章仲恒, 等. 臨床預測模型: 模型的建立. 中國循證心血管醫學雜志, 2019, 11(1): 14-16, 23.
30. 王俊峰, 章仲恒, 周支瑞, 等. 臨床預測模型: 模型的驗證. 中國循證心血管醫學雜志, 2019, 11(2): 141-144.
31. Royston P, Moons KG, Altman DG, et al. Prognosis and prognostic research: developing a prognostic model. BMJ, 2009, 338: b604.
32. Collins GS, Reitsma JB, Altman DG, et al. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BMJ, 2015, 350: g7594.
33. 葛欣, 王錫山. 低位前切除綜合征研究進展. 中華胃腸外科雜志, 2011, 14(12): 994-998.
34. Hain E, Manceau G, Maggiori L, et al. Bowel dysfunction after anastomotic leakage in laparoscopic sphincter-saving operative intervention for rectal cancer: a case-matched study in 46 patients using the low anterior resection score. Surgery, 2017, 161(4): 1028-1039.
35. Bolton WS, Chapman SJ, Corrigan N, et al. The incidence of low anterior resection syndrome as assessed in an international randomized controlled trial (MRC/NIHR ROLARR). Ann Surg, 2021, 274(6): e1223-e1229.
36. Rosen H, Sebesta CG, Sebesta C. Management of low anterior resection syndrome (LARS) following resection for rectal cancer. Cancers (Basel), 2023, 15(3): 778.

Chinese Journal of Evidence-Based Medicine

Risk prediction models for the occurrence of low anterior resection syndrome in patients with rectal cancer after surgery: a systematic review

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