Anal Canal ; pathology ; surgery ; Humans ; Rectal Neoplasms ; pathology ; surgery

OBJECTIVETo investigate the pathological characters and the corresponding clinical significance of internal hemorrhoids tissues.

METHODSNormal anal cushion and internal haemorrhoids tissue samples were obtained after stapled haemorrhoidectomy procedure from 24 grade III hemorrhoidal patients. The macroscopically normal cushions served as own controls and the normal cushions from a patient without a history of haemorrhoids as quality control. Routine Hematoxylin-Eosin and orcein were performed for elastic fibers.

RESULTSCompared with the corresponding normal anal cushions, the subepithelial vessels especially the cavernous vessels of the hemorrhoidal tissues showed obvious structural impair, retrograde changes, and the internal elastic lamina were ruptured and discontinuous. In addition, thrombosis and subsequent ischemic changes were observed. The Trietz's muscle and the fibro-elastic tissues showed hypertrophy, distortion, rupture and tortility. Obvious mucosal injury was observed in the mucous of hemorrhoidal tissues. Venous dilatation was infrequent in the hemorrhoidal tissues.

CONCLUSIONSThe anal cushions of hemorrhoids disease patients show significant pathological changes. The pathological changes include structural impair, retrograde changes of the cavernous vessels and the hypertrophy, distortion, rupture and tortility of the Trietz's muscle and the fibroelastic tissues, and mucosal injury of the mucous membranes. These pathological changes are the basis of pathogenesis and development of hemorrhoids.

Adult ; Anal Canal ; pathology ; Elastic Tissue ; pathology ; Hemorrhoids ; pathology ; surgery ; Humans ; Middle Aged

The most common metastatic sites of gastric cancer are liver, lung, bone and adrenal gland. However, skin metastases from gastric cancer are relatively rare. We herein report a case of advanced gastric cancer with perianal skin metastasis in a 70-year-old male. On admission, patient presented with epigastric pain. Endoscopy and abdominal CT scan demonstrated the stage IV gastric cancer. He had one painless nodule on perianal skin area, biopsy of that lesion showed a feature of poorly differentiated adenocarcinoma clinically from the stomach. We suspected that the perianal lesion was originated from gastric cancer.
Aged ; Anal Canal ; Humans ; Male ; Neoplasm Staging ; Skin Neoplasms/*diagnosis/pathology/*secondary ; Stomach Neoplasms/*diagnosis/pathology

OBJECTIVETo evaluate high resolution MR in imaging of the anatomy and tumor invasion of the anal canal.

METHODSTwenty-three patients with low rectal cancer confirmed by pathology results were recruited as the study group and 20 patients without history of anal canal diseases were recruited as the control group. All patients received MRI examinations containing three TSE-T2WI sequences and three 3D-VIBE sequences. The distance between the tumor and the anal margin was measured in the study group. Two radiologists finished T staging of the tumor independently.

RESULTSMRI had a clear demonstration of the anatomy of the anal canal in all 20 control patients. The T staging of 23 patients of study group was T2 (n=8), T3 (n=7), and T4 (n=8), and the depth of anal canal invasion (T-DACI) was T0-DACI (n=10), T1-DACI (n=1), T2a-DACI (n=3), T2-DACI (n=3), T3-DACI (n=4) and T4-DACI (n=2). Eight patients received surgery and the consistency between pathological staging and imaging staging was 75%.

CONCLUSIONHigh resolution MRI has the capacity of demonstrating the complex anatomy of the anal canal, and can provide evidence of anal canal invasion for low rectal cancer.

Anal Canal ; pathology ; Humans ; Magnetic Resonance Imaging ; Neoplasm Staging ; Rectal Neoplasms ; pathology

Anal Canal ; pathology ; surgery ; Humans ; Laparoscopy ; methods ; Rectal Neoplasms ; pathology ; surgery

Objective: To compare the long-term outcomes of intersphincteric (trans-internal and external) sphincter resection (ISR) and abdominoperineal proctocolectomy (APR) for low-grade rectal cancer. Methods: We used a meta-analytic approach to compare these procedures . Published reports comparing ISR and APR for low rectal cancer in Pubmed, Medline, EMBASE and Cochrane, China Knowledge Network (CNKI), China Biomedical Literature Database, and Vipers databases between January 2005 and January 2023 were searched and those meeting the eligibility criteria were selected for extraction of data for analysis. Inclusion criteria were as follows: (1) all reports comparing ISR and APR for low rectal cancer before January 2023; and (2) prospective randomized controlled studies or well-designed cohort studies. Exclusion criteria were as follows: (1) full text not available; (2) duplicate publications, missing primary outcome indicators, and unknown data; and (3) invalid statistical analysis. Results: Sixteen studies with 2498 patients were included in this study. Compared with the APR group, patients in the ISR group were relatively younger (weighted mean difference [WMD]=-1.82, 95%CI=-2.94 to -0.70, P=0.01), had tumors farther from the anal verge (WMD=0.43, 95%CI=0.18 to 0.67, P<0.01), and lower pathological T-stage (T3-4 stage: OR=0.54, 95%CI=0.36 to 0.81, P<0.01). In contrast, there were no statistically significant differences between the two groups in gender (P=0.78), body mass index (P=0.77), or pathological N stage (P=0.09). Compared with the APR group, patients in the ISR group had a lower rate of postoperative complications (OR=0.77, 95%CI=0.60 to 0.99, P=0.04), shorter hospital stay (WMD=-4.30, 95%CI=-7.07 to -1.53, P<0.01), higher 5-year overall survival (HR=0.54, 95%CI=0.33 to 0.88, P=0.01), and higher 5-year disease-free survival (HR=0.65, 95%CI=0.47 to 0.90, P<0.01). Five-year locoregional failure (HR=0.66, 95%CI=0.40 to 1.10, P=0.11) and time to surgery (WMD=-9.71, 95%CI=-41.89 to 22.47, P=0.55) did not differ significantly between the two groups. Conclusion: ISR is a safe and effective alternative to APR for early-stage low-grade rectal cancer.
Humans ; Prospective Studies ; Rectal Neoplasms/pathology* ; Rectum/surgery* ; Proctectomy ; Anal Canal/pathology* ; Treatment Outcome

Anal Canal ; surgery ; Humans ; Neoplasm Recurrence, Local ; prevention & control ; Rectal Neoplasms ; pathology ; surgery

OBJECTIVEHirschsprung's disease (HD), one of the most common causes resulting in lower intestinal obstruction in children, is prone to be misdiagnosed or to be missed from diagnosis because of its atypical clinical symptoms and inconspicuous morphological findings by barium enema X-ray. Recently, this situation has been largely ameliorated by increased comprehension of anorectal kinetics and improvement of instrument for measurement of anorectal pressure. By now, anorectal manometry (ARMM) has been regarded as a routine means for functional assessment and diagnosis for anorectal disease. Nevertheless, the accuracy rate of diagnosis of HD in neonate by ARMM remains to be elucidated. In this study the clinical evaluation of anorectal manometry as an early diagnostic method for neonates with Hirschsprung's disease was appraised.

METHODSForty-two HD patients defined by pathological study of rectal tissue obtained via rectal mucous membrane biopsy or operation were recruited in this study. ARMM was performed in liquid transmission using PC polygraph high rate gastrointestinal dynamical detection system (PC Polygraf HR, CTD-synectics, Sweden), with 4-lumen catheter with which a small 5-cm-long balloon was connected at the terminus. All children were positioned on their left side or back during the procedure and the pressure transducers were placed in the mid-axillary line level. The results of ARMM performed before operation or biopsy were compared with the results of barium enema X-ray testing. The decrease of internal anal sphincter pressure as rectoanal inhibitory reflex (RAIR) was measured based on the fluctuation curve of pressure detected. HD was defined when no decrease of anal catheter pressure was detected after insufflation (RAIR positive), and suspected HD state was assessed with the presentation of incomplete relaxation or positive/negative results coexisted (RAIR abnormal) in canal.

RESULTSThirty patients (71.43%) were diagnosed as HD by ARMM including 18 patients who showed negative response to RAIR and 12 patients whose response was abnormal. While barium enema examinations were carried out in all the 45 patients, the results showed 5 HD patients and 14 suspected HD patients, giving an overall diagnostic accuracy of 45.24%. There were also 16 patients with positive ARMM response and negative barium enema findings together, and 5 patients with negative ARMM results and positive barium enema findings at the same time. There was a significant difference between the two diagnostic methods (chi(m)(2) = 4.76, P < 0.05).

CONCLUSIONAnorectal manometry seems to be a more reliable method for diagnosis of Hirschsprung's disease in neonate than barium enema X-ray. Because ARMM is a simple, safe and non-invasive method, it can be used as a screening test of choice in neonates with clinically suspected HD. But for final diagnosis, it is reasonable to combine ARMM with other diagnostic methods in HD patients.

Anal Canal ; physiopathology ; Barium Sulfate ; Enema ; Hirschsprung Disease ; diagnosis ; Humans ; Infant, Newborn ; Manometry ; Rectum ; pathology ; physiopathology

OBJECTIVETo analyze the factors related to sphincter preserving(SP) operation for lower rectal cancer.

METHODSClinicopathological data of 316 patients with lower rectal cancer 1-5 cm from the anorectal line who underwent surgical resection from Aug. 1994 to Nov. 2005 were analyzed. The whole period was divided into two period based on the introduction of TME in Jan. 1999. The SP rates, leakage between the two period were compared.

RESULTSThe SP rate increased significantly from 44.9 % in period I (Aug. 1994-Dec. 1998) to 76.2 % in period II (Jan. 1999-Nov. 2005)(P=0.000). The factors significantly influencing SP were the distance from the anorectal line, sex, period, circumference of intramural spread, histological differentiation (P< 0.05). Significant differences were detected between the two period in sex, volume of blood transfusion, Dukes' stage (P< 0.05). The rate of leakage were 2.7 % and 1.3 % in the two period (P > 0.05).

CONCLUSIONSOver 12 years, the SP rate of rectal cancers 1-5 cm from the anorectal line was significantly increased and volume of blood transfusion reduced obviously due to the introduction of TME. These surgical techniques, however, have no effect on the operating time and leakage rates.

Anal Canal ; surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; surgery

OBJECTIVETo investigate the operative techniques and postoperative effects of ultralow anterior excision for rectal cancer.

METHODSFrom October 1996 to October 2006, 508 cases with rectal carcinoma at or below the peritoneal reflection with potential to preserve the anal function were divided into two groups. Of the patients, 365 cases underwent ultralow anterior excision and instrumental anastomosis, and 143 cases underwent manual colon-anal anastomosis (Parks operation).

RESULTSIn the group with anterior excision, the operations were all completed in the abdominal cavity, and avulsion of distal occlusive end occurred in 3 cases (0.9%), unsuccessful anastomosis happened in 2 cases (0.6%), unsatisfactory anastomosis with incomplete anastomosis circle turned out in 18 cases (5.6%). In the Parks operation group, the anastomosis was carried out manually at the anus and in abdominal cavity. Postoperative defecation function (times, soiling underwear, feeling of urgent defecation) in the group anterior excision was clearly better than that in the group of Parks operation (P < 0.05); difficulty of defecation (sense of residual stool, prolonging of defecation, cathartic usage) was also better in the group with anterior excision (P < 0.05). The anastomosis leakage rate was 3.5% in anterior excision group, compared to 5.6% in Parks operation group (P > 0.05). Anastomotic stenosis occurred in 77 cases (22.5%) in anterior excision group, and 40 cases (27.9%) in Parks operation group (P > 0.05). The local recurrence rate and 5-year survival rate were 11.8% and 68.8% in anterior excision group, and 10.1% and 66.8% in Parks operation group, respectively (P > 0.05).

CONCLUSIONSAlthough there is no significant differences in local recurrence and 5-year survival rate between the two groups, the function and difficulty of defecation with instrumental anastomosis demonstrates clear advantages over Parks operation.

Anal Canal ; surgery ; Anastomosis, Surgical ; methods ; Follow-Up Studies ; Humans ; Rectal Neoplasms ; pathology ; surgery ; Treatment Outcome