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International Journal of Colorectal Disease

Published in:

01-12-2016 | Original Article

Association between pathologic features of peripheral nerves and postoperative anal function after neoadjuvant therapy for low rectal cancer

Authors: Keinchi Koushi, Yuji Nishizawa, Motohiro Kojima, Satoshi Fujii, Norio Saito, Ryuichi Hayashi, Atsushi Ochiai, Masaaki Ito

Published in: International Journal of Colorectal Disease | Issue 12/2016

Abstract

Purpose

Neoadjuvant chemoradiotherapy (CRT) for rectal cancer improves local control but also induces severe postoperative anal dysfunction that may be related to neural degeneration. The aims of the study were to identify pathological features of neural degeneration caused by neoadjuvant CRT or neoadjuvant chemotherapy (NAC) and to evaluate the association between neural degeneration and anal function.

Methods

A retrospective study using chronologically different groups was performed in 95 patients with rectal cancer treated with curative resection with neoadjuvant CRT (n = 47), NAC (n = 27), or surgery alone (no neoadjuvant therapy) (n = 21) at National Cancer Center Hospital East from 2001 to 2014. Peripheral nerve degeneration was evaluated histopathologically using H&E stained sections, based on karyopyknosis, vacuolar or acidophilic degeneration, denucleation, adventitial neuron change, and fibrosis. Morphological analysis of peripheral nerves was compared among the three groups. The association between pathological features and anal function (Wexner Score) was evaluated.

Results

After CRT, the degree of fibrosis around the tumor was severe, and neural degeneration was found in peripheral neurons. With NAC and surgery alone, there was little fibrosis and neural degeneration. Pathological changes after CRT were more pronounced than those after NAC, indicating greater tissue degeneration due to CRT. There was an association between anal function and degeneration score in the CRT group, but not in the other groups.

Conclusions

Peripheral nerves in patients who received neoadjuvant CRT showed characteristic pathological features indicating greater degeneration, compared with patients who received NAC. Neural degeneration is associated with anal function and several pathological factors after CRT.

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Title: Association between pathologic features of peripheral nerves and postoperative anal function after neoadjuvant therapy for low rectal cancer
Authors: Keinchi Koushi
Yuji Nishizawa
Motohiro Kojima
Satoshi Fujii
Norio Saito
Ryuichi Hayashi
Atsushi Ochiai
Masaaki Ito
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 12/2016
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-016-2640-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Association between pathologic features of peripheral nerves and postoperative anal function after neoadjuvant therapy for low rectal cancer

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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