The Association Between Anal Function and Neural Degeneration After Preoperative Chemoradiotherapy Followed by Intersphincteric Resection
The Association Between Anal Function and Neural Degeneration After Preoperative Chemoradiotherapy Followed by Intersphincteric Resection
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DOI：
10.1097/dcr.0b013e31822c94e6
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发表时间：
2011-11-01
影响因子：
3.9
通讯作者：
Nishizawa, Yusuke
中科院分区：
文献类型：
--
作者：
Nishizawa, Yuji;Fujii, Satoshi;Nishizawa, Yusuke
背景技术背景：直肠癌术前放化疗是为了改善局部控制，但也可能导致术后严重的肛门功能障碍。目的：本研究的目的是评估术前放化疗对病理结果的影响，并检查这些结果与括约肌间切除术后严重肛门功能障碍的原因之间的相关性。设计：根据核固缩、空泡变性、细胞质嗜酸性变性、去核和外膜神经元变化，使用括约肌间切除术后手术标本的苏木精和伊红染色切片，对周围神经变性进行组织病理学评价。每个项目进行评分，以量化神经变性的水平，变性和肛门功能之间的关系进行了检查，在12个月后的造口关闭。地点：本研究于2001年至2006年在美国国立癌症中心医院东院进行。患者：受试者为68例低位直肠癌患者，均行括约肌间切除术，术前分别行47例和21例放化疗。主要观察指标：结果：放化疗组神经变性程度明显高于对照组，神经变性程度与Wexner评分显著相关结论：术前放化疗可引起直肠肿瘤周围神经退行性变。退变评分与术后肛门功能之间的显著相关性表明，该评分可能是预测术前放化疗对术后肛门功能影响的有用指标。
BACKGROUND: Preoperative chemoradiotherapy for rectal cancer is administered to improve local control, but it can also induce severe anal dysfunction after surgery.OBJECTIVE: The goals of the study were to assess the influence of preoperative chemoradiotherapy on pathological findings and to examine the correlation of these findings with the cause of severe anal dysfunction after intersphincteric resection.DESIGN: Peripheral nerve degeneration was evaluated histopathologically with the use of hematoxylin and eosin-stained sections of surgical specimens after intersphincteric resection, based on karyopyknosis, vacuolar degeneration, acidophilic degeneration of cytoplasm, denucleation, and adventitial neuronal changes. Each item was scored to quantify the level of neural degeneration, and the relationship between degeneration and anal function was examined at 12 months after closure of the stoma. Anal function was assessed by questionnaire, and incontinence was evaluated based on the Wexner score.SETTING: This study was conducted at the National Cancer Center Hospital East from 2001 to 2006.PATIENTS: The subjects were 68 patients with lower rectal cancer who underwent intersphincteric resection with (n = 47) or without (n = 21) preoperative chemoradiotherapy.MAIN OUTCOME MEASURES: The findings in the 2 groups were compared to clarify the association between the degree of histological degeneration and postoperative anal function.RESULTS: Neural degeneration was significantly higher in the chemoradiotherapy group, and the neural degeneration and Wexner scores had a significant correlation (P = .003, r = 0.477).CONCLUSION: Preoperative chemoradiotherapy induced marked neural degeneration around the rectal tumor. The significant correlation between the degeneration score and postoperative anal function suggests that this score may be a useful marker to predict the influence of preoperative chemoradiotherapy on anal function after surgery.