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

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International Journal of Colorectal Disease Aims and scope Submit manuscript

An Erratum to this article was published on 10 October 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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Author information

Authors and Affiliations

  1. Division of Surgical Oncology, National Cancer Center Hospital East, Kashiwa, Japan

    Keinchi Koushi, Yuji Nishizawa, Norio Saito & Masaaki Ito

  2. Juntendo University Graduate School of Medicine Advanced Clinical Research of Cancer, Tokyo, Japan

    Keinchi Koushi & Ryuichi Hayashi

  3. Division of Pathology, National Cancer Center Hospital East, Kashiwa, Japan

    Motohiro Kojima, Satoshi Fujii & Atsushi Ochiai

  4. Division of Head and Neck surgery, National Cancer Center Hospital East, Kashiwa, Japan

    Ryuichi Hayashi

Authors
  1. Keinchi Koushi
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  2. Yuji Nishizawa
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  3. Motohiro Kojima
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  4. Satoshi Fujii
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  5. Norio Saito
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  6. Ryuichi Hayashi
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  7. Atsushi Ochiai
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  8. Masaaki Ito
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Corresponding authors

Correspondence to Yuji Nishizawa or Masaaki Ito.

Ethics declarations

The study was approved by the institutional review board of the National Cancer Center.

Funding

There was no funding for this study.

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The authors declare that they have no conflict of interest.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s00384-016-2676-5.

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Koushi, K., Nishizawa, Y., Kojima, M. et al. Association between pathologic features of peripheral nerves and postoperative anal function after neoadjuvant therapy for low rectal cancer. Int J Colorectal Dis 31, 1845–1852 (2016). https://doi.org/10.1007/s00384-016-2640-4

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  • DOI: https://doi.org/10.1007/s00384-016-2640-4

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