{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T02:57:06Z","timestamp":1790650626963,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postoperative bowel dysfunction after sphincter\u2010preserving surgery for rectal cancer is heterogeneous and may not be fully captured by composite scores such as the low anterior resection syndrome (LARS) and Wexner scores. This study aimed to identify clinically relevant symptom domains and examine their associated clinical factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 320 patients who underwent low anterior resection with longitudinal bowel function assessment. Correlations among individual LARS and Wexner components were evaluated using Spearman's correlation and hierarchical clustering. Exploratory factor analysis using pooled postoperative observations was performed to identify latent symptom domains, and multivariable mixed\u2010effects models were used to examine associated clinical factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Correlation analysis demonstrated heterogeneous inter\u2010item relationships, and factor analysis identified three domains: incontinence, urgency\/clustering, and gas control. In multivariable analysis, greater incontinence severity was associated with age 50\u201370\u2009years, BMI \u2265\u200923, neoadjuvant chemotherapy, radiotherapy, very low anterior resection, and a transanal approach. Greater urgency\/clustering severity was associated with radiotherapy, whereas age \u2265\u200970\u2009years was associated with lower severity. Gas\u2010related symptoms may also represent a partially distinct domain. Postoperative time was a significant determinant of all three domains, with symptom severity remaining higher at 6, 12, and 24\u2009months than preoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Postoperative bowel dysfunction, as captured by the LARS and Wexner scores, appears to consist of multiple symptom domains with different clinical determinants. Patients with similar composite scores may have different symptom profiles requiring different management strategies. A domain\u2010based approach may support individualized functional assessment and treatment after rectal surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ags3.70289","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T02:01:22Z","timestamp":1790647282000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring Symptom Domains of Postoperative Bowel Dysfunction by Integrating\n                    <scp>LARS<\/scp>\n                    and Wexner Scores: A Longitudinal Factor\u2010Analytic Study"],"prefix":"10.1002","author":[{"given":"Yoshiko","family":"Matsumoto","sequence":"first","affiliation":[{"name":"Department of Gastroenterological Surgery Fukuoka University Hospital  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issei","family":"Takeshita","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Fukuoka University Hospital  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichi","family":"Shiokawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Fukuoka University Hospital  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurumi","family":"Sahara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Fukuoka University Hospital  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taro","family":"Munechika","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Fukuoka University Hospital  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6729-6040","authenticated-orcid":false,"given":"Ken","family":"Nagata","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Fukuoka University Hospital  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Nagano","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Fukuoka University Hospital  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Fukuoka University Hospital  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8641-8197","authenticated-orcid":false,"given":"Suguru","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Fukuoka University Hospital  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"issue":"3","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1097\/DCR.0000000000001583","article-title":"International Consensus Definition of Low Anterior Resection Syndrome","volume":"63","author":"Keane C.","year":"2020","journal-title":"Diseases of the Colon and Rectum"},{"issue":"8","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"2660","DOI":"10.1007\/s00268-018-4519-8","article-title":"Validation of the Japanese Version of the Low Anterior Resection Syndrome Score","volume":"42","author":"Akizuki E.","year":"2018","journal-title":"World Journal of Surgery"},{"issue":"5","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1097\/SLA.0b013e31824f1c21","article-title":"Low Anterior Resection Syndrome Score: Development and Validation of a Symptom\u2010Based Scoring System for Bowel Dysfunction After Low Anterior Resection for Rectal Cancer","volume":"255","author":"Emmertsen K. J.","year":"2012","journal-title":"Annals of Surgery"},{"issue":"1","key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/BF02050307","article-title":"Etiology and Management of Fecal Incontinence","volume":"36","author":"Jorge J. M.","year":"1993","journal-title":"Diseases of the Colon and Rectum"},{"issue":"1","key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.asjsur.2021.05.016","article-title":"Risk Factors of Postoperative Low Anterior Resection Syndrome for Colorectal Cancer: A Meta\u2010Analysis","volume":"45","author":"Ye L.","year":"2022","journal-title":"Asian Journal of Surgery"},{"issue":"8","key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"6059","DOI":"10.1007\/s00464-021-09002-y","article-title":"Risk Factors for Low Anterior Resection Syndrome (LARS) in Patients Undergoing Laparoscopic Surgery for Rectal Cancer","volume":"36","author":"Nicotera A.","year":"2022","journal-title":"Surgical Endoscopy"},{"issue":"1","key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1186\/s12876-022-02295-w","article-title":"Development and Evaluation of a Japanese Prediction Model for Low Anterior Resection Syndrome After Rectal Cancer Surgery","volume":"22","author":"Paku M.","year":"2022","journal-title":"BMC Gastroenterology"},{"issue":"7","key":"e_1_2_12_9_1","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1007\/s00595-023-02789-4","article-title":"Incidence and Risk Factors of Bowel Dysfunction After Minimally Invasive Rectal Cancer Surgery and Discrepancies Between the Wexner Score and the Low Anterior Resection Syndrome (LARS) Score","volume":"54","author":"Ota E.","year":"2024","journal-title":"Surgery Today"},{"issue":"1","key":"e_1_2_12_10_1","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1002\/ags3.12724","article-title":"Low Anterior Resection Syndrome: Incidence and Association With Quality of Life","volume":"8","author":"Homma Y.","year":"2024","journal-title":"Annals of Gastroenterological Surgery"},{"issue":"5","key":"e_1_2_12_11_1","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1007\/s00595-022-02598-1","article-title":"The Evaluation of Postoperative Bowel Dysfunction in Japanese Patients With Rectal Cancer","volume":"53","author":"Kiyozumi Y.","year":"2023","journal-title":"Surgery Today"},{"issue":"1","key":"e_1_2_12_12_1","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s00384-016-2659-6","article-title":"Long\u2010Term Functional Follow\u2010Up After Anterior Rectal Resection for Cancer","volume":"32","author":"Sturiale A.","year":"2017","journal-title":"International Journal of Colorectal Disease"},{"issue":"4","key":"e_1_2_12_13_1","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1136\/gutjnl-2016-312695","article-title":"Development and External Validation of a Nomogram and Online Tool to Predict Bowel Dysfunction Following Restorative Rectal Cancer Resection: The POLARS Score","volume":"67","author":"Battersby N. J.","year":"2018","journal-title":"Gut"},{"issue":"6","key":"e_1_2_12_14_1","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1007\/s00384-018-3006-x","article-title":"Outcome of Bowel Function Following Anterior Resection for Rectal Cancer\u2010An Analysis Using the Low Anterior Resection Syndrome (LARS) Score","volume":"33","author":"Kupsch J.","year":"2018","journal-title":"International Journal of Colorectal Disease"},{"issue":"5","key":"e_1_2_12_15_1","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1002\/ags3.12695","article-title":"Low Anterior Resection Syndrome","volume":"7","author":"Ryoo S. B.","year":"2023","journal-title":"Annals of Gastroenterological Surgery"},{"key":"e_1_2_12_16_1","first-page":"47","article-title":"Serotonin (5\u2010HT3) Receptor Antagonists for the Reduction of Symptoms of Low Anterior Resection Syndrome","volume":"7","author":"Itagaki R.","year":"2014","journal-title":"Clinical and Experimental Gastroenterology"},{"issue":"6","key":"e_1_2_12_17_1","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1093\/bjs\/znab071","article-title":"Anterior Resection Syndrome: A Randomized Clinical Trial of a 5\u2010HT3 Receptor Antagonist (Ramosetron) in Male Patients With Rectal Cancer","volume":"108","author":"Ryoo S. B.","year":"2021","journal-title":"British Journal of Surgery"},{"issue":"5","key":"e_1_2_12_18_1","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1097\/SLA.0000000000005632","article-title":"The Role of Pelvic Floor Muscle Training on Low Anterior Resection Syndrome: A Multicenter Randomized Controlled Trial","volume":"276","author":"Asnong A.","year":"2022","journal-title":"Annals of Surgery"},{"issue":"1","key":"e_1_2_12_19_1","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/SLA.0000000000005353","article-title":"Pelvic Floor Rehabilitation After Rectal Cancer Surgery: A Multicenter Randomized Clinical Trial (FORCE Trial)","volume":"276","author":"Heijden J. A. G.","year":"2022","journal-title":"Annals of Surgery"},{"issue":"5","key":"e_1_2_12_20_1","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1111\/codi.16055","article-title":"Is Evaluation by Questionnaires Sufficient to Cover All Aspects of Bowel Symptoms in Rectal Cancer Patients After Low Anterior Resection?","volume":"24","author":"Asnong A.","year":"2022","journal-title":"Colorectal Disease"}],"container-title":["Annals of Gastroenterological Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ags3.70289","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ags3.70289","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ags3.70289","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T02:01:26Z","timestamp":1790647286000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ags3.70289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":19,"alternative-id":["10.1002\/ags3.70289"],"URL":"https:\/\/doi.org\/10.1002\/ags3.70289","archive":["Portico"],"relation":{},"ISSN":["2475-0328","2475-0328"],"issn-type":[{"value":"2475-0328","type":"print"},{"value":"2475-0328","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"assertion":[{"value":"2026-05-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ags3.70289"}}