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Background <p>It has been suggested that chemoradiotherapy may cause fibrosis of the internal anal sphincter, resulting in sclerosis. However, no report has quantitatively investigated this relationship by using real-time tissue elastography.</p> Objective <p>To clarify the relationship between fibrosis and elasticity of the internal anal sphincter in patients undergoing surgery for lower rectal cancer with or without preoperative chemoradiotherapy from a histological perspective.</p> Design <p>A single-center, prospective cohort study.</p> Settings <p>The surgical and pathological departments in a tertiary referral university hospital.</p> Patients <p>Eighteen patients with rectal cancer who underwent abdominoperineal resection between May 2019 and May 2022 were included in the study.</p> Main outcome measures <p>Real-time tissue elastography was performed before surgery to measure internal anal sphincter hardness as “elasticity” (hardest (0) to softest (255); decreased elasticity indicated sclerotic changes). Internal anal sphincter fibrosis was evaluated using Masson’s trichrome and Elastica van Gieson staining. We evaluated internal anal sphincter elasticity after preoperative chemoradiotherapy and preoperatively in patients who did not undergo preoperative chemoradiotherapy and analyzed the correlation with the percentage of internal anal sphincter fibrosis in the resected specimens.</p> Results <p>Of the 18 patients, 10 underwent preoperative chemoradiotherapy. A significantly higher percentage of internal anal sphincter fibrosis was observed in the chemoradiotherapy group. Post-chemoradiotherapy elasticity was significantly lower in patients undergoing chemoradiotherapy compared to pre-chemoradiotherapy elasticity and that in patients not undergoing chemoradiotherapy. The analysis of the correlation between internal anal sphincter elasticity and fibrosis showed that elasticity decreased as the percentage of fibrosis increased.</p> Limitations <p>This study was conducted at a single institution, and the number of cases was small. The radiation dose to the anal canal may have differed depending on the location of the tumor, which may have affected internal anal sphincter elasticity.</p> Conclusions <p>Internal anal sphincter elasticity may reflect tissue sclerosis associated with fibrosis caused by chemoradiotherapy.</p>

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Relationship between fibrosis induced by preoperative chemoradiotherapy and real-time tissue elastography of internal anal sphincter

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月8日

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  • Akira Sakamoto,
  • Kazuhito Sasaki,
  • Hiroyuki Abe,
  • Ryosuke Kikuchi,
  • Hiroaki Nozawa,
  • Koji Murono,
  • Shigenobu Emoto,
  • Yuichiro Yokoyama,
  • Yuzo Nagai,
  • Shinya Abe,
  • Takahide Shinagawa,
  • Yuichi Tachikawa,
  • Satoshi Okada,
  • Tetsuo Ushiku,
  • Soichiro Ishihara

摘要

Background

It has been suggested that chemoradiotherapy may cause fibrosis of the internal anal sphincter, resulting in sclerosis. However, no report has quantitatively investigated this relationship by using real-time tissue elastography.

Objective

To clarify the relationship between fibrosis and elasticity of the internal anal sphincter in patients undergoing surgery for lower rectal cancer with or without preoperative chemoradiotherapy from a histological perspective.

Design

A single-center, prospective cohort study.

Settings

The surgical and pathological departments in a tertiary referral university hospital.

Patients

Eighteen patients with rectal cancer who underwent abdominoperineal resection between May 2019 and May 2022 were included in the study.

Main outcome measures

Real-time tissue elastography was performed before surgery to measure internal anal sphincter hardness as “elasticity” (hardest (0) to softest (255); decreased elasticity indicated sclerotic changes). Internal anal sphincter fibrosis was evaluated using Masson’s trichrome and Elastica van Gieson staining. We evaluated internal anal sphincter elasticity after preoperative chemoradiotherapy and preoperatively in patients who did not undergo preoperative chemoradiotherapy and analyzed the correlation with the percentage of internal anal sphincter fibrosis in the resected specimens.

Results

Of the 18 patients, 10 underwent preoperative chemoradiotherapy. A significantly higher percentage of internal anal sphincter fibrosis was observed in the chemoradiotherapy group. Post-chemoradiotherapy elasticity was significantly lower in patients undergoing chemoradiotherapy compared to pre-chemoradiotherapy elasticity and that in patients not undergoing chemoradiotherapy. The analysis of the correlation between internal anal sphincter elasticity and fibrosis showed that elasticity decreased as the percentage of fibrosis increased.

Limitations

This study was conducted at a single institution, and the number of cases was small. The radiation dose to the anal canal may have differed depending on the location of the tumor, which may have affected internal anal sphincter elasticity.

Conclusions

Internal anal sphincter elasticity may reflect tissue sclerosis associated with fibrosis caused by chemoradiotherapy.