Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2025; 17(1): 100910
Published online Jan 27, 2025. doi: 10.4240/wjgs.v17.i1.100910
Evaluation of surgical strategy for low anterior resection syndrome using preoperative low anterior resection syndrome score in China
Yang-Tao Pan, Yi-Min Lv, Shi-Chao Zhou, Dan-Yan Luo, Hao Sun, Wei-Feng Lao, Wei Zhou
Yang-Tao Pan, Yi-Min Lv, Wei-Feng Lao, Wei Zhou, Department of Colorectal Surgery, Sir Run Shaw Hospital Affiliated with Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Shi-Chao Zhou, School of Mathematics, Nanjing Audit University, Nanjing 211815, Jiangsu Province, China
Dan-Yan Luo, Department of Surgery, Zhejiang Hospital of Traditional Chinese Medicine (Zhejiang University of Traditional Chinese Medicine First Affiliated Hospital), Hangzhou 310000, Zhejiang Province, China
Hao Sun, NBU Health Science Center, Ningbo University, Ningbo 315000, Zhejiang Province, China
Co-first authors: Yang-Tao Pan and Yi-Min Lv.
Co-corresponding authors: Wei-Feng Lao and Wei Zhou.
Author contributions: Pan YT and Lv YM drafted the manuscript; Zhou SC was responsible for data analysis; Luo DY and Sun H were in charge of data collection; Lao WF and Zhou W provided critical revisions and insights; All authors significantly contributed to the design, execution, and analysis of the research study and have approved the final version of the manuscript for submission. Pan YT and Lv YM contributed equally to this work as co-first authors. First and foremost, Lao WF has been instrumental in the development of this project. He provided essential financial support and diligently monitored its progress throughout. Additionally, he conducted the final review of the manuscript, ensuring its quality and integrity. In light of these significant contributions, we believe it is appropriate for Lao WF to be recognized as the primary corresponding author for this work. On the other hand, Zhou W has effectively orchestrated interdisciplinary collaborations with colleagues, including Zhou SC. His insightful revisions and preliminary assessments of the draft were crucial in enhancing the quality of the manuscript. Consequently, all authors have unanimously agreed on Zhou W’s designation as a co-corresponding author.
Supported by the Natural Science Foundation of Jiangsu Higher Education Institutions, No. 22KJB510027; and the Project of the State Administration of Traditional Chinese Medicine of China, No. GZY-ZJ-KJ-24031.
Institutional review board statement: The research protocol was reviewed and approved by the Ethical Committee of Sir Run Shaw Hospital, Zhejiang University School of Medicine (No. 20210607-31).
Informed consent statement: This study primarily involves follow-up through phone messages and questionnaires on Wenjuanxing. Participants have been informed about the potential use of questionnaire data for scientific research and the measures in place to protect their privacy. An exemption for informed consent has been applied for, and the relevant documentation has been provided.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: All datasets generated and/or analyzed during the current study are available upon reasonable request to the corresponding author, Wei-Feng Lao, at laowf@zju.edu.cn.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Feng Lao, MD, Doctor, Surgical Oncologist, Teacher, Department of Colorectal Surgery, Sir Run Shaw Hospital Affiliated with Zhejiang University, No. 3 Qinchun Road, Hangzhou 310016, Zhejiang Province, China. laowf@zju.edu.cn
Received: August 30, 2024
Revised: October 3, 2024
Accepted: October 22, 2024
Published online: January 27, 2025
Processing time: 119 Days and 7.1 Hours
Abstract
BACKGROUND

Despite improved survival rates in rectal cancer treatment, many patients experience low anterior resection syndrome (LARS). The preoperative LARS score (POLARS) aims to address the limitations of LARS assessment by predicting outcomes preoperatively to enhance surgical planning.

AIM

To investigate the predictive accuracy of POLARS in assessing the occurrence of LARS.

METHODS

This study enrolled a total of 335 patients who underwent laparoscopic or robotic low anal sphincter-preserving surgery for rectal tumors. Patients were categorized into three groups according to their POLARS score: no LARS (score 0-20), minor LARS (score 21-29), and major LARS (score 30-42). The QLQ-C30/CR29 scores were compared among these groups, and the agreement between POLARS predictions and the actual LARS scores was analyzed.

RESULTS

The study population was divided into three groups: major LARS (n = 51, 27.42%), minor LARS (n = 109, 58.6%), and no LARS (n = 26, 13.98%). Significant differences in the QLQ-C30 scales of social function, diarrhea, and financial impact were detected between the no LARS and major LARS groups (P < 0.05) and between the minor LARS and major LARS groups (P < 0.05). Similarly, significant differences were detected in the QLQ-CR29 scales for blood and mucus in the stool, fecal incontinence, and stool frequency between the no LARS and minor LARS groups (P < 0.05), as well as between the minor LARS and major LARS groups (P < 0.05). The predictive precision for major LARS using the POLARS score was 82.35% (42/51), with a recall of 35.89% (42/117). The mean absolute error (MAE) between the POLARS score and the actual LARS score was 8.92 ± 5.47. In contrast, the XGBoost (extreme gradient boosting) model achieved a lower MAE of 6.29 ± 4.77, with a precision of 84.39% and a recall of 74.05% for predicting major LARS.

CONCLUSION

The POLARS score demonstrated effectiveness and precision in predicting major LARS, thereby providing valuable insights into postoperative symptoms and patient quality of life. However, the XGBoost model exhibited superior performance with a lower MAE and higher recall for predicting major LARS compared to the POLARS model.

Keywords: Low anterior resection syndrome; Preoperative assessment; Predictive Accuracy; Quality of life; Machine learning

Core Tip: The study evaluated the predictive accuracy of the preoperative low anterior resection syndrome score (POLARS) in predicting low anterior resection syndrome (LARS) among 335 patients. Patients were categorized into no LARS, minor LARS, and major LARS groups based on their POLARS scores. Significant differences in the quality of life metrics were identified between the groups. While POLARS effectively predicted major LARS with an 82.35% precision and a mean absolute error (MAE) of 8.92, the XGBoost model outperformed it with an MAE of 6.29 and better recall, highlighting its superior predictive capabilities.