Background Anal canal carcinoma (ACC) is reported to be a rare cancer worldwide. In Japan, while the incidence rate is similarly low compared to Western countries, its histological distribution differs. This paper aimed to clarify the epidemiological characteristics of ACC, particularly anal canal squamous cell carcinoma (SCC), in Japan and to compare them with Western data. Methods The epidemiological data were taken from the Japanese Society for Cancer of the Colon and Rectum (JSCCR) registry and a nationwide multi-institutional study. Clinicopathological features, human papillomavirus (HPV) status, treatment trends, and survival were analyzed. The comparative data were derived from major Western registry studies. Results In Japan, adenocarcinoma accounted for 66.8–75.5% of the ACC cases, while SCC represented only 16.2–24.4%, in contrast to the 70–85% SCC predominance reported in Western countries. Among Japanese SCC cases, women accounted for 71.5%, a higher proportion than in Western countries. HPV was positive in 85% of the SCC cases, with HPV-16 as the most prevalent genotype, which is consistent with global patterns. The adoption of chemoradiotherapy (CRT) increased from 14% in the 1990 s to over 80% after 2010, achieving survival outcomes comparable to surgery. Conclusions In Japan, adenocarcinoma was the predominant type of ACC, while SCC was less common. However, the characteristics of HPV-associated SCC were similar to those observed in Western countries. Standardization of classification and staging criteria and the expansion of HPV vaccination may be essential to improve clinical management and facilitate international comparisons.
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In 2024, the second edition of the Japan Society of Coloproctology (JSCP) Practice Guidelines for Fecal Incontinence was published in Japan, followed by the release of this English version. This marks the first major revision in 7 years since the publication of the first edition. The second edition was completed over a span of 3 years, and its overview and key features are summarized below. This guideline begins with a clinical flowchart outlining the general diagnostic and therapeutic approach. A notable update is the inclusion of insertable anal and vaginal continence devices, which are now considered a form of conservative therapy under clinical research frameworks. In Chapter I-B (Epidemiology), the prevalence of anal incontinence was newly reported: among a Japanese population with an average age of 35 years, 15.5% of men and 42.7% of women were affected. In Chapter II (Diagnosis), the utility of a bowel diary for patient assessment is discussed for the first time. The guideline also provides a detailed description of the evaluation method for digital rectal examination. Additionally, a new section was added addressing incontinence-associated dermatitis (IAD), including its risks and methods of assessment. In Chapter III (Diagnostic Testing), the guideline expands upon previously established diagnostic tests by newly including detailed descriptions of ultrasound techniques-specifically, endoanal ultrasound, transperineal ultrasound, and transvaginal ultrasound. Chapter IV (Treatment) outlines conservative treatment strategies, including dietary guidance, bowel habit instruction, and care for fecal incontinence. Pharmacologic therapies are presented with itemized explanations by drug type. Pelvic floor muscle training, biofeedback therapy, and transanal irrigation are classified under "specialized conservative therapies" and discussed in detail. For surgical treatment, a new Clinical Question (CQ) addresses postpartum fecal incontinence. It recommends early referral to a specialized center when a sphincter injury is present to be repaired, whereas observation for one year may be appropriate when no injury is identified. Another new CQ discusses the mode of delivery in subsequent pregnancies following obstetric anal sphincter injuries (OASIS), emphasizing the need to evaluate fecal incontinence severity, anal sphincter function, and its integrity before making clinical decisions. Stoma creation is described in detail as one of the surgical treatment options, including its implications for improved postoperative quality of life. For the first time, regenerative therapy for the anal sphincter is introduced as a novel surgical option, reporting promising long-term outcomes from trials involving the transplantation of autologous cultured myoblasts into the external anal sphincter. Finally, Chapter V addresses special clinical scenarios in detail, including fecal incontinence associated with neurological and spinal disorders, dementia, frailty, and bedridden elderly patients.
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肛門管癌は稀な疾患であり，本邦においても発生率は低い状況である．肛門管癌の組織型は，欧米では多くが扁平上皮癌であるのに対し，本邦では多くが腺癌症例である．一方，肛門管扁平上皮癌におけるHPV感染に関しては，本邦においても欧米と同様にHPV陽性率は高率であり，遺伝子型はHPV-16が最も高率である．また，肛門管癌は発生部位や組織型によって適応される規約や治療戦略が異なり，本邦では直腸型腺癌については大腸癌と同様に『大腸癌取扱い規約第9版』が用いられ，扁平上皮癌，肛門腺由来の癌，痔瘻癌についてはUICCのTNM分類第8版が用いられている．治療に関しては，腺癌症例では手術療法が主治療法となるのに対し，扁平上皮癌症例では化学放射線療法が主治療法となる．ただし，肛門管癌に関する報告は本邦はもとより国際的にも少ないため，今後更なる症例を蓄積して，適切な規約と治療ガイドラインを作成することが重要である．
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直腸癌と肛門管癌の国際的病期分類として，UICC・AJCCのTNM分類が用いられており，治療に関してはNCCNガイドラインが用いられている．日本では大腸癌取扱い規約と大腸癌治療ガイドラインが用いられているが，肛門管癌取扱い規約は無い．そこで，大腸癌研究会プロジェクト研究として『肛門管癌の病態解明とStagingに関する研究』を実施し，本邦の肛門管癌症例を多施設から収集して解析を行った．その結果，欧米では多くが扁平上皮癌であるのに対し，本邦では多くが腺癌症例であった．一方，肛門管扁平上皮癌におけるHPV感染に関しては，本邦においても欧米と同様にHPV陽性率は非常に高率であり，遺伝子形はHPV-16が最も高率であった．また，Stagingに関しては，T4症例をT4a（腫瘍径が5cm以下）とT4b（腫瘍径が5cmを超える）に細分類すると明らかに予後に相違があり，T4の細分類を反映したStagingが考慮される．これらに基づき，本邦における肛門管癌のStagingと適切な治療方針を提案し，臨床へ還元していくことが重要である．
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【目的】平時および熊本地震発生時（2016年4月）のオストメイトの実態を明らかにするとともに、今後の災害発生時に役立つオストメイト支援アプリを開発すること。 【方法】熊本県在住オストメイト2,265人を対象に、2018年8月末時点の現況および熊本地震の経験について郵送法にてアンケート調査を実施した。その結果を踏まえて支援アプリを開発した。 【結果】1,022人（45.1％）から回答を得た。平均年齢73.8歳、ストーマ保有平均期間9.4年であった。平時にはセルフケアが68.6％、医療従事者によるケアが14.4％で、35.0％がストーマに関するトラブルを抱えていた。22.1％はトラブル時の相談先を有さず、相談先を有さなくなる時期の目安は術後6年であった。熊本地震では21.1％が自宅外に避難し、27.8％がストーマに関するトラブルを経験していた。緊急支援物資などの情報は不足し、装具交換場所の確保が困難であった。これらの結果を踏まえて、オストメイト支援アプリ「オストメイトまもるモン」を開発し、熊本県内で2024年1月より本格運用を開始した。 【結論】万が一の災害発生時に、支援側とオストメイトを繋ぐツールとして「オストメイトまもるモン」が活用され、ストーマケアに役立つことを期待する。
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Abstract Objectives:Conservativetreatment forhemorrhoidsmaybelong-term,but thereareonlyafewstudies that have reportedon the long-termuse of corticosteroid-containingpreparations. Therefore, the aimof this studywas toconduct aclinical investigation into the long-termuseandsafetyofKilledEscherichiacoli suspension-hydrocortisonecombinationointment for thetreatmentofhemorrhoids. Methods:Areviewof578hemorrhoidpatientswhoexperiencedanadversereactiontoKilledEscherichia coli suspension-hydrocortisone combinationointment at ColoproctologyCenter TakanoHospital between June2019andDecember2019wasconducted. Results:Of the578patients included in theanalysis, 430patients (74.4%) had internal hemorrhoids and themediandurationfromthedateof initialdiagnosiswas0.70months.Themedianprescriptionperiodof patients treatedwithKilledEscherichiacoli suspension-hydrocortisonecombinationointmentwas20days, andnoadverse reactionswereobserved.When theprescriptionperiodof patients treatedwithKilledEscherichiacoli suspension-hydrocortisonecombinationointmentwascategorizedintoawithin30-dayperiod (n=332),a31-90-dayperiod(n=63), anda 91-dayperiod(n=23), themediandiseasedurationat initialdiagnosiswas0.46months,1.00months, and8.00months, respectively.Thesefindings indicate that theprescriptionperiodtendedtobelongerasthediseasedurationincreased. Conclusions: Inthisstudy, theonsetofadversereactions totheuseofKilledEscherichiacoli suspensionhydrocortisonecombinationointment inthetreatmentofhemorrhoidscouldnotbeconfirmed.Furtherstudiestoinvestigatethesafetyof thelong-termuseof thistreatmentneedstobeconducted.
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Abstract

Crohn's disease (CD) causes gastrointestinal symptoms (i.e., diarrhea and abdominal pain), systemic symptoms (i.e., fatigue, anemia, weight loss, and fever), and perianal fistulas that produce anal pain. Because of the frequent occurrence of diarrhea and ulcers in the rectum, CD is often exacerbated by perianal abscesses and/or fistulas. Perianal fistulizing CD (PFCD) has an unknown etiology and recurring symptoms such as pain and discharge, which seriously affects the patient's quality of life (QOL). In the past, radical surgery was performed for PFCD, but due to the risk of anal sphincter impairment, conservative therapy using antibiotics and immunosuppressive medications is currently the first treatment option. PFCD management has greatly improved with the use of biologics such as the antitumor necrosis factor alpha (TNF-α) antibodies infliximab and adalimumab. In this review, the results of the administration of anti-TNF-α (certolizumab pegol), anti-interleukin-12/23 (ustekinumab), and anti-α4β7 integrin antibodies (vedolizumab) were evaluated. Our investigation showed that these medications may be effective for maintenance therapy to prevent the recurrence of anal fistulas. In addition to biologics, molecular target drugs and even regenerative medicine using mesenchymal stem cells have been introduced to further expand the treatment options for consideration by medical personnel. We herein discuss the management of PFCD by focusing on studies conducted in the United States and Europe where researchers used recommended guidelines and consensus statements to evaluate the efficacy of each medication and published their findings in peer-reviewed journals.

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