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.	夏宾松. 老年患者腹腔镜低位直肠癌根治术行回肠末端预防性造口的安全性和有效性分析. 南昌: 南昌大学, 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.	张蕊, 郑黎强, 潘国伟. 疾病发病风险预测模型的应用与建立. 中国卫生统计, 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.	赵海蓉, 张连香, 张志琴. 直肠癌保肛术后低位前切除综合征风险的危险因素研究. 结直肠肛门外科, 2018, 24(5): 441-445.
12.	王珂, 张波, 杨莹, 等. 低位直肠癌保肛术后LARS风险的预测模型建立及分析. 现代消化及介入诊疗, 2019, 24(12): 1449-1452.
13.	郑利. 老年直肠癌保肛术后出现低位前切除综合征风险预测模型的建立. 中国疗养医学, 2020, 29(11): 1131-1133.
14.	岳中屹, 李秀庚, 张敏, 等. 建立预测直肠癌术后前切除综合征的列线图模型. 现代肿瘤医学, 2021, 29(23): 4141-4145.
15.	张峻岭, 董洁晶, 吴涛, 等. 直肠癌保肛根治术后低位前切除综合征危险因素的列线图分析. 中华普通外科杂志, 2021, 36(2): 81-85.
16.	卜旻淳, 曹先东, 周波. 直肠癌保肛根治术后低位前切除综合征危险因素分析及列线图预测模型构建. 安徽医科大学学报, 2021, 56(10): 1632-1636.
17.	张登云, 高玉熙, 张凯, 等. 直肠LARS危险因素分析及风险预测模型构建. 青岛大学学报(医学版), 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.	庞雪滢, 胡少华, 李慧, 等. 直肠癌患者保肛术1年后发生重度低位前切除综合征列线图预测模型的构建. 护理学报, 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.	谷鸿秋, 王俊峰, 章仲恒, 等. 临床预测模型: 模型的建立. 中国循证心血管医学杂志, 2019, 11(1): 14-16, 23.
30.	王俊峰, 章仲恒, 周支瑞, 等. 临床预测模型: 模型的验证. 中国循证心血管医学杂志, 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, 王锡山. 低位前切除综合征研究进展. 中华胃肠外科杂志, 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. 夏宾松. 老年患者腹腔镜低位直肠癌根治术行回肠末端预防性造口的安全性和有效性分析. 南昌: 南昌大学, 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. 张蕊, 郑黎强, 潘国伟. 疾病发病风险预测模型的应用与建立. 中国卫生统计, 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. 赵海蓉, 张连香, 张志琴. 直肠癌保肛术后低位前切除综合征风险的危险因素研究. 结直肠肛门外科, 2018, 24(5): 441-445.
12. 王珂, 张波, 杨莹, 等. 低位直肠癌保肛术后LARS风险的预测模型建立及分析. 现代消化及介入诊疗, 2019, 24(12): 1449-1452.
13. 郑利. 老年直肠癌保肛术后出现低位前切除综合征风险预测模型的建立. 中国疗养医学, 2020, 29(11): 1131-1133.
14. 岳中屹, 李秀庚, 张敏, 等. 建立预测直肠癌术后前切除综合征的列线图模型. 现代肿瘤医学, 2021, 29(23): 4141-4145.
15. 张峻岭, 董洁晶, 吴涛, 等. 直肠癌保肛根治术后低位前切除综合征危险因素的列线图分析. 中华普通外科杂志, 2021, 36(2): 81-85.
16. 卜旻淳, 曹先东, 周波. 直肠癌保肛根治术后低位前切除综合征危险因素分析及列线图预测模型构建. 安徽医科大学学报, 2021, 56(10): 1632-1636.
17. 张登云, 高玉熙, 张凯, 等. 直肠LARS危险因素分析及风险预测模型构建. 青岛大学学报(医学版), 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. 庞雪滢, 胡少华, 李慧, 等. 直肠癌患者保肛术1年后发生重度低位前切除综合征列线图预测模型的构建. 护理学报, 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. 谷鸿秋, 王俊峰, 章仲恒, 等. 临床预测模型: 模型的建立. 中国循证心血管医学杂志, 2019, 11(1): 14-16, 23.
30. 王俊峰, 章仲恒, 周支瑞, 等. 临床预测模型: 模型的验证. 中国循证心血管医学杂志, 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, 王锡山. 低位前切除综合征研究进展. 中华胃肠外科杂志, 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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