Susanne D. Otto

Staging Anal Cancer: Prospective Comparison of Transanal Endoscopic Ultrasound and Magnetic Resonance Imaging

PurposeThe staging of anal cancer is extremely important for therapy and prognosis. Transanal endoscopic ultrasound and magnetic resonance imaging are routinely applied. The aim of this prospective comparative study is to evaluate whether tumor staging is concordant between these techniques.MethodsForty-five anal cancer patients underwent endoscopic ultrasound and magnetic resonance imaging. Histological confirmation was obtained in all patients. The two test methods were compared with the kappa concordance index and sensitivity for the initial method of tumor detection was calculated. For six patients who were operated upon because of tumor progression, the results were evaluated against the histological tumor stage.ResultsHigh concordance was found in the assessment of tumor size and nodal status (kappa index 0.63 and 0.77). Cancer patients were correctly identified with 100% sensitivity (45/45) by endoscopic ultrasound and with 88.9% (40/45) sensitivity by magnetic resonance imaging. In the six operated patients, T stage was correctly assessed in four of six patients by endoscopic ultrasound and in three of six patients by magnetic resonance imaging.ConclusionThe results of endoscopic ultrasound strongly coincide with those of magnetic resonance imaging. Endoscopic ultrasound may be superior to magnetic resonance imaging for detection of small superficial tumors. However, magnetic resonance imaging is needed for N staging.

Sacral Nerve Stimulation Induces Changes in the Pelvic Floor and Rectum that Improve Continence and Quality of Life

PurposeSacral nerve stimulation (SNS) can improve fecal incontinence, though the exact mechanism is not known. This study examines the following hypotheses: SNS leads to contraction of the pelvic floor, influences rectal perception, and improves continence and quality of life.MethodsFourteen patients with sacral nerve stimulators implanted for fecal incontinence were examined prospectively. Morphological and functional assessment was done by endosonography, manometry, and volumetry with the stimulator turned on and off in direct succession. Questionnaires were used to determine incontinence and quality of life.ResultsWith the stimulator turned on, rectal filling conditions were perceived only at higher volumes; in particular, the defecation urge was sensed only at higher volumes. There was also a reduction in the diameters of the external and internal anal sphincters and a decrease in the distance between the anal mucosa and the symphysis as a sign of pelvic floor elevation. Six months after surgery, continence and quality of life were markedly better than before the operation.ConclusionsWe were able to confirm the hypotheses given above. The improvements of pelvic floor contraction and rectal perception are rapid adjustment processes in response to stimulation of sacral nerves S3/S4 when turning on the stimulator.

Rectal Anatomy After Rectopexy: Cinedefecography Versus MR-Defecography

BACKGROUND Conventional defecography can reveal abnormalities in patients with evacuatory disorders. With fast dynamic MR imaging systems, MR-defecography has become possible, which does not expose patients to ionizing radiation. The purpose of this study was to assess the correlation of both methods after rectopexy. MATERIALS AND METHODS Twenty-one consecutive patients underwent abdominal sigmoidectomy and rectopexy due to evacuatory disorders. Postoperatively, all patients were investigated by cineradiographic defecography. Fourteen patients underwent MR-defecography additionally. The results were screened for anorectal angle and pelvic floor position (rest, squeezing, and evacuation). The findings were depicted in Box plot analysis and compared with the Friedman-test. Descent of pelvic organs was also assessed. RESULTS In MR-defecography, anorectal angle at rest was smaller than in conventional defecography, but there was no difference during squeezing and defecation. Concerning pelvic floor position, during squeezing, MR-defecography illustrated a lower perineum and a broader range of pelvic settings, but no difference at rest and during evacuation. In four patients, MR-defecography visualized a descent of the bladder. However, in four patients with complete evacuation in cineradiography and with no clinical complaints about incomplete evacuation, MR imaging showed deficient evacuation. Overall continence of patients was significantly improved through surgery, but there was no change in sphincter pressure, radial asymmetry, or sphincter length. CONCLUSIONS In general, with respect to anorectal angle and perineal motility, both methods revealed consistent results. The concomitant depiction of structures in MR-defecography is helpful in the assessment of descent of pelvic organs and permits visualization of enteroceles. However, in 30% of patients, MR-defecography wrongly showed incomplete evacuation.

Morphological alterations of the enteric nervous system in young male patients with rectal prolapse.

ObjectivesThe pathogenesis of rectal prolapse (RP) defined by a circumferential, full-thickness invagination of the rectal wall into the anal canal is controversial. RP is normally encountered in elderly women and attributed to several etiological factors (e.g., advanced age, pudendal nerve injury, laxity of supporting ligaments). RP affecting young male patients is unlikely to be explained by these factors and may be due to a rectal motility disorder. Therefore, the enteric nervous system (ENS) as key regulator of intestinal motility was evaluated by a systematic morphometric analysis.Patients and methodsFull-thickness rectosigmoid specimens obtained from young male patients with symptomatic RP (n = 5) and male controls (n = 15) were processed for conventional histology and immunohistochemistry using anti-HuC/D as pan-neuronal marker. Enteric ganglia, nerve and glial cells were quantified separately in the myenteric (MP) and submucosal plexus (SMP).ResultsCompared to controls, patients with RP showed significantly (p < 0.05) increased mean ganglionic area both in MP and SMP, increased mean neuronal content of submucosal ganglia, and nearly threefold higher frequency of submucosal ganglia containing ≥7 neurons.ConclusionThe morphometric analysis reveals distinct quantitative alterations of the ENS in young male patients with RP mainly characterized by submucosal hyperganglionosis similar to histopathological features described in intestinal neuronal dysplasia. The data give evidence that RP in this unusual subgroup is associated with morphological changes of enteric ganglia which may contribute to the development of RP and complement established etiological concepts.

Repeatability of anorectal manometry in healthy volunteers and patients

BACKGROUND Anorectal manometry is used extensively in the assessment of patients with disorders of the pelvic floor. The present study investigated the repeatability of anorectal manometry in healthy volunteers and patients. PATIENTS AND METHODS A total of 30 healthy volunteers (15 men and 15 women) and 10 patients with fecal incontinence (4 men and 6 women) underwent perfusion manometry and volumetry. Intraindividual variability was evaluated using the intraindividual correlation coefficient (ICC). Interindividual variability was expressed as the standard deviation from the calculated mean values. RESULTS We found a high intraindividual correlation for the squeezing pressure (ICC 0.75-0.95), vector volume (ICC 0.88-0.97), and rectal perception (ICC 0.82-0.98). The anal resting pressure showed moderate repeatability (ICC 0.60-0.72). However, with regard to sphincter asymmetry, rectal compliance, and the rectoanal inhibitory reflex, a wide range of variability was found. In the female volunteers, the squeezing pressure and vector volume were lower than in those in the male volunteers. The anal pressure, vector volume, thresholds for urgency, and the maximum tolerable volume were lower in the incontinent patients than in the healthy volunteers. CONCLUSIONS The squeezing pressure, vector volume, and rectal perception allow a reliable analysis of anal sphincter function. Sphincter asymmetry, rectal compliance, and the rectoanal inhibitory reflex were of limited diagnostic value.

T1107 Staging Anal Cancer: Prospective Comparison of Transrectal Endoscopic Ultrasound and Magnetic Resonance Imaging

Purpose The staging of anal cancer is extremely important for therapy and prognosis. Transanal endoscopic ultrasound and magnetic resonance imaging are routinely applied. The aim of this prospective comparative study is to evaluate whether tumor staging is concordant between these techniques.

Therapie des duktalen Pankreaskarzinoms in einem immunkompetenten Rattenmodell: Suramin unterdrückt Primärtumorwachstum und Metastasierung nahezu vollständig

A previous study demonstrated that Suramin, a naphthyl urea derivative, reduces the proliferation of human pancreas carcinoma cells in vitro. The aim of the present study was to examine the effect of Suramin on tumor growth and metastasis in vivo using a clinically relevant orthotopic immunocompetent rat model of pancreatic cancer. 1 mm3 tumor-fragments of the ductal rat-pancreatic cell line DSL-6A/C1 were orthotopically implanted into the pancreas of 16 Lewis-rats. The animals were randomized into therapy group (n = 8, Suramin 60 mg/kg, weekly i. p.) and control-group (n = 8). 4 weeks after implantation, intravital microscopy was performed, and the tumor volume and metastasis were determined at autopsy. The animals of the control-group developed large tumors with local infiltration and metastasis. In contrast, half of the animals of the therapy-group showed no tumor growth, the other half developed only small tumors without metastasis. In conclusion, Suramin reduces primary tumor growth and dissemination in the early stage of tumor development in an immunocompetent rat model of pancreatic cancer.