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.

中文翻译：

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用于预测修复性直肠癌切除术后肠功能障碍的列线图和在线工具的开发和外部验证：POLARS 评分

目的 恢复性直肠癌切除术后肠功能障碍很常见，但症状严重程度和生活质量受损程度差异很大。一项国际验证的患者报告结果指标，即低前路切除综合征 (LARS) 评分，现在可以测量这些症状。研究目的是：（1）开发预测术后肠功能的模型；(2) 外部验证模型和 (3) 将这些发现合并到列线图和在线工具中，以便个性化患者咨询并帮助术前同意。设计 治愈性修复性前切除术后 1 年以上的患者（英国，中位 54 个月；丹麦 (DK)，手术后 56 个月）受邀完成欧洲癌症研究和治疗组织生活质量问卷 - 核心 30 版本 3（EORTC QLQ-C30 v3）、LARS 和 Wexner 失禁评分。记录人口统计学、肿瘤特征、术前/术后治疗和手术程序。使用针对个体预后或诊断 (TRIPOD) 指南的多变量预测模型的透明报告，通过先进的线性回归收缩技术对每个数据集 (UK:DK) 独立评估肠功能障碍的风险因素。结果 开发（英国，n=463）和验证（DK，n=938）数据集中的患者报告的平均 (SD) LARS 分数分别为 26 (11) 和 24 (11)。LARS 的关键预测因素是：年龄（手术时）；肿瘤高度，完全与部分直肠系膜切除、造口和术前放疗的对比，模型校准令人满意，Mallow's Cp 分别为 7.5 和 5.5。结论 术前 LARS 评分 (POLARS) 是第一个预测前切除术前肠功能障碍严重程度的列线图和在线工具。结直肠外科医生、胃肠病学家和护士专家可能会使用 POLARS 来帮助患者了解其肠道功能障碍的风险，并在术前突出显示可能需要额外术后支持的患者。