Low Anterior Resection Syndrome (Celia Keane/Ian Bissett)


Project name:
LARS international consensus definition and severity scoring tool 

Full title of study: International consensus definition and new severity scoring tool for low anterior resection syndrome (LARS)

Lead investigators:

  • Celia Keane, Ian Bissett, Kirsty Wing, NZ
  • Nicola Fearnhead, Azmina Rose, UK
  • Liliana Bordeianou, Craig Messick, Guy Orangio, Anders Mellgren, USA
  • Peter Christensen, Soren Laurberg, Denmark
  • Eloy Espin Basany, Spain


The LARS International Collaborative Group: V. An, A. Bryant, C. Byrne, T. Chen, D. Clark, S. Croft, P. Dinning, M. Gladman, A. Heriot, S. Kariappa, J. Keck, D. Lubowski, A. Khera, K. Kirkwood, D. Petersen, K. Sloots, B. Totten, M. Weston (Australia); P. Andersen, C. Bachmann, H. Barht, K. Emmertsen, P. Faaborg, I. Gögenur, P. Ingerslev, D. Isaksen, H. Iversen, L. Iversen, K. Jacobsen, T. Jansen, I. Jocobsen, T. Juul, D. Kjær, K. Krogh, M. Majgaard, A. Mynster, A. Neuenschwander, C. Nielsen, M. Nielsen, R. Nielsen, T. Nielsen, J. Olsen, B. Poulsen, H. Rahr, B. Snedker, G. Sørensen, T. Stolzenburg, P. Vaabengaard (Denmark); A. Acheson, J. Andreyev, S. Bach, N. Battersby, J. Bradbury, S. Brown, T. Cecil, M. Chapman, S. Chapman, H. Chave, T. Cook, L. Cuffy, J. Davies, C. Dawson, J. Dixon, S. Duff, C. Edwards, I. Geh, C. Hamilton, L. Hancock, D. Harji, J. Hill, S. Holtham, J. Jenkins, R. Johnston, S. Kapur, C. Maxwell‐Armstrong, D. McArthur, B. Moran, C. Norton, K. Nugent, L. Pateman, Y. Perston, T. Rockall, P. Sagar, M. Saunders, D. Sebag‐Montefiore, A. Senapati, B. Singh, P. Skaife, N. Smart, H. Sykes, C. Taylor, G. Thorpe, G. Tierney, S. Voyce, C. Walsh, O. Warren, J. Wheeler, A. Woodward (England); D. Winter (Ireland); S. Abbott, V. Beban, M. Bennett, T. Chadwick, R. Collinson, S. Corbett, E. Dennett, T. Eglinton, A. Fraser, J. Glue, D. Hohaia, E. Menzi, M. O’Connor, D. Stevenson, C. Wells, S. Wolyncewicz, J. Woodfield (New Zealand); K. Bence, M. Boutros, M. Brueseke, J. DeKorte, C. Floruta, T. Francone, F. Frederick, J. Grasso, B. Gurland, K. Higgins, T. Hull, D. Keller, A. Laffan, S. Lovett, J. Marlatt, D. McAdams, C. McCarthy, H. Milch, S. Natale, E. Pappou, I. Paquette, S. Pulskamp, M. Rich, L. Savitt, M. Shafi, S. Steele, S. Stein, M. Tolbert, M. Varma, S. Vogler, T. Vuong, K. Wells, S. Wexner, J. Wo, J. Wright, C. Wunderlich (North America); K. Campbell, M. Lim, S. Moug, R. Oliphant (Scotland); M. Araujo‐Ferreiro, C. Ballester, A. Belen‐Bueno, R. Blanco‐Colino, J. Carrillo‐Moreno, J. Castillo, A. Codina‐Cazador, J. M. Enriquez‐Navascuez, M. Gallego‐García, J. Jerez, L. M. Jimenez, I. Labaka‐Aretaga, M. Martin‐Fernández, C. Martinez‐Sanchez, A. Muñoz, G. Paniagua‐Cayetano, M. Pascual‐Damieta, F. de la Portilla, L. Ramirez, C. Sanchez‐García, G. Vaquer‐Casas, E. Vico‐García, V. Vigorita (Spain); R. Adams, J. Cornish, M. Davies, M. Evans, J. Torkington, J. Turner (Wales).


  • The Bowel Disease Research Foundation (BDRF), UK
  • Association of Coloproctology of Great Britain and Ireland (ACPGBI)
  • Royal Society of Medicine (RSM) Section of Coloproctology
  • Colorectal Surgical Society of Australia and New Zealand (CSSANZ)
  • Colon and Rectal Surgery Section of the Royal Australasian College of Surgeons (RACS) 
  • European Society of Coloproctology (ESCP)
  • American Society of Colon and Rectal Surgeons (ASCRS)

Contact email: i.bissett@auckland.ac.nz

Permission to include project and contact email on Tripartite 2022 website: yes

Short update on progress so far:

An international consensus definition of LARS was produced with a 3-phase methodology that included an online Delphi survey, regional patient consultation meetings, and a face to face patient-provider consensus meeting. The definition includes 8 symptom complexes and 8 consequences of these symptoms.

This is the first phase in a wider international collaborative to develop a new tool which will more accurately measure the patient experience of LARS and will be responsive to changes over time and with intervention. The next step in development of this tool - transformation of the definition into questions - has begun but the timelines have lengthened due to the COVID-19 pandemic. The transformation phase will be an iterative process that involves developing the questions and response categories necessary to adequately assess the severity of LARS. Once this step has been validated in a research population, the tool will be translated across a wide range of languages followed by an opportunity for engagement with the wider academic surgical community to validate the tool across a broad international population and over time in longitudinal cohort studies. 

Funding bodies to be acknowledged:

  • Sir Douglas Robb Memorial Fund, NZ
  • Bowel Disease Research Foundation (BDRF) 
  • ESCP
  • Danish Cancer Society
  • Auckland Medical Research Foundation

Published simultaneously in three Tripartite journals:

International consensus definition of low anterior resection syndrome.
Keane C, Fearnhead NS, Bordeianou L, Christensen P, Espin Basany E, Laurberg S, Mellgren A, Messick C, Orangio GR, Verjee A, Wing K, Bissett I; LARS International Collaborative Group.
Colorectal Dis. 2020 Mar;22(3):331-341.


International consensus definition of low anterior resection syndrome.

Keane C, Fearnhead NS, Bordeianou LG, Christensen P, Espin Basany E, Laurberg S, Mellgren A, Messick C, Orangio GR, Verjee A, Wing K, Bissett IP; LARS International Collaborative Group.
ANZ J Surg. 2020 Mar;90(3):300-307.


International Consensus Definition of Low Anterior Resection Syndrome.

Keane C, Fearnhead NS, Bordeianou LG, Christensen P, Basany EE, Laurberg S, Mellgren A, Messick C, Orangio GR, Verjee A, Wing K, Bissett I; LARS International Collaborative Group.
Dis Colon Rectum. 2020 Mar;63(3):274-284.

Awarded Robert W. Beart, MD, Impact Paper of the Year Award 2020 by DCR

Phase 2: Peter Christensen (Aarhus) now leading on development of scoring system.


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