Skip to main content

Advertisement

SpringerLink
Log in

Differences in tissue degeneration between preoperative chemotherapy and preoperative chemoradiotherapy for colorectal cancer

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Preoperative chemoradiotherapy (CRT) for rectal cancer is administered to improve local control, but can also induce severe anal dysfunction after surgery, while preoperative chemotherapy that significantly reduces the primary lesion in rectal cancer has recently been developed. The aim of the study was to examine differences in the effects of preoperative CRT and chemotherapy on tissue degeneration of patients with colorectal cancer.

Methods

The subjects were 91 patients, including 68 with rectal cancer who underwent internal sphincteric resection with (n = 47, CRT group) or without (n = 21, control group) preoperative CRT, and 23 with colorectal cancer who received preoperative FOLFOX treatment. Peripheral nerve degeneration was evaluated histopathologically using H&E-stained sections, based on karyopyknosis, disparity of the nucleus, denucleation, vacuolar or acidophilic degeneration of the cytoplasm, and adventitial neuronal changes.

Results

The incidence of neural degeneration was significantly higher in the CRT group than in the control group and FOLFOX group. There were no differences in any items of neural degeneration between the FOLFOX and control groups.

Conclusion

CRT induced marked neural degeneration around the rectal tumor. FOLFOX treatment produced mild neural degeneration similar to that in the control group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Paty PB, Enker WE, Cohen AM, Lauwers GY (1994) Treatment of rectal cancer by low anterior resection with coloanal anastomosis. Ann Surg 219(4):365–373

    Article  PubMed  CAS  Google Scholar 

  2. Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M (1994) Intersphincteric resection for low rectal tumours. Br J Surg 81(9):1376–1378

    Article  PubMed  CAS  Google Scholar 

  3. Saito N, Sugito M, Ito M, Kobayashi A, Nishizawa Y, Yoneyama Y, Minagawa N (2009) Oncologic outcome of intersphincteric resection for very low rectal cancer. World J Surg. doi:10.1007/s00268-009-0079-2

  4. Gamagami RA, Liagre A, Chiotasso P, Istvan G, Lazorthes F (1999) Coloanal anastomosis for distal third rectal cancer: prospective study of oncologic results. Dis Colon Rectum 42(10):1272–1275

    Article  PubMed  CAS  Google Scholar 

  5. Hohenberger W, Merkel S, Matzel K, Bittorf B, Papadopoulos T, Gohl J (2006) The influence of abdomino-peranal (intersphincteric) resection of lower third rectal carcinoma on the rates of sphincter preservation and locoregional recurrence. Colorectal Dis 8(1):23–33. doi:10.1111/j.1463-1318.2005.00839.x

    Article  PubMed  CAS  Google Scholar 

  6. Rullier E, Laurent C, Bretagnol F, Rullier A, Vendrely V, Zerbib F (2005) Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg 241(3):465–469

    Article  PubMed  Google Scholar 

  7. Bonadeo FA, Vaccaro CA, Benati ML, Quintana GM, Garione XE, Telenta MT (2001) Rectal cancer: local recurrence after surgery without radiotherapy. Dis Colon Rectum 44(3):374–379

    Article  PubMed  CAS  Google Scholar 

  8. Saito N, Ono M, Sugito M, Ito M, Morihiro M, Kosugi C, Sato K, Kotaka M, Nomura S, Arai M, Kobatake T (2004) Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomy. Dis Colon Rectum 47(4):459–466. doi:10.1007/s10350-003-0088-4

    Article  PubMed  Google Scholar 

  9. Bretagnol F, Rullier E, Laurent C, Zerbib F, Gontier R, Saric J (2004) Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer. Dis Colon Rectum 47(6):832–838. doi:10.1007/s10350-004-0523-1

    Article  PubMed  Google Scholar 

  10. Tiret E, Poupardin B, McNamara D, Dehni N, Parc R (2003) Ultralow anterior resection with intersphincteric dissection—what is the limit of safe sphincter preservation? Colorectal Dis 5(5):454–457

    Article  PubMed  CAS  Google Scholar 

  11. Rullier E, Zerbib F, Laurent C, Bonnel C, Caudry M, Saric J, Parneix M (1999) Intersphincteric resection with excision of internal anal sphincter for conservative treatment of very low rectal cancer. Dis Colon Rectum 42(9):1168–1175

    Article  PubMed  CAS  Google Scholar 

  12. Kohler A, Athanasiadis S, Ommer A, Psarakis E (2000) Long-term results of low anterior resection with intersphincteric anastomosis in carcinoma of the lower one-third of the rectum: analysis of 31 patients. Dis Colon Rectum 43(6):843–850

    Article  PubMed  CAS  Google Scholar 

  13. Ito M, Saito N, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y (2009) Analysis of clinical factors associated with anal function after intersphincteric resection for very low rectal cancer. Dis Colon Rectum 52(1):64–70. doi:10.1007/DCR.0b013e31819739a0

    Article  PubMed  Google Scholar 

  14. Chamlou R, Parc Y, Simon T, Bennis M, Dehni N, Parc R, Tiret E (2007) Long-term results of intersphincteric resection for low rectal cancer. Ann Surg 246(6):916–921, discussion 921-912. doi:10.1097/SLA.0b013e31815c29ff

    Article  PubMed  Google Scholar 

  15. Lim JF, Tang CL, Seow-Choen F, Heah SM (2005) Prospective, randomized trial comparing intraoperative colonic irrigation with manual decompression only for obstructed left-sided colorectal cancer. Dis Colon Rectum 48(2):205–209. doi:10.1007/s10350-004-0803-9

    Article  PubMed  CAS  Google Scholar 

  16. Chen FC, Mackay JR, Woods RJ, Collopy BT, Fink RJ, Guiney MJ (1995) Early experience with postoperative adjuvant chemoradiation for rectal carcinoma: focus on morbidity. Aust N Z J Surg 65(10):732–736

    Article  PubMed  CAS  Google Scholar 

  17. Kollmorgen CF, Meagher AP, Wolff BG, Pemberton JH, Martenson JA, Illstrup DM (1994) The long-term effect of adjuvant postoperative chemoradiotherapy for rectal carcinoma on bowel function. Ann Surg 220(5):676–682

    Article  PubMed  CAS  Google Scholar 

  18. Da Silva GM, Berho M, Wexner SD, Efron J, Weiss EG, Nogueras JJ, Vernava AM 3rd, Connor JT, Gervaz P (2003) Histologic analysis of the irradiated anal sphincter. Dis Colon Rectum 46(11):1492–1497. doi:10.1097/01.DCR.0000093642.89267.67

    Article  PubMed  Google Scholar 

  19. Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P, Bechstein WO, Primrose JN, Walpole ET, Finch-Jones M, Jaeck D, Mirza D, Parks RW, Collette L, Praet M, Bethe U, Van Cutsem E, Scheithauer W, Gruenberger T (2008) Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC intergroup trial 40983): a randomised controlled trial. Lancet 371(9617):1007–1016. doi:10.1016/S0140-6736(08)60455-9

    Article  PubMed  CAS  Google Scholar 

  20. Porschen R, Arkenau HT, Kubicka S, Greil R, Seufferlein T, Freier W, Kretzschmar A, Graeven U, Grothey A, Hinke A, Schmiegel W, Schmoll HJ (2007) Phase III study of capecitabine plus oxaliplatin compared with fluorouracil and leucovorin plus oxaliplatin in metastatic colorectal cancer: a final report of the AIO colorectal study group. J Clin Oncol 25(27):4217–4223. doi:10.1200/JCO.2006.09.2684

    Article  PubMed  CAS  Google Scholar 

  21. Diaz-Rubio E, Tabernero J, Gomez-Espana A, Massuti B, Sastre J, Chaves M, Abad A, Carrato A, Queralt B, Reina JJ, Maurel J, Gonzalez-Flores E, Aparicio J, Rivera F, Losa F, Aranda E (2007) Phase III study of capecitabine plus oxaliplatin compared with continuous-infusion fluorouracil plus oxaliplatin as first-line therapy in metastatic colorectal cancer: final report of the Spanish Cooperative Group for the treatment of digestive tumors trial. J Clin Oncol 25(27):4224–4230. doi:10.1200/JCO.2006.09.8467

    Article  PubMed  CAS  Google Scholar 

  22. Rothenberg ML, Cox JV, Butts C, Navarro M, Bang YJ, Goel R, Gollins S, Siu LL, Laguerre S, Cunningham D (2008) Capecitabine plus oxaliplatin (XELOX) versus 5-fluorouracil/folinic acid plus oxaliplatin (FOLFOX-4) as second-line therapy in metastatic colorectal cancer: a randomized phase III noninferiority study. Ann Oncol 19(10):1720–1726. doi:10.1093/annonc/mdn370

    Article  PubMed  CAS  Google Scholar 

  23. Chau I, Brown G, Cunningham D, Tait D, Wotherspoon A, Norman AR, Tebbutt N, Hill M, Ross PJ, Massey A, Oates J (2006) Neoadjuvant capecitabine and oxaliplatin followed by synchronous chemoradiation and total mesorectal excision in magnetic resonance imaging-defined poor-risk rectal cancer. J Clin Oncol 24(4):668–674. doi:10.1200/JCO.2005.04.4875

    Article  PubMed  CAS  Google Scholar 

  24. Sobin L, Wittekind CE, (UICC) IUAC (2002) TNM classification of malignant tumors, 6th edn. Wiley, New York

    Google Scholar 

  25. Saito N, Sarashina H, Nunomura M, Koda K, Takiguchi N, Nakajima N (1998) Clinical evaluation of nerve-sparing surgery combined with preoperative radiotherapy in advanced rectal cancer patients. Am J Surg 175(4):277–282

    Article  PubMed  CAS  Google Scholar 

  26. de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, Boni C, Cortes-Funes H, Cervantes A, Freyer G, Papamichael D, Le Bail N, Louvet C, Hendler D, de Braud F, Wilson C, Morvan F, Bonetti A (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18(16):2938–2947

    PubMed  Google Scholar 

  27. Cavanna L, Artioli F, Codignola C, Lazzaro A, Rizzi A, Gamboni A, Rota L, Rodino C, Boni F, Iop A, Zaniboni A (2006) Oxaliplatin in combination with 5-fluorouracil (5-FU) and leucovorin (LV) in patients with metastatic gastric cancer (MGC). Am J Clin Oncol 29(4):371–375. doi:10.1097/01.coc.0000221358.57089.f2

    Article  PubMed  CAS  Google Scholar 

  28. Louvet C, Andre T, Tigaud JM, Gamelin E, Douillard JY, Brunet R, Francois E, Jacob JH, Levoir D, Taamma A, Rougier P, Cvitkovic E, de Gramont A (2002) Phase II study of oxaliplatin, fluorouracil, and folinic acid in locally advanced or metastatic gastric cancer patients. J Clin Oncol 20(23):4543–4548

    Article  PubMed  CAS  Google Scholar 

  29. Wilson RH, Lehky T, Thomas RR, Quinn MG, Floeter MK, Grem JL (2002) Acute oxaliplatin-induced peripheral nerve hyperexcitability. J Clin Oncol 20(7):1767–1774

    Article  PubMed  CAS  Google Scholar 

  30. Lehky TJ, Leonard GD, Wilson RH, Grem JL, Floeter MK (2004) Oxaliplatin-induced neurotoxicity: acute hyperexcitability and chronic neuropathy. Muscle Nerve 29(3):387–392. doi:10.1002/mus.10559

    Article  PubMed  CAS  Google Scholar 

  31. Gamelin L, Capitain O, Morel A, Dumont A, Traore S, le Anne B, Gilles S, Boisdron-Celle M, Gamelin E (2007) Predictive factors of oxaliplatin neurotoxicity: the involvement of the oxalate outcome pathway. Clin Cancer Res 13(21):6359–6368. doi:10.1158/1078-0432.CCR-07-0660

    Article  PubMed  CAS  Google Scholar 

  32. Park SB, Goldstein D, Lin CS, Krishnan AV, Friedlander ML, Kiernan MC (2009) Acute abnormalities of sensory nerve function associated with oxaliplatin-induced neurotoxicity. J Clin Oncol 27(8):1243–1249. doi:10.1200/JCO.2008.19.3425

    Article  PubMed  CAS  Google Scholar 

  33. Nishizawa Y, Fujii S, Saito N (2011) The association between anal function and neural degeneration after preoperative chemoradiotherapy followed by intersphincteric resection. Dis Colon Rectum 54. doi:10.1097/DCR.0b013e31822c94e6

Download references

Author information

Authors and Affiliations

  1. Colorectal Surgery Division, Department of Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Yuji Nishizawa, Norio Saito, Masaaki Ito, Kentaro Nakajima, Masanori Sugito, Akihiro Kobayashi & Yusuke Nishizawa

  2. Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, 277-8577, Japan

    Satoshi Fujii & Atsushi Ochiai

Authors
  1. Yuji Nishizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Satoshi Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Norio Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masaaki Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kentaro Nakajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Atsushi Ochiai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masanori Sugito
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Akihiro Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yusuke Nishizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Norio Saito.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nishizawa, Y., Fujii, S., Saito, N. et al. Differences in tissue degeneration between preoperative chemotherapy and preoperative chemoradiotherapy for colorectal cancer. Int J Colorectal Dis 27, 1047–1053 (2012). https://doi.org/10.1007/s00384-012-1434-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-012-1434-6

Keywords

Search

Navigation