Histologic Analysis of the Irradiated Anal Sphincter

Silva, Giovanna M. da; Berho, Mariana; Wexner, Steven D.; Efron, Jonathan E.; Weiss, Eric G.; Nogueras, Juan J.; Vernava, Anthony M.; Connor, Jason T.; Gervaz, Pascal

doi:10.1007/s10350-004-6800-1

Cited by 95 publications

(67 citation statements)

References 19 publications

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“…Reported risk factors associated with anorectal dysfunction after ISR include pre-CRT 12,19) , total resection of IAS 19,20) , the tumor level and height of the anastomosis 17) , and age 21) . In particular, pre-CRT has been considered to be a significant negative factor for anorectal function after ISR because of ischemic and fibrous changes in the pelvis tissue induced by irradiation 13) . In this study, we excluded patients who received pre-CRT and were thus able to assess the long-term anorectal function of selected patients who underwent ISR and CAA without resection of the IAS to clarify the magnitude of extensive resection of the IAS for earlier-stage tumors.…”

Section: Discussionmentioning

confidence: 99%

“…ISR was performed as open surgery until March 2006 and laparoscopically thereafter. Additionally, patients with LRC who received pre-CRT were excluded from this study because pre-CRT for advanced rectal cancer may be a negative factor for anorectal function after surgery for LRC [12][13][14][15] . Our goal was to clarify the clinical impact of extensive resection of the IAS for earlier-stage tumors for which pre-CRT could not be administered.…”

Section: Patientsmentioning

confidence: 99%

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Long-term assessment of anorectal function after extensive resection of the internal anal sphincter for treatment of low-lying rectal cancer near the anus

Shiokawa

Funahashi

Kaneko

et al. 2017

J Anus Rectum Colon

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Abstract:Objectives: Intersphincteric resection (ISR) for low-lying rectal cancer (LRC) may induce major problems associated with anorectal function. In this study, we assessed the severity of ISR-induced impairment in anorectal function. Methods: In total, 45 patients followed up regularly !2 years after diverting ileostoma closure were eligible. The patients underwent ISR (n=35) or conventional coloanal anastomosis without resection of the internal anal sphincter (IAS) (n=10) for treatment of LRC from January 2000 to December 2011. We retrospectively compared anorectal function [stool frequency, urgency, Wexner incontinence scale (WIS) score, and patient satisfaction with bowel movement habits on a visual analog scale (VAS) score] for !2 years after stoma closure between the two groups. Results: The median follow-up period was 4.0 years (range, 2.0-6.5 years). Of the total, 17 (48.6%) patients who underwent ISR had poor anorectal function, including two with complete incontinence. Significant differences were found between the groups in the incidence of urgency (p=0.042), WIS score (p=0.024), and defecation disorder with a WIS score of !10 (p= 0.034) but not in stool frequency. Based on the VAS score, 45.7% of patients who underwent ISR were dissatisfied with their bowel movement habits (p=0.041). Conclusions: Extensive resection of the IAS has negative short-and long-term effects on anorectal function.

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Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Long-term assessment of anorectal function after extensive resection of the internal anal sphincter for treatment of low-lying rectal cancer near the anus

Shiokawa

Funahashi

Kaneko

et al. 2017

J Anus Rectum Colon

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“…Autonomic nerve damage during surgery is thought to play a crucial role in the etiology of the pelvic floor dysfunctions that can be seen after RH (9). RT is associated to fibroelastic and muscle alterations (10)(11)(12). Moreover, RT and CT can cause ovary failure and early menopause, leading to a decrease in vaginal lubrication and elasticity as well as on the strength of the pelvic floor muscles (13).…”

Section: Methodsmentioning

confidence: 99%

Treatments for invasive carcinoma of the cervix: what are their impacts on the pelvic floor functions?

et al. 2013

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Aims: Describe the impact of surgery, radiotherapy and chemoradiation in the pelvic floor functions in cervical cancer patients. Materials and Methods: A prospective study with women submitted to radical hysterectomy (RH) (n = 20), exclusive radiotherapy (RT) (n = 20) or chemoradiation (CT/RT) (n = 20) for invasive cervical cancer. Urinary, intestinal and sexual function, as well as vaginal length and pelvic floor muscle contraction were evaluated. Comparisons between groups were performed by Kruskal-Wallis and Chi-square tests (p < 0.05). Results: The groups were similar in stress urinary incontinence incidence (p = 0.56), urinary urgency (p = 0.44), urge incontinence (p = 0.54), nocturia (p = 0.53), incomplete bowel emptying (p = 0.76), bowel urgency (p = 0.12) and soilage (p = 0.43). The CT/ RT group presented a higher urinary frequency (p < 0.001) and diarrhea (p = 0.025). Patients in the RH group were more sexually active (p = 0.01) and experienced less dyspareunia (p = 0.021). Vaginal length was shorter in RT group (5.5 ± 1.9 cm) and CT/ RT(5.3 ± 1.5 cm) than in the RH group (7.4 ± 1.1 cm) (p < 0.001). Pelvic floor muscle contraction was similar (p = 0.302). Conclusions: RT and CT/RT treatment for cervical carcinoma are more associated to sexual and intestinal dysfunctions.

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“…Sphincter injury following irradiation was evaluated from anal canal specimens collected from patients undergoing abdominoperineal resection [76] . Increased fibrosis and nerve density in the chemoradiotherapy group compared to the control group increased as the interval between radiation and surgery increased.…”

Section: Human Anorectal Functionmentioning

confidence: 99%

Effects of radiation upon gastrointestinal motility

Otterson¹

2007

WJG

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neural and chemical control. Myogenic control refers to the electrical activity generated by the smooth muscle of the gut. Electrical control activity (ECA) [1][2][3][4] is the omnipresent rhythmic depolarization of the cell membranes of the smooth muscle of the small intestine. With neural or chemical stimulation, membrane depolarization exceeds an excitation threshold and a contraction results. The electrical correlate of a contraction is called electrical response activity (ERA) [1][2][3][4] . These bursts of electrical response activity have a 1:1 relationship with contractions. Because ERA occurs only during the depolarization phase of the ECA cycle, the frequency of contractions is limited to and determined by the frequency of ECA. Neural and chemical stimulation may not be present during each depolarization of ECA, and thus contractions then do not occur at the maximum possible frequency (Figure 1). Recordings of gastrointestinal motility can either be made with devices that record physical contractions (manometry catheter or strain gauges) or motility can be implied from electrical activity or transit times.Single dose (938 Gy) in a canine model disrupted normal electrical patterns [5] . Jejunal myoelectric activity decreased in frequency, duration and length of migration o f E R A p o s t p r a n d i a l l y. E C A wa s i r r e g u l a r w i t h nonuniform morphology and occasionally migrated in an orad direction. ECA was occasionally uncoupled; coupling is a phenomenon in which corresponding ECAs recorded from different areas maintain a consistent time shift [6] . In spite of these functional abnormalities, the histology was minimally altered. These changes in electrical activity suggest a profound change in the physiology of the smooth muscle as well as the nerves controlling the muscle.Gastrointestinal smooth muscle contractile activity can also be influenced by extrinsic autonomic (parasympathetic and sympathetic) from the CNS and the intrinsic neurons of the enteric ner vous system. The stomach, small intestine and proximal colon derive their parasympathetic innervation through the vagus nerve which contains both afferent and efferent fibers. Relative to the intrinsic enteric neurons, the efferent potion of the vagus is really quite small; however, each vagal efferent fiber may influence about 2000 enteric neurons [7,8] . The sensory component of the vagus nerve is much greater. Sensory fibers account for 80% of all vagal fibers [9] . Vagal afferents detect both the mechanical and chemical stimulation of the small intestine and relay this information centrally for processing. Sympathetic innervation of the intestine arises from the thoracic and lumbar spinal nerves. These �� Effects of radiation upon gastrointestinal motility AbstractWhether due to therapeutic or belligerent exposure, the gastrointestinal effects of irradiation produce symptoms dreaded by a majority of the population. Nausea, vomiting, diarrhea and abdominal cramping are hallmarks of the prodromal ph...

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Histologic Analysis of the Irradiated Anal Sphincter

Cited by 95 publications

References 19 publications

Long-term assessment of anorectal function after extensive resection of the internal anal sphincter for treatment of low-lying rectal cancer near the anus

Long-term assessment of anorectal function after extensive resection of the internal anal sphincter for treatment of low-lying rectal cancer near the anus

Treatments for invasive carcinoma of the cervix: what are their impacts on the pelvic floor functions?

Effects of radiation upon gastrointestinal motility

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