title: The association between anal function and neural degeneration after preoperative chemoradiotherapy followed by intersphincteric resection.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  This study was conducted at the National Cancer Center Hospital East from 2001 to 2006.
  
  
  METHODS
  The subjects were 68 patients with lower rectal cancer who underwent intersphincteric resection with (n = 47) or without (n = 21) preoperative chemoradiotherapy.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors: Colorectal and Pelvic Surgery Division, Department of Surgical Oncology, National Cancer Center Hospital East, Kashiwa-City, Japan.
authors: Yuji
authors: Y
authors: Nishizawa
authors: Satoshi
authors: S
authors: Fujii
authors: Norio
authors: N
authors: Saito
authors: Masaaki
authors: M
authors: Ito
authors: Atsushi
authors: A
authors: Ochiai
authors: Masanori
authors: M
authors: Sugito
authors: Akihiro
authors: A
authors: Kobayashi
authors: Yusuke
authors: Y
authors: Nishizawa
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000294:innervation* / Q000503:physiopathology* / Q000601:surgery; D059248:Chemoradiotherapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009410:Nerve Degeneration / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D012004:Rectal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome