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Anorectal Disease: Current Challenges in Diagnosis and Treatment
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Anorectal Disease: Current Challenges in Diagnosis and Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (10 May 2024) | Viewed by 4212

Special Issue Editor

Dr. Yoav Mazor

E-Mail Website
Guest Editor
1. Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
2. Department of Medical Neurobiology, The Hebrew University of Jerusalem, Jerusalem, Israel
Interests: anorectal manometry; anorectal biofeedback; fecal incontinence; evacuation disorders; irritable bowel syndrome; anorectal pain; anorectal physiology

Special Issue Information

Dear Colleagues,

Anorectal disease, whether stemming from anatomical/organic or functional causes, can lead to significant symptoms and reduced quality of life for patients. These symptoms may manifest as fecal incontinence resulting from sphincter injury, anorectal radiation, trauma, or post-obstetric factors; obstructed defecation symptoms caused by prolapse, dyssynergia, or large rectocele; and anal pain arising from anal fissure, abscess, or functional pain. The diagnostic pathway, ancillary testing, and treatment options can vary depending on physician specialty and local expertise. While surgery can offer improvement for some symptoms, it may result in unsuccessful outcomes, especially when performed for the wrong indication. Lastly, anorectal disease should be addressed within the context of pelvic floor disorders, considering associated urinary symptoms and, in female patients, gynecological dysfunction.

This Special Issue aims to primarily focus on the current challenges associated with diagnosing and treating anorectal disease. We particularly encourage the submission of original research articles that adopt interdisciplinary approaches to examining either organic or functional anorectal symptoms. Additionally, we welcome the submission of high-interest review articles on this topic.

Dr. Yoav Mazor
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • anorectal disease
  • fecal incontinence
  • obstructed defecation
  • anal pain
  • pelvic floor disorders
  • interdisciplinary approaches
  • quality of life

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Published Papers (3 papers)

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Research

10 pages, 213 KiB  
Article
Risk Factors for Rectal Cancer Recurrence after Local Excision of T1 Lesions from a Decade-Long Multicenter Retrospective Study
by Yaron Rudnicki, Nitzan Goldberg, Nir Horesh, Assaf Harbi, Barak Lubianiker, Eraan Green, Guy Raveh, Moran Slavin, Lior Segev, Haim Gilshtein, Alexander Barenboim, Nir Wasserberg, Marat Khaikin, Hagit Tulchinsky, Nidal Issa, Daniel Duek, Shmuel Avital and Ian White
J. Clin. Med. 2024, 13(14), 4139; https://doi.org/10.3390/jcm13144139 - 16 Jul 2024
Viewed by 607
Abstract
Background: Local surgical excision of T1 rectal adenocarcinoma is a well-established approach. Yet, there are still open questions regarding the recurrence rates and its risk factors. Methods: A retrospective multicenter study including all patients who underwent local excision of early rectal cancer with [...] Read more.
Background: Local surgical excision of T1 rectal adenocarcinoma is a well-established approach. Yet, there are still open questions regarding the recurrence rates and its risk factors. Methods: A retrospective multicenter study including all patients who underwent local excision of early rectal cancer with an open or MIS approach and had a T1 lesion from 2010 to 2020 in six academic centers. Data included demographics, preoperative studies, surgical findings, postoperative outcomes, and local and systemic recurrence. A univariable and multivariable logistic regression analysis was performed to identify risk factors for recurrence. Results: Overall, 274 patients underwent local excision of rectal lesions. Of them, 97 (35.4%) patients with a T1 lesion were included in the cohort. The mean age was 69 ± 10.5 years, and 42 (43.3%) were female. The mean distance of the lesions from the anal verge was 7.8 ± 3.2 cm, and the average tumor size was 2.7 ± 1.6 cm. Eighty-two patients (85%) had a full-thickness resection. Eight patients (8%) had postoperative complications. Kikuchi classification of submucosal (SM) involvement was reported in 29 (30%) patients. Twelve patients had SM1, two SM2, and fifteen SM3. Following pathology, 24 patients (24.7%) returned for additional surgery or treatment. The overall recurrence rate was 14.4% (14 patients), with 11 patients having a local recurrence and 6 having a systemic metastatic recurrence, 3 of which had both. The mean time for recurrence was 2.78 ± 2.8 years and the overall mortality rate was 11%. On univariable and multivariable logistic regression analysis of recurrence vs. non-recurrence groups, the strongest and most significant association and possible risk factors for recurrence were larger lesions (4.3 vs. 2.5 cm, p < 0.001) with an OR of 6.67 (CI—1.82–24.36), especially for tumors larger than 3.5 cm, mucinous histology (14.3% vs. 1.2%, p = 0.004, OR of 14.02, CI—1.13–173.85), and involved margins (41.7% vs. 16.2%, p = 0.003, OR of 9.59, CI—2.14–43.07). The open transanal excision (TAE) approach was also identified as a possible significant risk factor in univariant analysis, while SM3 level penetration showed only a trend. Conclusion: Surgical local excision of T1 rectal malignancy is a safe and viable option. Still, one in four patients received additional treatment. There is an almost 15% chance for recurrence, especially in large tumors, mucinous histology, or involved margin cases. These high-risk patients might warrant additional intervention and stricter surveillance protocols. Full article
(This article belongs to the Special Issue Anorectal Disease: Current Challenges in Diagnosis and Treatment)
18 pages, 2179 KiB  
Article
Performance and Dimensionality of Pretreatment MRI Radiomics in Rectal Carcinoma Chemoradiotherapy Prediction
by Mladen Marinkovic, Suzana Stojanovic-Rundic, Aleksandra Stanojevic, Aleksandar Tomasevic, Radmila Jankovic, Jerome Zoidakis, Sergi Castellví-Bel, Remond J. A. Fijneman, Milena Cavic and Marko Radulovic
J. Clin. Med. 2024, 13(2), 421; https://doi.org/10.3390/jcm13020421 - 12 Jan 2024
Viewed by 1265
Abstract
(1) Background: This study aimed to develop a machine learning model based on radiomics of pretreatment magnetic resonance imaging (MRI) 3D T2W contrast sequence scans combined with clinical parameters (CP) to predict neoadjuvant chemoradiotherapy (nCRT) response in patients with locally advanced rectal carcinoma [...] Read more.
(1) Background: This study aimed to develop a machine learning model based on radiomics of pretreatment magnetic resonance imaging (MRI) 3D T2W contrast sequence scans combined with clinical parameters (CP) to predict neoadjuvant chemoradiotherapy (nCRT) response in patients with locally advanced rectal carcinoma (LARC). The study also assessed the impact of radiomics dimensionality on predictive performance. (2) Methods: Seventy-five patients were prospectively enrolled with clinicopathologically confirmed LARC and nCRT before surgery. Tumor properties were assessed by calculating 2141 radiomics features. Least absolute shrinkage selection operator (LASSO) and multivariate regression were used for feature selection. (3) Results: Two predictive models were constructed, one starting from 72 CP and 107 radiomics features, and the other from 72 CP and 1862 radiomics features. The models revealed moderately advantageous impact of increased dimensionality, with their predictive respective AUCs of 0.86 and 0.90 in the entire cohort and 0.84 within validation folds. Both models outperformed the CP-only model (AUC = 0.80) which served as the benchmark for predictive performance without radiomics. (4) Conclusions: Predictive models developed in this study combining pretreatment MRI radiomics and clinicopathological features may potentially provide a routine clinical predictor of chemoradiotherapy responders, enabling clinicians to personalize treatment strategies for rectal carcinoma. Full article
(This article belongs to the Special Issue Anorectal Disease: Current Challenges in Diagnosis and Treatment)
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13 pages, 1571 KiB  
Article
Assessment of Quality of Life in Patients with Chronic Anal Fissures: A 1-Year Follow-Up Study before and after Botulinum Toxin (Botox) Injection
by Sonia-Roxana Burtic, Luca Castiglione, Marius Murariu, Ovidiu Rosca, Catalin Dumitru and Octavian Neagoe
J. Clin. Med. 2024, 13(2), 316; https://doi.org/10.3390/jcm13020316 - 5 Jan 2024
Viewed by 1744
Abstract
This longitudinal study aimed to assess the quality of life in patients with anal fissures treated with botulinum toxin (Botox) injections over a one-year period. The study hypothesized that Botox injections would significantly improve quality of life and that these improvements would be [...] Read more.
This longitudinal study aimed to assess the quality of life in patients with anal fissures treated with botulinum toxin (Botox) injections over a one-year period. The study hypothesized that Botox injections would significantly improve quality of life and that these improvements would be sustained over a year. Conducted as a cross-sectional study, it assessed adults diagnosed with chronic anal fissures unresponsive to conventional treatments. Participants received 25 U of Botox in two sessions and their quality of life was assessed using the WHOQOL-BREF, COPE-60, Hospital Anxiety and Depression Scale (HADS), and SF-36 surveys. Data were collected at baseline six months and one year post-treatment. The study involved 113 patients, with a mean age of 38.1 years. Significant improvements were observed in the WHOQOL-BREF scores across all domains from baseline to 12 months (physical domain: 49.4 ± 10.5 to 70.2 ± 10.6, p < 0.001; mental domain: 34.8 ± 11.2 to 61.9 ± 11.5, p < 0.001). SF-36 scores also showed significant enhancements in physical and mental health components (physical: 44.3 ± 7.5 to 56.9 ± 5.9, p < 0.001; mental: 41.1 ± 7.2 to 54.4 ± 6.3, p < 0.001). Additionally, significant improvements were noted in patient perception on quality of life from the perspective of various aspects including physical discomfort, pain management, and mood and emotional well-being. The study demonstrated that Botox injections significantly improved the quality of life in patients with chronic anal fissures, with sustained benefits observed over a year. These findings suggest Botox as an effective treatment modality for enhancing life quality in patients with this condition, highlighting the potential for broader applications in managing chronic anal fissures. Full article
(This article belongs to the Special Issue Anorectal Disease: Current Challenges in Diagnosis and Treatment)
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