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Khedr EME, Tarek M, NasrEl-Din HM, Abdelsattar AH, Abdelazim O. Laparoscopic-assisted Combined Abdominal and Sacral Approach for Sacrococcygeal Teratoma Altman II/III Excision: Case Series. J Indian Assoc Pediatr Surg 2025; 30:215-219. [PMID: 40191490 PMCID: PMC11968056 DOI: 10.4103/jiaps.jiaps_174_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 10/23/2024] [Accepted: 11/14/2024] [Indexed: 04/09/2025] Open
Abstract
Context This study aims to optimize patient outcomes and surgical efficacy by integrating laparoscopic and sacral approaches for the excision of presacral teratomas, focusing on Altman type II-III classifications. Methods A case series was conducted with seven patients diagnosed with sacrococcygeal teratoma (SCT) Altman type II-III. Short- and intermediate-term surgical outcomes were assessed following a combined laparoscopic and sacral approach. The diagnosis was based on clinical examination, elevated serum alpha-fetoprotein levels, and preoperative pelvic magnetic resonance imaging classification. The study evaluates the safety and efficacy of this surgical method, emphasizing feasibility and potential benefits for treating presacral teratomas of varying complexity. Results The age of patients ranged from 8 days to 1.5 years, with a mean age of 115.93 ± 192.3 days. The average duration of surgery was 2.7 h (range: 2-3.15 h), with no intraoperative bleeding. Postoperative recovery was smooth; 71.43% of patients resumed a full diet within 3 days, while the remaining patients did so within 4 days. One patient experienced mild skin erythema, managed conservatively, and two patients had perineal wound separation, resolved with topical treatment. The median hospital stay was 7 days (range: 5-78 days). No postoperative urinary or stool incontinence was observed. Conclusions The combined laparoscopic and posterior sacral approach is a safe and reliable method for the excision of SCTs, potentially improving patient outcomes and reducing postoperative complications.
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Affiliation(s)
| | - Mahmoud Tarek
- Department of Paediatric Surgery, Cairo University Specialized Paediatric Hospital, Cairo University, Giza, Egypt
| | - Hadeer Mohamed NasrEl-Din
- Department of Paediatric Surgery, Cairo University Specialized Paediatric Hospital, Cairo University, Giza, Egypt
| | - Ayman Hussein Abdelsattar
- Department of Paediatric Surgery, Cairo University Specialized Paediatric Hospital, Cairo University, Giza, Egypt
| | - Osama Abdelazim
- Department of Paediatric Surgery, Cairo University Specialized Paediatric Hospital, Cairo University, Giza, Egypt
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Kubetsky YE, Labzina EE, Kosimshoev MA, Kholtobin DP, Khalepa RV, Nabiev AO, Rzaev DA. [Laparoscopic resection of neurogenic presacral tumors]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2025; 89:59-67. [PMID: 39907668 DOI: 10.17116/neiro20258901159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2025]
Abstract
Laparoscopic approach is common in pelvic tumor surgery. Several small samples of patients after laparoscopic resection of presacral neurogenic tumors were described. Safety and advantages of this intervention are interesting. OBJECTIVE To analyze clinical outcomes of laparoscopic resection of presacral neurogenic tumors. MATERIAL AND METHODS Eleven patients including 2 children aged 11 and 17 years underwent laparoscopic tumor resection between 2021 and 2024. We estimated tumor size and localization, surgery time, blood loss, complications, postoperative hospital-stay, histological diagnosis and continued growth or recurrence in the follow-up period. The median follow-up was 19.2 (3-36) months. RESULTS Tumor size ranged from 4 to 10 cm, mean surgery time - 153.6 min, blood loss - 356.4 ml. Postoperative complications developed in 7 patients, including acute urinary retention, neuropathic pain syndrome, hematomas and dynamic intestinal obstruction. Total resection was achieved in 8 (72.7%) patients, subtotal resection - 2 (18.2%), partial resection - 1 (9.1%) case. Tumors were predominantly neurogenic: 6 (54.5%) - sacral nerve schwannomas, 1 (9%) - NF1-related schwannomatosis, 1 (9%) - meningioma, 1 (9%) - ganglioneuroma, 1 (9%) - fibromyxoid sarcoma, 1 (9%) - solitary fibrous tumor. There were no recurrences, continued growth or recurrence of preoperative symptoms in the follow-up period. CONCLUSION Laparoscopic resection of presacral neurogenic tumors is an effective surgical technique with good visualization of surgical field and possible gross total resection.
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Affiliation(s)
- Y E Kubetsky
- Federal Neurosurgical Center, Novosibirsk, Russia
| | - E E Labzina
- Novosibirsk National Research State University, Novosibirsk, Russia
| | | | | | - R V Khalepa
- Federal Neurosurgical Center, Novosibirsk, Russia
- Novosibirsk State Medical University, Novosibirsk, Russia
| | - A O Nabiev
- Avicenna Medical Center, Novosibirsk, Russia
| | - D A Rzaev
- Federal Neurosurgical Center, Novosibirsk, Russia
- Novosibirsk National Research State University, Novosibirsk, Russia
- Novosibirsk State Medical University, Novosibirsk, Russia
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Chung JS, Kwak HD, Ju JK. Laparoscopic approach in the surgical treatment of large retrorectal tumors: a short-term experience at a single tertiary center case series in Korea. JOURNAL OF MINIMALLY INVASIVE SURGERY 2024; 27:221-226. [PMID: 39675756 DOI: 10.7602/jmis.2024.27.4.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 08/26/2024] [Accepted: 09/01/2024] [Indexed: 12/17/2024]
Abstract
Retrorectal tumors, although rare, pose diagnostic and treatment challenges due to their nonspecific symptoms and complex anatomical location. This single-center case series reports short-term outcomes of laparoscopic transabdominal resection as a surgical approach for large retrorectal tumors. Between 2017 and 2020, five patients underwent this procedure. The median patient age was 53.2 years (range, 34-60 years), and the median operating time was 130 minutes (range, 95-205 minutes). All tumors were located in the retrorectal space. The median tumor size was 5.8 × 4.3 cm (range, 3.5-7.5 cm). Biopsy results included epidermoid cysts, tailgut cyst, lipoma, and keratinous cyst. The median hospital stay was 7.8 days (range, 5-11 days), and the median follow-up duration was 78.0 days (range, 14-219 days). One patient developed a postoperative surgical site infection. Overall, laparoscopic transabdominal resection appears to be a minimally invasive and effective treatment option for retrorectal tumors.
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Affiliation(s)
- Jun Seong Chung
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Han Deok Kwak
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Kyun Ju
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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Lin C, Wang ZY, Wang PP, Xu KW, Zhou JL, Qiu HZ, Wu B. Risk factors for long-term urination and sexual function impairment following laparoscopic resection of presacral lesions. Heliyon 2024; 10:e38756. [PMID: 39512315 PMCID: PMC11541431 DOI: 10.1016/j.heliyon.2024.e38756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 09/13/2024] [Accepted: 09/29/2024] [Indexed: 11/15/2024] Open
Abstract
Background Presacral cysts are rare congenital lesions predominantly affecting females. Surgery is often recommended after diagnosis due to the risk of malignant transformation and complications associated with cyst enlargement. Laparoscopic excision is increasingly favored due to its enhanced visualization and precision. Aim To assess long-term urinary, sexual function outcomes and quality of life in female patients undergoing laparoscopic resection of presacral cysts. Methods We conducted a retrospective review of female patients who underwent laparoscopic resection of presacral cysts between August 2012 and May 2020. Patient demographics, surgical outcomes, and postoperative complications were analyzed. The urinary function was assessed using the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Module (ICIQ-FLUTS), the sexual function was evaluated using the Female Sexual Function Index (FSFI), and quality of life was assessed using the 36-item Short-Form Health Survey (SF-36). Results Among the 32 female patients included, 10 experienced postoperative urinary incontinence, predominantly of the mixed type. The risk factors for urinary incontinence included abdominal distension and the proximity of the cyst to the rectum. Notably, urinary incontinence significantly impacted the overall lower urinary tract symptoms and quality of life. Additionally, seven patients reported postoperative sexual dysfunction, with previous abdominal or pelvic surgery and cyst location under S3 identified as risk factors, affecting the mental health aspects of their quality of life. Conclusion Laparoscopic cyst resection in females poses risks of urinary and sexual dysfunction, potentially impacting quality of life. Thus, tailored management approaches are crucial.
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Affiliation(s)
| | | | - Pei-Pei Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Kai-Wen Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jiao-Lin Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Hui-Zhong Qiu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Bin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
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Fechner K, Bittorf B, Langheinrich M, Weber K, Brunner M, Grützmann R, Matzel KE. The management of retrorectal tumors - a single-center analysis of 21 cases and overview of the literature. Langenbecks Arch Surg 2024; 409:279. [PMID: 39276267 PMCID: PMC11401784 DOI: 10.1007/s00423-024-03471-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 09/04/2024] [Indexed: 09/16/2024]
Abstract
AIM Retrorectal tumors are rare and heterogeneous. They are often asymptomatic or present with nonspecific symptoms, making management challenging. This study examines the diagnosis and treatment of retrorectal tumors. METHODS Between 2002 and 2022, 21 patients with retrorectal tumors were treated in our department. We analyzed patient characteristics, diagnosis and treatment modalities retrospectively. Additionally, a literature review (2002-2023, "retrorectal tumors" and "presacral tumors", 20 or more cases included) was performed. RESULTS Of the 21 patients (median age 54 years, 62% female), 17 patients (81%) suffered from benign lesions and 4 (19%) from malignant lesions. Symptoms were mostly nonspecific, with pain being the most common (11/21 (52%)). Diagnosis was incidental in eight cases. Magnetic resonance imaging was performed in 20 (95%) and biopsy was obtained in 10 (48%). Twenty patients underwent surgery, mostly via a posterior approach (14/20 (70%)). At a mean follow-up of 42 months (median 10 months, range 1-166 months), the local recurrence rate was 19%. There was no mortality. Our Pubmed search identified 39 publications. CONCLUSION Our data confirms the significant heterogeneity of retrorectal tumors, which poses a challenge to management, especially considering the often nonspecific symptoms. Regarding diagnosis and treatment, our data highlights the importance of MRI and surgical resection. In particular a malignancy rate of almost 20% warrants a surgical resection in case of the findings of a retrorectal tumour. A local recurrence rate of 19% supports the need for follow up.
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Affiliation(s)
- K Fechner
- Department of Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Krankenhausstraße 12, D-91054, Erlangen, Germany.
| | - B Bittorf
- Department of Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Krankenhausstraße 12, D-91054, Erlangen, Germany
| | - M Langheinrich
- Department of General, Thoracic and Vascular Surgery, Greifswald University, Ferdinand-Sauerbruch-Straße, Greifswald, Germany
| | - K Weber
- Department of Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Krankenhausstraße 12, D-91054, Erlangen, Germany
| | - M Brunner
- Department of Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Krankenhausstraße 12, D-91054, Erlangen, Germany
| | - R Grützmann
- Department of Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Krankenhausstraße 12, D-91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
- Comprehensive Cancer Center Alliance WERA (CCC WERA), Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - K E Matzel
- Department of Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Krankenhausstraße 12, D-91054, Erlangen, Germany
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Shbani A, Suleiman Q, Suleiman F. A rare case of benign retrorectal teratoma in an adult female: Diagnostic challenges and successful surgical management. Int J Surg Case Rep 2024; 122:110052. [PMID: 39067097 PMCID: PMC11562400 DOI: 10.1016/j.ijscr.2024.110052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION Retrorectal tumors are rare growths with various types which are found in the space behind the rectum. They can be diverse and are often diagnosed through imaging and surgery. PRESENTATION A 31-year-old female patient came to the clinic with concerns about irregular periods and constipation, but no history of abdominal pain, pelvic pressure, or weight loss. She had a previous surgery to remove an ovarian teratoma when she was three months old. Physical exams and lab tests showed no significant findings, except for a pelvic ultrasound that revealed a normal right ovary with a small follicle and a missing left ovary due to prior surgery for a dermoid cyst. Another cyst, measuring 8.2 × 9.3 × 5.7 cm, was found behind the uterus, believed to be a presacral cyst possibly originating from elsewhere. Further investigation with a CT scan confirmed the presence of a large cyst near the rectum, leading to an open surgical procedure to remove it. The cyst, located deep behind the rectum and next to the levator ani muscle, contained a substance resembling cheese with hair, suggesting a benign dermoid cyst with granulation tissue. The surgery was successful, and the diagnosis was confirmed through histopathological analysis. DISCUSSION Retrorectal teratomas are rare germ cell tumors that mainly affect children, often presenting with vague symptoms like constipation. Diagnosis involves imaging tests like ultrasound, CT scans, and MRI, with surgical removal being the primary treatment option. Recurrence rates are low with complete excision of benign tumors. CONCLUSION Retrorectal or presacral teratomas are rare tumors with vague symptoms, making diagnosis difficult. They are often detected late and require radiological assessment for surgical planning. Treatment success hinges on a coordinated effort by skilled radiologists and surgeons specializing in pelvic and oncological care to ensure favorable outcomes with lower recurrence rates and risks.
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Affiliation(s)
| | - Qamar Suleiman
- Tartous university, Faculty of Medicine, Tartous, Syrian Arab Republic
| | - Fadi Suleiman
- Department of General surgery, Tartous University, Tartous, Syrian Arab Republic.
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7
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Pan ZK, Wu MH, Ye JS. Retrorectal teratoma: A case report with insight on treatment and outcomes. Asian J Surg 2024; 47:3648-3649. [PMID: 38653694 DOI: 10.1016/j.asjsur.2024.04.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
- Zhen-Kun Pan
- Department of General Surgery, Beijing Yanqing Hospital of Traditional Chinese Medicine, Beijing, China
| | - Meng-Hua Wu
- Department of Urology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jin-Sheng Ye
- Department of General Surgery/Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
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Bardol T, Souche R, Druet C, Bertrand MM, Ferrandis C, Prudhomme M, Borie F, Fabre JM. Minimally invasive approach for retrorectal tumors above and below S3: a multicentric tertiary center retrospective study (MiaRT study). Tech Coloproctol 2024; 28:67. [PMID: 38860990 PMCID: PMC11166785 DOI: 10.1007/s10151-024-02938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/15/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Retrorectal tumors are uncommon lesions developed in the retrorectal space. Data on their minimally invasive resection are scarce and the optimal surgical approach for tumors below S3 remains debated. METHODS We performed a retrospective review of consecutive patients who underwent minimally invasive resection of retrorectal tumors between 2005 and 2022 at two tertiary university hospital centers, by comparing the results obtained for lesions located above or below S3. RESULTS Of over 41 patients identified with retrorectal tumors, surgical approach was minimally invasive for 23 patients, with laparoscopy alone in 19, with transanal excision in 2, and with combined approach in 2. Retrorectal tumor was above S3 in 11 patients (> S3 group) and below S3 in 12 patients (< S3 group). Patient characteristics and median tumor size were not significantly different between the two groups (60 vs 67 mm; p = 0.975). Overall median operative time was 131.5 min and conversion rate was 13% without significant difference between the two groups (126 vs 197 min and 18% vs 8%, respectively; p > 0.05). Final pathology was tailgut cyst (48%), schwannoma (22%), neural origin tumor (17%), gastrointestinal stromal tumor (4%), and other (19%). The 90-day complication rates were 27% and 58% in the > S3 and < S3 groups, respectively, without severe morbidity or mortality. After a median follow-up of 3.3 years, no recurrence was observed in both groups. Three patients presented chronic pain, three anal dysfunction, and three urinary dysfunction. All were successfully managed without reintervention. CONCLUSIONS Minimally invasive surgery for retrorectal tumors can be performed safely and effectively with low morbidity and no mortality. Laparoscopic and transanal techniques alone or in combination may be recommended as the treatment of choice of benign retrorectal tumors, even for lesions below S3, in centers experienced with minimally invasive surgery.
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Affiliation(s)
- T Bardol
- Digestive and Minimally Invasive Surgery Unit, Montpellier University Hospital, University of Montpellier-Nîmes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France.
| | - R Souche
- Digestive and Minimally Invasive Surgery Unit, Montpellier University Hospital, University of Montpellier-Nîmes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - C Druet
- Department of Digestive and Oncological Surgery, Nîmes University Hospital, Montpellier-Nîmes University, Montpellier, France
| | - M M Bertrand
- Department of Digestive and Oncological Surgery, Nîmes University Hospital, Montpellier-Nîmes University, Montpellier, France
| | - C Ferrandis
- Digestive and Minimally Invasive Surgery Unit, Montpellier University Hospital, University of Montpellier-Nîmes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - M Prudhomme
- Department of Digestive and Oncological Surgery, Nîmes University Hospital, Montpellier-Nîmes University, Montpellier, France
| | - F Borie
- Department of Digestive and Oncological Surgery, Nîmes University Hospital, Montpellier-Nîmes University, Montpellier, France
| | - J-M Fabre
- Digestive and Minimally Invasive Surgery Unit, Montpellier University Hospital, University of Montpellier-Nîmes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
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Kobayashi T, Ishida M, Miki H, Yagyu T, Hatta M, Hamada M, Hirose Y, Sekimoto M. Analysis of the clinicopathological features of tailgut cyst with emphasis on the development of neoplastic lesions. Oncol Lett 2024; 27:286. [PMID: 38736740 PMCID: PMC11083925 DOI: 10.3892/ol.2024.14419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Tailgut cyst is a rare congenital cyst occurring in the retrorectal space and development of neoplastic lesions in tailgut cyst has been reported. Due to the rarity of the tumor, the histogenesis of neoplastic lesions in tailgut cyst has remained elusive. In the present study, the clinicopathological features of tailgut cyst were analyzed with a particular focus on the development of neoplastic lesions. The clinicopathological features of four patients with tailgut cyst (one female and three males) were retrospectively reviewed. No symptoms were present in two patients. Perineal discomfort, and constipation and urinary retention, were described in the other two patients, respectively. Magnetic resonance imaging showed that the cystic lesions were hypointense on T1- and hyperintense on T2-weigted images in all patients. Histopathological analysis revealed that all lesions were multilocular, and cystic walls were covered by squamous and ciliated epithelia without nuclear atypia. The development of neoplastic lesions was noted in two patients. Dysplastic change composed of piling-up proliferation of glandular cells with mild to moderate nuclear atypia was present in one patient, and invasive adenocarcinoma with a dysplasia component was observed in another patient. Dysplasia of the glandular cells, as seen in two patients in the present series, may be a precursor lesion of invasive adenocarcinoma; therefore, adenocarcinoma arsing in tailgut cyst may show a dysplasia-carcinoma sequence. While the reported incidence of neoplastic lesions in tailgut cysts is ~9% or less, their frequency remains to be accurately determined. Therefore, complete surgical resection is important for the management of patients with tailgut cyst. Additional clinicopathological and molecular studies with large cohorts may be required to clarify the histogenesis of neoplastic lesion in tailgut cyst.
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Affiliation(s)
- Toshinori Kobayashi
- Department of Surgery, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Mitsuaki Ishida
- Department of Pathology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka 569-8686, Japan
| | - Hisanori Miki
- Department of Surgery, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Takuki Yagyu
- Department of Surgery, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Masahiko Hatta
- Department of Surgery, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Madoka Hamada
- Department of Surgery, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
- Department of Gastrointestinal Surgery, Kansai Medical University Hospital, Hirakata, Osaka 573-1010, Japan
| | - Yoshinobu Hirose
- Department of Pathology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka 569-8686, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
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10
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Otote J, Butnari V, Ravichandran PS, Mansuri A, Ahmed M, Pestrin O, Rajendran N, Kaul S. Presacral tumors: A systematic review of literature. J Clin Imaging Sci 2024; 14:17. [PMID: 38841312 PMCID: PMC11152553 DOI: 10.25259/jcis_27_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
Presacral/Retrorectal tumors (RRT) are rare lesions that comprise a multitude of histological types. Data on surgical management are limited to case reports and small case series. The aim of the study was to provide a comprehensive review of the epidemiology, pathological subtypes, surgical approaches, and clinical outcomes. A PubMed search using terms "retrorectal tumor" and "presacral tumor" was used to identify articles reporting RRT of non-urological, non-gynecologic, and non-metastatic origin. Articles included were between 2015 and 2023. A total of 68 studies were included, comprising 570 patients. About 68.2% of patients were female, and the mean overall age of both sexes was 48.6 years. Based on histopathology, 466 patients (81.8%) had benign lesions, and 104 (18.2%) were malignant. In terms of surgical approach, 191 (33.5%) were treated anteriorly, 240 (42.1%) through a posterior approach, and 66 (11.6%) combined. The mean length of stay was 7.6 days. Patients treated using the posterior approach had a shorter length of stay (5.7 days) compared to the anterior and combined approaches. RRT are rare tumors of congenital nature with prevalence among the female sex. R0 resection is crucial in its management, and minimal access surgery appears to be a safer option in appropriate case selection.
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Affiliation(s)
- Jeffrey Otote
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Valentin Butnari
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Praveen Surya Ravichandran
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Ahmer Mansuri
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Mehnaz Ahmed
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Olivia Pestrin
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Nirooshun Rajendran
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Sandeep Kaul
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
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11
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Ferrari D, Violante T, Addison P, Perry WRG, Merchea A, Kelley SR, Mathis KL, Dozois EJ, Larson DW. Robotic resection of presacral tumors. Tech Coloproctol 2024; 28:49. [PMID: 38653930 DOI: 10.1007/s10151-024-02922-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/16/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Presacral tumors are a rare entity typically treated with an open surgical approach. A limited number of minimally invasive resections have been described. The aim of the study is to evaluate the safety and efficacy of roboticresection of presacral tumors. METHODS This is a retrospective single system analysis, conducted at a quaternary referral academic healthcare system, and included all patients who underwent a robotic excision of a presacral tumor between 2015 and 2023. Outcomes of interest were operative time, estimated blood loss, complications, length of stay, margin status, and recurrence rates. RESULTS Sixteen patients (11 females and 5 males) were included. The median age of the cohort was 51 years (range 25-69 years). The median operative time was 197 min (range 98-802 min). The median estimated blood loss was 40 ml, ranging from 0 to 1800 ml, with one patient experiencing conversion to open surgery after uncontrolled hemorrhage. Urinary retention was the only postoperative complication that occurred in three patients (19%) and was solved within 30 days in all cases. The median length of stay was one day (range 1-6 days). The median follow-up was 6.7 months (range 1-110 months). All tumors were excised with appropriate margins, but one benign and one malignant tumor recurred (12.5%). Ten tumors were classified as congenital (one was malignant), two were mesenchymal (both malignant), and five were miscellaneous (one malignant). CONCLUSIONS Robotic resection of select presacral pathology is feasible and safe. Further studies must be conducted to determine complication rates, outcomes, and long-term safety profiles.
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Affiliation(s)
- D Ferrari
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
- General Surgery Residency Program, University of Milan, Milan, Italy
| | - T Violante
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
- School of General Surgery, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - P Addison
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - W R G Perry
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - A Merchea
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - S R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - K L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - E J Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - D W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA.
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12
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Bilkhu AS, Wild J, Sagar PM. Management of retrorectal tumours. Br J Surg 2024; 111:znae012. [PMID: 38291005 DOI: 10.1093/bjs/znae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/06/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Amarvir S Bilkhu
- Colorectal & Peritoneal Oncology, The Christie Foundation NHS Trust, Manchester, UK
| | - Jonathan Wild
- Colorectal & Peritoneal Oncology, The Christie Foundation NHS Trust, Manchester, UK
| | - Peter M Sagar
- John Goligher Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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13
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Sandonà D, Grossi U, Vittadello F, Frasson A, Sarzo G, Zucchella M, Mammano E, Passuello N. Laparoscopic resection of a retrorectal cystic tumor. Tech Coloproctol 2023; 27:1405-1406. [PMID: 37131115 DOI: 10.1007/s10151-023-02806-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/12/2023] [Indexed: 05/04/2023]
Affiliation(s)
- D Sandonà
- Department of Surgery, Hospital Sant' Antonio, University of Padua, Padua, Italy
| | - U Grossi
- Surgery Unit 2, Regional Hospital Treviso, Piazzale dell'Ospedale 1, 31100, Treviso, Italy.
- Department of Surgery, Oncology and Gastroenterology-DISCOG, University of Padua, Padua, Italy.
| | - F Vittadello
- Department of Surgery, Hospital Sant' Antonio, University of Padua, Padua, Italy
| | - A Frasson
- Department of Surgery, Hospital Sant' Antonio, University of Padua, Padua, Italy
| | - G Sarzo
- Department of Surgery, Hospital Sant' Antonio, University of Padua, Padua, Italy
| | - M Zucchella
- Surgery Unit 2, Regional Hospital Treviso, Piazzale dell'Ospedale 1, 31100, Treviso, Italy
| | - E Mammano
- Department of Surgery, Hospital Sant' Antonio, University of Padua, Padua, Italy
| | - N Passuello
- Department of Surgery, Hospital Sant' Antonio, University of Padua, Padua, Italy
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14
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Salameh F, Gilshtein H, Abramov R, Ashkenazi I, Duek D. Transanal endoscopic microsurgery technique: an acceptable approach for retrorectal tumors. Tech Coloproctol 2023; 27:673-678. [PMID: 36645584 DOI: 10.1007/s10151-023-02753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Retrorectal lesions (RRLs) are rare lesions that originate from the tissue present in the retrorectal space. The gold standard of care is complete resection regardless of pathology. The traditional approaches (anterior, posterior, and combined) are relatively well described. Transanal Endoscopic Microsurgery (TEM) is a minimally invasive technique offered as an alternative approach for RRLs. AIM To evaluate the outcomes of patients diagnosed with RRL and treated by the TEM approach, especially postoperative complications, and the recurrence rate. METHODS Patients with RRLs treated with the TEM technique in one medical center between 2000 and 2020 were identified. Their postoperative outcomes were compared with historical controls. RESULTS Thirty-nine patients diagnosed with RRL were operated on using the TEM platform. Thirty-seven RRLs were benign, and two were malignant. Their median size (IQR) was 20 mm (15, 32.5). The median distance (IQR) from the anal verge was 50 mm (50, 72.5). The median operative time (IQR) was 48.5 min (41.75, 60). All, except one lesion, were completely resected. The median length of stay (IQR) was one day (1, 1 day). Postoperative complications were diagnosed in three patients, two of which resolved following a second operation. CONCLUSIONS The implementation of TEM for the resection of RRLs demonstrated excellent overall results with acceptable complication and recurrence rate and represented a viable alternative surgical approach.
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Affiliation(s)
- F Salameh
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel.
| | - H Gilshtein
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
| | - R Abramov
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
| | - I Ashkenazi
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
| | - D Duek
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
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15
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Moshtaghian M, Shahsiah R, Jafari F, Aghili M. Malignant transformation of tailgut cyst to squamous cell carcinoma, a rare case with poor outcome. Clin Case Rep 2023; 11:e6893. [PMID: 36777790 PMCID: PMC9900233 DOI: 10.1002/ccr3.6893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 02/08/2023] Open
Abstract
Tailgut cyst, a type of retro-rectal cyst, is a rare condition requiring evaluation for malignant transformation. We report a case of squamous cell carcinoma arising in the retro-rectal cyst, in a 51-year-old female who underwent incomplete resection of the cyst and chemo-radiotherapy, subsequently became locally recurred and metastatic.
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Affiliation(s)
- Mahsa Moshtaghian
- Cancer Research CenterIran Cancer InstituteImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Reza Shahsiah
- Department of PathologyTehran University of Medical SciencesTehranIran
| | - Fatemeh Jafari
- Cancer Research CenterIran Cancer InstituteImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Mahdi Aghili
- Cancer Research CenterIran Cancer InstituteImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
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16
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Brown IS, Sokolova A, Rosty C, Graham RP. Cystic lesions of the retrorectal space. Histopathology 2023; 82:232-241. [PMID: 35962741 DOI: 10.1111/his.14769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 12/24/2022]
Abstract
Cysts of the retrorectal space comprise a heterogeneous group of rare lesions. Most develop from embryological remnants and include tailgut cysts, dermoid cysts, rectal duplication cysts, anal canal duplication cysts, sacrococcygeal teratomas and anterior meningocoele. Tailgut cyst is the most common cyst of developmental origin, usually presenting as a multilocular cystic mass with mucoid content and lined by multiple epithelial types. Compared with tailgut cysts, rectal duplication cysts display all layers of the large bowel wall including a well-defined muscularis propria. Retrorectal cysts of non-developmental origin are far less common and represent lesions that either infrequently involve the retrorectal space or undergo extensive cystic change. This review provides an overview of the various histological types of cystic lesions of the retrorectal space, divided into cysts of developmental origin and those of non-developmental origin. A practical pathological and multidisciplinary approach to diagnosing these lesions is presented.
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Affiliation(s)
- Ian S Brown
- Envoi Specialist Pathologists, Brisbane, Queensland, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Anna Sokolova
- Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Christophe Rosty
- Envoi Specialist Pathologists, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
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17
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Malliou P, Syrnioti A, Koletsa T, Karlafti E, Karakatsanis A, Raptou G, Apostolidis S, Michalopoulos A, Paramythiotis D. Mucinous adenocarcinoma arising from a tailgut cyst: A case report. World J Clin Oncol 2022; 13:853-860. [PMID: 36337315 PMCID: PMC9630997 DOI: 10.5306/wjco.v13.i10.853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/12/2022] [Accepted: 10/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Retrorectal hamartomas or tailgut cysts (TCs) are rare. In most cases, they are asymptomatic and benign; however, rarely, they undergo malignant transformation, mainly in the form of adenocarcinoma. CASE SUMMARY A 55-year-old woman presented to our hospital with lower back pain. On magnetic resonance imaging, a large pelvic mass was found, which was located on the right of the ischiorectal fossa, extending to the minor pelvis. The patient underwent extensive surgical resection of the lesion through the right buttock. Histological examination confirmed the diagnosis of a retrorectal mucinous adenocarcinoma originating from a TC. Surgical resection of the tumour was complete, and the patient recovered without complications. The pilonidal sinus was then excised. One year later, semi-annual positron emission tomography-computed tomography and magnetic resonance imaging scans did not reveal any evidence of local recurrence or metastatic disease. CONCLUSION Preoperative recognition, histological diagnosis, and treatment of TCs pose significant challenges. In addition, the possibility of developing invasive mucinous adenocarcinoma, although rare, should be considered.
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Affiliation(s)
- Petra Malliou
- The First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki 54636, Greece
| | - Antonia Syrnioti
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Triantafyllia Koletsa
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Eleni Karlafti
- Department of Emergency, AHEPA University Hospital, Thessaloniki 54636, Greece
| | - Anestis Karakatsanis
- The First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki 54636, Greece
| | - Georgia Raptou
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Stylianos Apostolidis
- The First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki 54636, Greece
| | - Antonios Michalopoulos
- The First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki 54636, Greece
| | - Daniel Paramythiotis
- The First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki 54636, Greece
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18
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Agirlar Trabzonlu T, Modak M, Horowitz JM. MR Imaging of Mimics of Adnexal Pathology. Magn Reson Imaging Clin N Am 2022; 31:137-148. [DOI: 10.1016/j.mric.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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19
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Wang YS, Guo QY, Zheng FH, Huang ZW, Yan JL, Fan FX, Liu T, Ji SX, Zhao XF, Zheng YX. Retrorectal mucinous adenocarcinoma arising from a tailgut cyst: A case report and review of literature. World J Gastrointest Surg 2022; 14:1072-1081. [PMID: 36185552 PMCID: PMC9521465 DOI: 10.4240/wjgs.v14.i9.1072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/30/2022] [Accepted: 08/21/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tailgut cysts are defined as congenital cysts that develop in the rectosacral space from the residue of the primitive tail. As a congenital disease, caudal cysts are very rare, and their canceration is even rarer, which makes the disease prone to misdiagnosis and delayed treatment. We describe a case of caudal cyst with adenocarcinogenesis and summarize in detail the characteristics of cases with analytical value reported since 1990.
CASE SUMMARY A 35-year-old woman found a mass in her lower abdomen 2 mo ago. She was asymptomatic at that time and was not treated because of the coronavirus disease 2019 pandemic. Two weeks ago, the patient developed abdominal distension and right waist discomfort and came to our hospital. Except for the high level of serum carcinoembryonic antigen, the medical history and laboratory tests were not remarkable. Magnetic resonance imaging showed a well-defined, slightly lobulated cystic-solid mass with a straight diameter of approximately 10 cm × 9 cm in the presacral space, slightly high signal intensity on T2-weighted imaging, and moderate signal intensity on T1-weighted imaging. The mass was completely removed by laparoscopic surgery. Histopathological examination showed that the lesion was an intestinal mucinous adenocarcinoma, and the multidisciplinary team decided to implement postoperative chemotherapy. The patient recovered well, the tumor marker levels returned to normal, and tumor-free survival has been achieved thus far.
CONCLUSION The case and literature summary can help clinicians and researchers develop appropriate examination and therapeutic methods for diagnosis and treatment of this rare disease.
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Affiliation(s)
- Yan-Shuai Wang
- Department of General Surgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
| | - Qing-Yun Guo
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, Zhejiang Province, China
| | - Fang-Hong Zheng
- Department of General Surgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
| | - Zi-Wei Huang
- Department of General Surgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
| | - Jia-Lang Yan
- Department of General Surgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
| | - Fu-Xiang Fan
- Department of General Surgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
| | - Tian Liu
- Department of Intensive Care Unit, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
| | - Shun-Xian Ji
- Department of Pathology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
| | - Xiao-Feng Zhao
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, Zhejiang Province, China
| | - Yi-Xiong Zheng
- Department of General Surgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
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20
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Gong J, Xu Y, Zhang Y, Qiao L, Xu H, Zhu P, Yang B. Primary malignant tumours and malignant transformation of cysts in the retrorectal space: MRI diagnosis and treatment outcomes. Gastroenterol Rep (Oxf) 2022; 10:goac048. [PMID: 36157328 PMCID: PMC9491843 DOI: 10.1093/gastro/goac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 06/11/2022] [Accepted: 07/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are no clear guidelines for the diagnosis and treatment of malignant retrorectal tumours. The purpose of this study was to increase preoperative diagnostic knowledge and to describe the outcomes of treatment for these patients. METHODS This retrospective study was conducted on patients who underwent complete retrorectal tumour resection between May 2006 and July 2018, and had confirmed post-operative pathology reports. Demographic and clinical data (including imaging, perioperative, pathological, and prognostic data) were collected and analysed. RESULTS Malignant lesions were identified in 15 (9 [60%], female) patients. The median age of the patients was 59 years (range, 34-72 years). Primary malignant tumours were identified in seven patients with solid tumours, in which gastrointestinal stromal tumours accounted for 71.4% (five of seven) and the remainder were chordoma or mucinous adenocarcinoma. Malignant transformation of cysts occurred in another eight patients with heterogeneous tumours, while histopathological features were present in 75% (six of eight) of patients with mucinous adenocarcinoma, and the remainder were squamous-cell carcinoma or neuroendocrine tumour (Grade 2). The malignant characteristics of the solid portions observed using magnetic resonance imaging (MRI) were as follows: the cyst wall of the tumour was irregularly thickened; the surface was convex or lobed; the solid tumour had no capsule, or the capsule was destroyed; and the surface had a gyrus-like morphology. At a median follow-up time of 52 months (range, 13-100 months), the overall recurrence-free survival rate was 40.0% and the survival rate was 46.7%. CONCLUSION Some MRI features can be used to distinguish malignant retrorectal tumours from benign retrorectal tumours. The survival rate of patients with malignant retrorectal tumours is poor.
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Affiliation(s)
- Jing Gong
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Yumeng Xu
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Yan Zhang
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Lichao Qiao
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Haixia Xu
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Ping Zhu
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Bolin Yang
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
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21
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Aldave D, Teijo A, Abril C, Cerezo L. Squamous cell carcinoma arising in a tailgut cyst: role of radiotherapy. BMJ Case Rep 2022; 15:e247985. [PMID: 39901389 PMCID: PMC9445786 DOI: 10.1136/bcr-2021-247985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/21/2022] Open
Abstract
Tailgut cysts (TGCs) are rare tumours which can undergo malignant transformation. The gold standard of treatment is complete surgical excision. Multidisciplinary assessment is advisable in order to apply adjuvant treatment. Postoperative radiotherapy should be given in case of compromised surgical margins or other factors such as high histological grade or perineural and lymphovascular invasion. Here, we present a case of a squamous cell carcinoma arising from a retrorectal TGC treated with surgery and postoperative radiotherapy and review the main indications and techniques of this therapy.
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Affiliation(s)
- Diego Aldave
- Radiation Oncology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Ana Teijo
- Pathology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Pathology, MD Anderson Madrid, Madrid, Spain
| | - Claudia Abril
- Pathology, Hospital Virgen de la Salud, Toledo, Spain
| | - Laura Cerezo
- Radiation Oncology, Hospital Universitario de la Princesa, Madrid, Spain
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22
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Burke JR, Shetty K, Thomas O, Kowal M, Quyn A, Sagar P. The management of retrorectal tumours: tertiary centre retrospective study. BJS Open 2022; 6:zrac044. [PMID: 35441209 PMCID: PMC9019068 DOI: 10.1093/bjsopen/zrac044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/03/2022] [Accepted: 02/13/2022] [Indexed: 11/12/2022] Open
Abstract
AIM Tumours of the retrorectal space are uncommon, pathologically heterogeneous, and difficult to diagnose, with ongoing controversy over their surgical management. The aim of this study was to evaluate the surgical management of a consecutive series of patients who had undergone excision of primary retrorectal tumours (PRRTs) at a tertiary referral centre. METHOD Patients were identified from a prospectively maintained database between 1 March 2001 and 1 August 2021. Electronic patient records were reviewed for demographics, preoperative imaging, operative details, histology, and follow-up. A chi-squared test was used to assess the statistical significance of findings. RESULTS A total of 144 patients were included in the study. Of these, 103 patients were female (71.5 per cent), 46 patients (31.9 per cent) presented incidentally, and 99 of the patients had tumours located below S3 (68.7 per cent). Overall, 76 patients underwent a transperineal approach (52.7 per cent) with the most common findings of a benign tailgut cyst occurring in 59 (40.9 per cent) of cases. Preoperative MRI predicted urovascular and pelvic sidewall involvement assessed intraoperatively with a sensitivity of 83.3 and 90 per cent and a specificity of 98.1 and 98 per cent respectively. Risk of malignancy in solid tumours was 31.4 versus 8.8 per cent in cystic tumours (relative risk 3.5, 95 per cent c.i. 1.6 to 7.6, P < 0.001). Major complications (Clavien-Dindo grade III and above) occurred in eight patients (5.6 per cent) and all-cause long-term mortality was 4.8 per cent (seven patients). DISCUSSION PRRTs can be safely excised with minimal complications in specialized centres by surgical teams with the relevant expertise. This study questions the conservative management of cystic tumours and given the risk of solid tumour malignancy, supports surgical management.
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Affiliation(s)
- Joshua R. Burke
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Kunal Shetty
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Owen Thomas
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Mikolaj Kowal
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Aaron Quyn
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Peter Sagar
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
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23
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Ortega-Checa D, Vojvodic-Hernández I, Rios-Quintana K. Tumor retrorrectal: Reporte de un caso de Schwannoma. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2025] Open
Abstract
Introducción. En el espacio retrorrectal o presacro pueden desarrollarse lesiones tumorales, tanto benignas como malignas. La mayoría de los pacientes son asintomáticos y, cuando presentan síntomas, éstos son inespecíficos. Entre los tumores retrorrectales se destaca el grupo de origen neurogénico, donde el Schwannoma es el más frecuente.
Caso clínico. Mujer de 32 años, con tumor retrorrectal, que producía una sintomatología escasa e imprecisa, diagnosticado durante una intervención quirúrgica por mioma uterino, que finalmente resultó ser un Schawnnoma.
Conclusión. La tomografía computarizada y la resonancia magnética son importantes para el diagnóstico y para establecer el nivel de la lesión en relación con el sacro. La piedra angular del tratamiento es la resección quirúrgica. El abordaje puede ser anterior (abdominal), posterior (perineal, transsacro o parasacrococígeo) o combinado, de acuerdo con su localización al nivel S4.
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24
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Wang PP, Lin C, Zhou JL, Xu KW, Qiu HZ, Wu B. Risk factors for perioperative complications in laparoscopic surgeries of retrorectal cystic lesions. World J Gastrointest Surg 2021; 13:1685-1695. [PMID: 35070073 PMCID: PMC8727184 DOI: 10.4240/wjgs.v13.i12.1685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/14/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of retrorectal lesions is low, and no consensus has been reached regarding the most optimal surgical approach. Laparoscopic approach has the advantage of minimally invasive. The risk factors influencing perioperative complications of laparoscopic surgery are rarely discussed. AIM To investigate the risk factors for perioperative complications in laparoscopic surgeries of retrorectal cystic lesions. METHODS We retrospectively reviewed the medical records of patients who underwent laparoscopic excision of retrorectal cystic lesions between August 2012 and May 2020 at our hospital. All surgeries were performed in the general surgery department. Patients were divided into groups based on the lesion location and diameter. We analysed the risk factors like type 2 diabetes mellitus, hypertension, the history of abdominal surgery, previous treatment, clinical manifestation, operation duration, blood loss, perioperative complications, and readmission rate within 90 d retrospectively. RESULTS Severe perioperative complications occurred in seven patients. Prophylactic transverse colostomy was performed in four patients with suspected rectal injury. Two patients underwent puncture drainage due to postoperative pelvic infection. One patient underwent debridement in the operating room due to incision infection. The massive-lesion group had a significantly longer surgery duration, higher blood loss, higher incidence of perioperative complications, and higher readmission rate within 90 d (P < 0.05). Univariate analysis, multivariate analysis, and logistic regression showed that lesion diameter was an independent risk factor for the development of perioperative complications in patients who underwent laparoscopic excision of retrorectal cystic lesions. CONCLUSION The diameter of the lesion is an independent risk factor for perioperative complications in patients who undergo laparoscopic excision of retrorectal cystic lesions. The location of the lesion was not a determining factor of the surgical approach. Laparoscopic surgery is minimally invasive, high-resolution, and flexible, and its use in retrorectal cystic lesions is safe and feasible, also for lesions below the S3 level.
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Affiliation(s)
- Pei-Pei Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Chen Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jiao-Lin Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Kai-Wen Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hui-Zhong Qiu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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25
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Balci B, Yildiz A, Leventoğlu S, Mentes B. Retrorectal tumors: A challenge for the surgeons. World J Gastrointest Surg 2021; 13:1327-1337. [PMID: 34950423 PMCID: PMC8649566 DOI: 10.4240/wjgs.v13.i11.1327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/26/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
Retrorectal or presacral tumors are rare lesions located in the presacral area and considered as being derived from multiple embryological remnants. These tumors are classified as congenital, neurogenic, osseous, inflammatory, or miscellaneous. The most common among these are congenital benign lesions that present with non-specific symptoms, such as lower back pain and change in bowel habit. Although congenital and developmental tumors occur in younger patients, the median age of presentation is reported to be 45 years. Magnetic resonance imaging plays a crucial role in treatment management through accurate diagnosis of the lesion, the evaluation of invasion to adjacent structures, and the decision of appropriate surgical approach. The usefulness of preoperative biopsy is still debated; currently, it is only indicated for solid or heterogeneous tumors if it will alter the treatment management. Surgical resection with clear margins is considered the optimal treatment; described approaches are transabdominal, perineal, combined abdominoperineal, and minimally invasive. Benign retrorectal tumors have favorable long-term outcomes with a low incidence of recurrence, whereas malignant tumors have a potential for distant organ metastasis in addition to local recurrence.
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Affiliation(s)
- Bengi Balci
- Department of General Surgery, Ankara Oncology Training and Research Hospital, Ankara 06060, Turkey
| | - Alp Yildiz
- Department of General Surgery, Ankara Yenimahalle Training and Research Hospital, Ankara 06370, Turkey
| | - Sezai Leventoğlu
- Department of Surgery, Gazi University Medical School, Ankara 06530, Turkey
| | - Bulent Mentes
- Department of General Surgery, Memorial Ankara Hospital, Ankara 06060, Turkey
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26
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Gould LE, Pring ET, Corr A, Fletcher J, Warusavitarne J, Burling D, Northover JMA, Jenkins JT. Evolution of the management of retrorectal masses: A retrospective cohort study. Colorectal Dis 2021; 23:2988-2998. [PMID: 34459085 DOI: 10.1111/codi.15893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/25/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023]
Abstract
AIM Retrorectal masses are abnormalities located anatomically in the retrorectal space. A significant proportion are asymptomatic with no malignant potential while others cause symptoms due to mechanical pressure or malignant infiltration. We reviewed and categorised the retrorectal masses encountered over a 30-year time period in a specialist colorectal hospital and describe our management algorithm for consideration by other multidisciplinary teams (MDT). METHODS This was a retrospective analysis of consecutive patients referred between 1984-2019. A detailed review of clinical presentation, imaging features, postoperative histology and impact on morbidity and anorectal function is reported. RESULTS A total of 143 patients with median age of 46 years and female preponderance (74%) were reviewed. The commonest presenting symptom was pain (46%) and all malignant cases had symptoms (n = 17). Over the last decade, more asymptomatic patients have presented with a retrorectal mass (33%, p = 0.04) and more patients are opting for surveillance rather than resection (33%, p = 0.013). Increasing age and lesion size were associated with malignancy (p < 0.05). Radiological features associated with malignancy included: solid/heterogeneous component, lobulated borders or locally invasive. Following surgery, complications included chronic pain (40%), poor wound healing (23%) and bowel dysfunction (10%). CONCLUSIONS The management of retrorectal masses remains complex. There are features, both clinical and radiological, that can help determine the best management strategy. Management should be in a high-volume tertiary centre and preferably through a complex rectal cancer MDT. Long-term sequelae such as chronic pain must be highlighted to patients. We advocate the establishment of an international registry to further record and characterise these rare, potentially troublesome lesions.
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Affiliation(s)
- Laura E Gould
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Edward T Pring
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Alison Corr
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Jordan Fletcher
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | | | - David Burling
- Department of Surgery and Cancer, Imperial College, London, UK
| | - John M A Northover
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - John T Jenkins
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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27
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Surgical Management of Retrorectal Tumors: A French Multicentric Experience of 270 Consecutives Cases. Ann Surg 2021; 274:766-772. [PMID: 34334645 DOI: 10.1097/sla.0000000000005119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report the largest multicentric experience on surgical management of retrorectal tumors (RRT). SUMMARY BACKGROUND DATA Literature data on RRT is limited. There is no consensus concerning the best surgical approach for the management of RRT. METHODS Patients operated for RRT in 18 academic French centers were retrospectively included (2000-2019). RESULTS 270 patients were included. Surgery was performed through abdominal (n=72, 27%), bottom (n=190, 70%) or combined approach (n=8, 3%). Abdominal approach was laparoscopic in 53/72 (74%) and bottom approach was a Kraske modified procedures in 169/190 (89%) patients. In laparoscopic abdominal group, tumors were more frequently symptomatic (37/53, 70% vs 88/169, 52%, p=0.02), larger (mean diameter = 60.5 ± 24 (range, 13-107) vs 51 ± 26 (20-105) mm, p=0.02) and located above S3 vertebra (n=3/42, 7% vs 0, p=0.001) than those from Kraske modified group. Laparoscopy was associated with a higher risk of postoperative ileus (n=4/53, 7.5% vs 0%, p=0.002) and rectal fistula (n=3/53, 6% vs 0%, p=0.01) but less wound abscess (n=1/53, 2% vs 24/169, 14%, p=0.02) than Kraske modified procedures. RRT was malignant in 8%. After a mean follow up of 27 ±39 (1-221) months, local recurrence was noted in 8% of the patients. After surgery, chronic pain was observed in 17% of the patients without significant difference between the 2 groups (15/74, 20% vs 3/30, 10%; p=0.3). CONCLUSIONS Both laparoscopic and Kraske modified approaches can be used for surgical treatment of RRT (according to their location and their size), with similar long-term results.
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28
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Willis MA, Enderes J, Exner D, Stoffels B, Tischler V, Luetkens J, Gonzalez-Carmona M, Egger EK, Kalff JC, Vilz TO. [Incidental finding of an intestinally differentiated adenocarcinoma in a tailgut cyst after robotic-assisted resection]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:677-682. [PMID: 34255316 DOI: 10.1055/a-1330-9194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Due to pelvic symptoms, a diagnostic sectional imaging was initiated in a 52-year-old female patient. This revealed a cystic, retrorectal mass, suspected to be a tailgut cyst. Due to the symptoms and the unclear dignity after several frustrating endosonographic punctures, a robotic-assisted resection of the cystic Tumor was performed after careful interdisciplinary consultation.The histological examination confirmed the diagnosis of a tailgut cyst but also revealed parts of an intestinally differentiated adenocarcinoma.Due to the unclear metastatic behaviour, robotic-assisted low anterior resection with total mesorectal excision was performed as oncological resection, similar to rectal carcinomas. No residuals or lymph node metastases were detectable in the histological examination, so that follow- up monitoring was recommended.Retrorectal tumours are an extremely rare entity, worldwide only 28 cases of an intestinally differentiated carcinoma in a tailgut cyst have been described so far. Since there are no clear recommendations in the literature regarding the diagnostic or therapeutic procedure, we would like to discuss a possible algorithm in case of a proven retrorectal mass in our case study.
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Affiliation(s)
- Maria Andrea Willis
- Klinik- und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn
| | - Jana Enderes
- Klinik- und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn
| | - Daniel Exner
- Klinik- und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn
| | - Burkhard Stoffels
- Klinik- und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn
| | | | - Julian Luetkens
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn
| | | | - Eva Katharina Egger
- Klinik für Gynäkologie und Gynäkologische Onkologie, Universitätsklinikum Bonn
| | - Jörg C Kalff
- Klinik- und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn
| | - Tim Oliver Vilz
- Klinik- und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn
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29
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El Yamine O, Fatine A, Boufettal R, Errguibi D, Hajri A, Rifki El Jay S, Chehab F. Retrorectal cystic hamartoma: A case report. Ann Med Surg (Lond) 2021; 66:102362. [PMID: 34040764 PMCID: PMC8141499 DOI: 10.1016/j.amsu.2021.102362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 11/03/2022] Open
Abstract
Introduction and importance: Retrorectal cystic hamartoma (RCH) is a rare congenital lesion of the presacral space, which is part of the vestigial cystic tumors often benign and predominantly in women. Generally asymptomatic, the appearance of symptoms such as pain or neurological disorders should raise suspicion of degeneration. Case presentation We report an unusual observation of a 62-year-old patient admitted for perineal pain evolving for 2 months associated with tenesma and chronic constipation. The digital rectal examination found a posterior bulge at 4 cm from the anal margin, without intraluminal lesion. Rectosigmoidoscopy had noted posterior extrinsic compression but no rectal tumor. Pelvic CT and MRI had shown a solidocystic formation of the retro-rectal and presacral spaces, related to an enteric cyst. The operation was performed by abdominal approach and the surgical exploration had found a bilobed cystic formation. The cystic mass was removed and the anatomopathological examination concluded that it was a cystic hamartoma with no sign of malignancy. Clinical discussion Retrorectal tumors develop in the space bounded anteriorly by the propria fascia of the rectum and posteriorly by the presacral fascia overlying the sacrum. Common in children and then often malignant, inversely, in adults, they are rare and most often benign tumors. They are generally asymptomatic with a predominance of females, unlike our observation where the patient was male with a symptomatology dominated by perineal pain and constipation. The discovery is incidental in the majority of cases, however, in some cases, these cysts may be revealed by complications. The lesion can be explored by transrectal or suprapubic ultrasound, MRI and CT scan. Rectoscopy and fistulography may complete the exploration in case of diagnostic doubt. The resection must be thorough and in monobloc because of the risk of recurrence and the approach depends on the location and the size of the lesion. Conclusion RCH is a rare benign lesion whose morphological characteristics seem quite stereotyped. A detailed postoperative anatomopathological examination allows the diagnosis to be made and, above all, to look for a site of malignant transformation. This is why a complete surgical removal is necessary to prevent recurrence.
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Affiliation(s)
- Othmane El Yamine
- Surgical Department of Cancerology and Liver Transplantation Universitary Hospital Center Casablanca morocco, Morocco
| | - Amine Fatine
- Surgical Department of Cancerology and Liver Transplantation Universitary Hospital Center Casablanca morocco, Morocco
| | - Rachid Boufettal
- Surgical Department of Cancerology and Liver Transplantation Universitary Hospital Center Casablanca morocco, Morocco
| | - Driss Errguibi
- Surgical Department of Cancerology and Liver Transplantation Universitary Hospital Center Casablanca morocco, Morocco
| | - Amal Hajri
- Surgical Department of Cancerology and Liver Transplantation Universitary Hospital Center Casablanca morocco, Morocco
| | - Saad Rifki El Jay
- Surgical Department of Cancerology and Liver Transplantation Universitary Hospital Center Casablanca morocco, Morocco
| | - Farid Chehab
- Surgical Department of Cancerology and Liver Transplantation Universitary Hospital Center Casablanca morocco, Morocco
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30
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Li Z, Lu M. Presacral Tumor: Insights From a Decade's Experience of This Rare and Diverse Disease. Front Oncol 2021; 11:639028. [PMID: 33796466 PMCID: PMC8008122 DOI: 10.3389/fonc.2021.639028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background Presacral tumors are a group of rare and heterogeneous tumors that arise from the potential presacral space between the rectum and sacrum. The low occurrence and diverse origins make the diagnosis and treatment of these tumors a challenge. The aim of the study was to retrospectively review patient demographics and to identify advantages and disadvantages in the diagnosis and treatment of these tumors. Methods Retrospectively collected and reviewed data from patients who received treatment of presacral tumors at the First Affiliated Hospital of China Medical University between August 2009 and June 2019. Results The data from forty-four patients (33 females) with a median age of 50 years who were diagnosed with a presacral/retrorectal tumor were analyzed. The majority of tumors were congenital (61.4%) and benign tumors are more common (59.1%). The median age of patients with benign tumor was significantly higher than that of malignant tumor. The most common symptoms were sacrococcygeal/perianal pain (56.8%) and mass (36.4%), and 8 out of 9 patients having lower limb symptoms diagnosed with malignant tumor. The tumor detection rate of digital rectal examination was 75% and more than 90% of all patients underwent one or more radiology imaging exams for tumor diagnosis. Every patient had a biopsy result. The most common type of tumor was presacral cyst (40.9%) with overall tumor median size of 5.6 cm. Thirty-one (70.5%) patients underwent surgery, most often via the posterior route (83.9%). Posterior route surgery had significantly shorter operation time and tumors operated via posterior route were significantly smaller. The survival rate after surgery was 100%. The median course of disease was 6 months and median follow-up was 25 months. Conclusions Presacral tumors have low occurrence and are more frequently observed in females in their 30s and 50s indicating a possible link between tumor occurrence and hormonal changes. Patients with lower limb symptoms were more likely to have a malignant presacral tumor. Posterior route was the most commonly utilized surgical approach. Supplementary iodine tincture treatment of cysts ruptured in operation could potentially be helpful in reducing the chance of recurrence.
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Affiliation(s)
- Zeyu Li
- Department of Colorectal Surgery, First Affiliated Hospital of China Medical University, Shenyang, China.,Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Min Lu
- Department of Colorectal Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
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31
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Alyousef Z, Aleissa M, Alaamer O, Alselaim N. Combined laparoscopic and posterior approach resection of large sacrococcygeal cystic teratoma. Surg Case Rep 2021; 7:20. [PMID: 33438088 PMCID: PMC7803854 DOI: 10.1186/s40792-020-01104-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/28/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Teratoma is a true neoplasm and originates from the three germ cell layers and it can contain any tissue derived from these layers. The location of teratoma is variable according to the age group. In adults, sacrococcygeal teratoma is rare and carries a low risk of malignant transformation. Surgical resection is the mainstay of treatment and is challenging due to tumor location. CASE PRESENTATION We are presenting a case report of a 16-year old female referred to our hospital with recurrent attacks of urine retention. Imaging study showed a large sacrococcygeal tumor. It was successfully resected by a combined laparoscopic and posterior approach without any major complication. CONCLUSION The combined laparoscopic and posterior approach is a safe surgical technique for resection of the large sacrococcygeal tumor. This surgical method has been published around 10 times in separated reports around the world and for first time in our region.
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Affiliation(s)
- Ziyad Alyousef
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maryam Aleissa
- Prince Noura Bin Abdulrahman University, Riyadh, Saudi Arabia. .,Department of Surgery, King Faisal Specialist Hospital & Research Center, , Riyadh, Saudi Arabia.
| | - Ohood Alaamer
- Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nahar Alselaim
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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32
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La Greca G, Trombatore G, Basile G, Conti P. Retrorectal tumors: Case report and review of literature. Int J Surg Case Rep 2020; 77:726-729. [PMID: 33395883 PMCID: PMC7718133 DOI: 10.1016/j.ijscr.2020.11.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Retrorectal tumors are rare diseases and they can be challenging to diagnose and to manage. Usually they have a slow growth and they are asymptomatic. When present, symptoms depends on the dimensions of the tumor and their position. Inside the retrorectal space may develope a wide variety of benign and malignant masses. CASE REPORT A 70-years-old, obese, female patient was admitted to our hospital referring pelvic and lower-back pain for six months. The retrorectal mass was incidentally detected on imaging, and treated with a modified Kraske procedure.
Pathological examination revealed a rare retrorectal epidermoid cyst. We also reviewed the informations present in the scientific literature about the incidence, diagnosis and treatment options of retrorectal tumors. CONCLUSIONS Even though the rarity and heterogeneity of these tumors, we agree with literature that their surgical management is mandatory in order to achieve a definitive diagnosis and to avoid complications including malignant transformation. The surgical approach should be tailored for each patient and according to tumor's features.
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Affiliation(s)
- Giorgio La Greca
- Division of General Surgery, Civil Hospital of Lentini, C/da Colle Roggio, 96016 Lentini, SR, Italy.
| | - Giovanni Trombatore
- Division of General Surgery, Civil Hospital of Lentini, C/da Colle Roggio, 96016 Lentini, SR, Italy
| | - Guido Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, via S. Sofia, 78, 95123 Catania, Italy
| | - Pietro Conti
- Division of General Surgery, Civil Hospital of Lentini, C/da Colle Roggio, 96016 Lentini, SR, Italy
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33
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Carpelan-Holmström M, Koskenvuo L, Haapamäki C, Renkonen-Sinisalo L, Lepistö A. Clinical management of 52 consecutive retro-rectal tumours treated at a tertiary referral centre. Colorectal Dis 2020; 22:1279-1285. [PMID: 32336000 DOI: 10.1111/codi.15080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/01/2020] [Indexed: 12/12/2022]
Abstract
AIM The aim of this single-institution study was to analyse the diagnostic methods, preoperative work-up and outcomes of 52 retro-rectal tumours. METHOD All patients treated for retro-rectal tumours from 2012 to 2017 were included. RESULTS Out of 52 patients, 40 (77%) were women. The median age of patients at the time of surgery was 43 (19-76) years, and 30 (58%) were asymptomatic at the time of diagnosis. All tumours were visible on magnetic resonance imaging (MRI) prior to surgery. The sensitivity and specificity for predicting malignancy on preoperative imaging for retro-rectal tumours were 25% and 98%, respectively. Forty-four procedures (85%) were performed using the perineal approach. The median hospital stay was 3 (1-18) days. There was no 30-day postoperative mortality. Eleven (21%) patients developed postoperative complications, mostly surgical site infections. Twenty-nine tumours (56%) were benign tailgut cysts. Four (8%) tumours were malignant and were considered to be removed with a tumour-free resection margin. Local recurrent disease was detected on MRI in 14 (27%) patients at a median of 1.05 (range 0.78-1.77) years after primary surgery. Only the multi-lobular shape of the tumour was found to be an independent risk factor for recurrence (P = 0.030). CONCLUSION A preoperative MRI is mandatory in order to plan the surgical strategy for retro-rectal tumours. Symptomatic, solid, large tumours should be removed because of the risk of malignancy. Minor cystic lesions with thin walls as well as asymptomatic recurrences of benign tumours are suitable to be followed conservatively.
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Affiliation(s)
- M Carpelan-Holmström
- Department of Colorectal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - L Koskenvuo
- Department of Colorectal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - C Haapamäki
- Department of Colorectal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - L Renkonen-Sinisalo
- Department of Colorectal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - A Lepistö
- Department of Colorectal Surgery, Helsinki University Hospital, Helsinki, Finland
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34
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Brown KG, Lee PJ. Algorithms for the surgical management of benign and malignant presacral tumors. SEMINARS IN COLON AND RECTAL SURGERY 2020. [DOI: 10.1016/j.scrs.2020.100762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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35
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Primary Leiomyoma of the Pelvis Complicated by Obstructive Uropathy: a Rare Entity in an Adult Male. Indian J Surg Oncol 2020; 11:237-239. [PMID: 33364707 DOI: 10.1007/s13193-020-01194-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022] Open
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36
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Yalav O, Topal U, Eray İC, Deveci MA, Gencel E, Rencuzogullari A. Retrorectal tumor: a single-center 10-years' experience. Ann Surg Treat Res 2020; 99:110-117. [PMID: 32802816 PMCID: PMC7406398 DOI: 10.4174/astr.2020.99.2.110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/09/2020] [Accepted: 05/30/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose Retrorectal tumors (RTs) are a rare incidence and recommendations on the ideal surgical approaches are lacking. This study aimed to evaluate outcomes and follow-up results of patients undergoing excision of RTs at our institution. Methods A retrospective review was conducted for undergoing surgery for RT between January 2009 and January 2019. Demographic characteristics, presenting symptoms, preoperative diagnostic tests, surgical procedures, histopathological results, intraoperative and postoperative complications, postoperative hospital stay, postoperative 30-day mortality, 90-day unplanned readmission rate, and long-term outcomes were evaluated. Results Twenty patients with a mean age of 48.3 ± 14.2 were analyzed. The most common presenting complaint was perineal pain (35.0%). Magnetic resonance imaging and computed tomography was preferred in 18 and 2 patients, respectively. Tumor localization was below the level of the third sacral vertebrae in 14 patients for whom the posterior surgical approach was used. No postoperative mortality was recorded at the end of follow-up of 53.8 ± 40 months. Mean length of postoperative hospital stay was 8.6 ± 9.4 days. Ten percent of the patients had unplanned hospital readmission within 90 days after discharge. Recurrence developed in 1 patient, for whom pathology were reported as chordoma. Conclusion RT should be managed by a multidisciplinary team given the complexity and heterogeneity of these tumors despite the fact that the majority are benign. A good understanding of pelvic anatomy and characterization of lesions through detailed radiological imaging is crucial to optimize surgical planning. Complete surgical resection is key for prolonged disease-free and overall survival of patients diagnosed with RTs.
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Affiliation(s)
- Orçun Yalav
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Uğur Topal
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - İsmail Cem Eray
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Mehmet Ali Deveci
- Department of Orthopedics and Traumatology, Çukurova University Faculty of Medicine, Adana, Turkey.,Department of Orthopedics and Traumatology, Koç University Faculty of Medicine, Istanbul, Turkey
| | - Eyüphan Gencel
- Department of Plastic and Reconstructive Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Ahmet Rencuzogullari
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
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Abstract
RATIONALE Tailgut cyst (TGC) is a rare congenital disease that originates from residues of the tail intestine during the embryonic period. Most TGCs are benign lesions and the malignant transition is very rare. PATIENT CONCERNS A 50-year-old woman attended our department complaining of defecation difficulty for more than 2 months. She reported irregular defecation with a small amount of liquid stool, 3 to 4 times per day. DIAGNOSIS Biochemical analysis showed high levels of carcinoembryonic antigen (79.89 ng/mL; normal, 0-3 ng/mL) and carbohydrate antigen 199 (57.60 U/mL; normal, 0-35 U/mL). Abdominal computer tomography and magnetic resonance imaging showed a large cystic mass with enhanced signals. Post-surgical histopathology indicated that the mass was a TGC with adenocarcinoma transition. INTERVENTIONS The cyst was completely resected. Symptomatic treatment was further performed, and the patient recovered well. LESSONS We reported a rare case of a large TGC with adenocarcinoma transition. CT, MRI, and histopathology are important to diagnose TGC. Complete surgical resection is the first choice to treat TGC.
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Affiliation(s)
| | - Guoliang Liu
- Operating Theater and Department of Anesthesiology
| | - Yu Mu
- Department of General Surgery
| | - Hongyu He
- Operating Theater and Department of Anesthesiology
| | - Shuang Wang
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin, China
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38
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Successful excision of a retrorectal cyst through trans-sacral approach: A case report. Int J Surg Case Rep 2020; 71:307-310. [PMID: 32485636 PMCID: PMC7264461 DOI: 10.1016/j.ijscr.2020.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/07/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
Retrorectal cysts are rare congenital cystic lesions commonly seen in middle-aged women. A 38-year-old woman with retrorectal cyst underwent trans-sacral resection. She showed no postoperative complications. Trans-sacral resection provides adequate exposure of the posterior retrorectal cyst. Introduction Retrorectal cysts are rare congenital cystic lesions usually diagnosed in middle-aged women. They are generally asymptomatic; however, local pressure may result in complications. Pain or discomfort in the pelvic, sacral, lower back or perianal area are the most common symptoms. The diagnosis is difficult, and multidisciplinary management is required. An epidermoid cyst is the most common type. Surgical resection is the main treatment, and 3 operative approaches are commonly used: abdominal, trans-sacral, and combined abdominosacral. The selection of the approach depends on the nature and location of the lesion. Here, we present a case that demonstrates the trans-sacral approach to a retrorectal cyst is a feasible option in terms of safety and minimal invasiveness for selected patients with this rare type of retrorectal cystic lesion. Presentation of case A 38-year-old woman with no comorbidities incidentally showed a retrorectal cyst on magnetic resonance imaging performed during pregnancy. The patient underwent surgical resection under general anesthesia, trans-sacral incision was performed, the posterior rectum exposed, and the cyst removed. No complications were seen in the postoperative period. Discussion Posterior trans-sacral resection (Kraske) is preferred for patients with posterior retrorectal cyst because it provides adequate exposure. Conclusion Posterior trans-sacral resection allows proximal extension for elimination of the infection and in cases of adherence of the cyst to surrounding structures or in malignancy, which require en bloc resection.
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39
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Martins P, Canotilho R, Peyroteo M, Afonso M, Moreira A, de Sousa A. Tailgut cyst adenocarcinoma. AUTOPSY AND CASE REPORTS 2019; 10:e2019115. [PMID: 32039057 PMCID: PMC6945306 DOI: 10.4322/acr.2019.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 02/22/2019] [Indexed: 12/14/2022] Open
Abstract
Tailgut cysts (TGCs) are rare congenital entities arising from remnants of the embryological postanal primitive gut. Malignancy in TGCs is rare, with the majority being adenocarcinomas and carcinoid tumors. A search of the published literature yielded only 27 cases of adenocarcinoma developing in TGCs. We described the case of a 54-year-old female who presented with complaints of pelvic and perineal pain of several weeks. After the initial work-up, a mass in the right presacral location was diagnosed. She underwent radical resection of the tumor, using a posterior approach. The lesion was removed en bloc with the middle rectum, coccyx, and sacrum (S4-S5). The histopathologic examination revealed an adenocarcinoma arising in a TGC, and the patient received adjuvant chemoradiotherapy. Our case underlines that diagnosing a TGC is difficult as it is a rare congenital lesion. Clinical examination may be challenging as TGCs present with various symptoms, which can mimic other commonly proctologic disorders. Patients should be referred to a tertiary center with experience in pelvic surgery and must be managed by a multidisciplinary approach to maximize successful treatment. The recommended treatment is surgical excision given the malignant potential of TGCs and their risk of causing local complications.
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Affiliation(s)
- Pedro Martins
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal
| | - Rita Canotilho
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal
| | - Mariana Peyroteo
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal
| | - Mariana Afonso
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Anatomic Pathology Service. Porto, Portugal
| | - Augusto Moreira
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal
| | - Abreu de Sousa
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal
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40
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Wang R, Yan Z. Rectal Mucinous Adenocarcinoma Invading Retrorectal Dermoid Cysts: A Case Report. Front Oncol 2019; 9:1389. [PMID: 31921646 PMCID: PMC6914684 DOI: 10.3389/fonc.2019.01389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022] Open
Abstract
Rectal mucinous adenocarcinoma is a subtype of colorectal adenocarcinoma, which is more aggressive and prone to invade adjacent normal organs or tissues compared with non-mucinous adenocarcinoma. Retrorectal dermoid cyst is a rare congenital disease, which usually are benign but with a potential for malignant degeneration. In this article, we report a case which presented a rectal mucinous adenocarcinoma invading into retrorectal dermoid cysts, indicating that besides adjacent normal organs or tissues, malignancies can also invade adjacent tumors, making their diagnosis and management more complicated. In such cases, double primary tumors should be considered, and they should be removed surgically.
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Affiliation(s)
- Rui Wang
- Department of Critical Care Medicine, Shengjing Hospital, China Medical University, Shenyang, China
| | - Zhaopeng Yan
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang, China
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41
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Li W, Li J, Yu K, Zhang K, Li J. Retrorectal adenocarcinoma arising from tailgut cysts: a rare case report. BMC Surg 2019; 19:180. [PMID: 31775691 PMCID: PMC6882221 DOI: 10.1186/s12893-019-0639-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/31/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tailgut cysts arise from the remnants of the tailgut during the embryonic period. Although malignant transition of tailgut cysts is very rarely observed in the clinic, this congenital condition should be carefully monitored for early diagnosis and appropriate treatment, especially when the tailgut cysts are malignant. CASE PRESENTATION Here, we report the case of a 33-year-old man with retrorectal adenocarcinoma originating from the tailgut cysts. Magnetic resonance imaging (MRI) showed many cystic masses in the posterior rectal space, the largest of which was approximately 100 mm × 59 mm × 53 mm in size and compressed the rectum. The patient underwent surgical resection of the masses located in the retrorectal and anterior sacral spaces. Histological and immunohistological examinations confirmed adenocarcinoma transition of the tailgut cysts. The patient recovered well and was discharged 10 days after surgery. CONCLUSIONS We have reported a rare case of retrorectal adenocarcinoma originating from tailgut cysts. MRI, histological, and immunohistological examinations are vital for the diagnosis of tailgut cysts. Complete surgical resection of the tumor should be better performed.
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Affiliation(s)
- Wei Li
- Department of General Surgery, The Second Hospital of Jilin University, 218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, China
| | - Jian Li
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Ke Yu
- Operating Theater and Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Kai Zhang
- Department of General Surgery, The Second Hospital of Jilin University, 218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, China.
| | - Jiannan Li
- Department of General Surgery, The Second Hospital of Jilin University, 218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, China.
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42
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Poškus E, Račkauskas R, Danys D, Valančienė D, Poškus T, Strupas K. Does a retrorectal tumour remain a challenge for surgeons? Acta Chir Belg 2019; 119:289-293. [PMID: 30270764 DOI: 10.1080/00015458.2018.1515397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/12/2018] [Indexed: 12/28/2022]
Abstract
Background: Retrorectal tumours are lesions with a wide range of histological differentiation that are often diagnostic and clinical challenges due to their rare occurrence. Many cases of this pathology are treated in regional hospitals, which results in serious complications because physicians fail to recognize this pathology. We present our experience in treating these tumours. Methods: A retrospective analysis of a prospectively maintained database was performed using the Vilnius University Hospital Santaros Clinics patient database. Thirty-five cases were identified. Results: Occurrence of retrorectal tumours was higher in women than in men and accounted for 82.86% and 17.14%, respectively. Computer tomography and magnetic resonance imaging were the main methods used to confirm diagnosis and plan surgical treatment. We have used a laparotomy, perineal or combined approach for tumour extirpation. The laparotomy approach was the most used, followed by perineal extirpation. The most common histological type was cystic hamartoma, accounting for 20% of cases. In 80% of cases, the histological findings greatly varied. Hospital stays varied from 3 to 21 days with a mean of 11.6 ± 5.83 days. The postoperative complication rate was 17.14% and was present in six cases. Overall survival was 85.17%, with an average follow-up period of 71.83 months. There were no recurrent tumours diagnosed during follow-up. Conclusion: Retrorectal tumours are a very rare pathology with high histological heterogeneity and problematic diagnostics. Patients should be referred to a tertiary centre that has experience and diagnostic capabilities for the best diagnostic and treatment options.
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Affiliation(s)
- Eligijus Poškus
- Center of Abdominal Surgery, Vilnius University , Vilnius , Lithuania
| | - Rokas Račkauskas
- Center of Abdominal Surgery, Vilnius University , Vilnius , Lithuania
| | - Donatas Danys
- Center of Abdominal Surgery, Vilnius University , Vilnius , Lithuania
| | - Dileta Valančienė
- Center of Radiology and Nuclear Medicine, Vilnius University Hospital Santaros Klinikos , Vilnius , Lithuania
| | - Tomas Poškus
- Center of Abdominal Surgery, Vilnius University , Vilnius , Lithuania
| | - Kęstutis Strupas
- Center of Abdominal Surgery, Vilnius University , Vilnius , Lithuania
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43
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Roy SP, Khalessi A, Phan-Thien KC. Robotic resection of a multicystic tailgut cyst. BMJ Case Rep 2019; 12:12/9/e231286. [PMID: 31511270 DOI: 10.1136/bcr-2019-231286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A 29-year-old woman with recurrent pelvic pain that progressed post partum was diagnosed with a multicystic pararectal lesion on ultrasound and CT scan. Physiology was conducted to establish a preoperative function and pudendal nerve integrity. The lesion was resected using a Da Vinci Xi robotic system. She recovered uneventfully with complete resolution of her symptoms. Hindgut cysts most often arise in the presacral space as the result of incomplete embryogenesis. Patients may present with various non-specific symptoms. Although the majority are benign, resection is recommended, as there is a 30%-43% risk of malignancy.
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Affiliation(s)
- Susmit Prosun Roy
- Department of Medicine and Surgery, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia.,Department of General Surgery, Saint George Hospital, Kogarah, New South Wales, Australia
| | - Amirala Khalessi
- Department of Surgery, Hurstville Private, Hurstville, New South Wales, Australia
| | - Kim-Chi Phan-Thien
- Department of Colorectal Surgery, Saint George Hospital, Kogarah, New South Wales, Australia
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44
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45
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Wee IJY, Ngu JCY. Comment on "A systematic review of minimally invasive surgery for retrorectal tumors". Tech Coloproctol 2018; 22:991-992. [PMID: 30219932 DOI: 10.1007/s10151-018-1851-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/08/2018] [Indexed: 10/28/2022]
Affiliation(s)
- I J Y Wee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - J C-Y Ngu
- Department of Surgery, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
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46
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A systematic review of minimally invasive surgery for retrorectal tumors. Tech Coloproctol 2018; 22:255-263. [PMID: 29679245 DOI: 10.1007/s10151-018-1781-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/28/2018] [Indexed: 02/06/2023]
Abstract
Retrorectal tumors are rare tumors that require resection for symptoms, malignancy and potential malignant transformation. Traditional approaches have included laparotomy, perineal excision or a combination. Multiple minimally invasive techniques are available which have the potential to minimize morbidity and enhance recovery. We performed a systematic review of the literature to determine the feasibility and surgical outcomes of retrorectal tumors approached using minimally invasive surgical techniques. Publications in which adult patients (≥ 18 years) had a minimally invasive approach (laparoscopic or robotic) for resection of a primary retrorectal tumor were included. Data were collected on approach, preoperative investigation, size and sacral level of the tumor, operating time, length of stay, perioperative complications, margins and recurrence. Thirty-five articles which included a total of 82 patients met the inclusion criteria. The majority of patients were female (n = 65; 79.2%), with a mean age of 41.7 years (range 18-89 years). Seventy-three patients (89.0%) underwent laparoscopic or combined laparoscopic-perineal resection, and 9 (10.8%) had a robotic approach. The conversion rate was 5.5%. The overall 30-day morbidity rate was 15.7%, including 1 intraoperative rectal injury (1.2%). Ninety-five percent (n = 78) of the retrorectal tumors were benign. Median length of stay was 4 days for both laparoscopic and robotic groups, with ranges of 1-8 and 2-10 days, respectively. No tumor recurrence was noted during follow-up [median 28 months (range 5-71 months)]. A minimally invasive approach for the resection of retrorectal tumors is feasible in selected patients. Careful patient selection is necessary to avoid incomplete resection and higher morbidity than traditional approaches.
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47
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Hernandez Casanovas P, Bollo Rodriguez J, Martinez Sanchez C, Pernas Canadell JC, Targarona Soler EM. Transanal endoscopic microsurgery treatment of twice recurred tail-gut. Cir Esp 2018; 96:455-456. [PMID: 29448984 DOI: 10.1016/j.ciresp.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 12/13/2017] [Indexed: 11/26/2022]
Affiliation(s)
| | - Jesus Bollo Rodriguez
- Unidad de Coloproctología, Servicio de Cirugía General, Hospital Sant Pau, Barcelona, España
| | - Carmen Martinez Sanchez
- Unidad de Coloproctología, Servicio de Cirugía General, Hospital Sant Pau, Barcelona, España
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48
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Torres Alfonso JR, Tejedor P, Pastor C, de Andrés P, Ortega M, Garcia-Olmo D. Combined abdomino-sacral laparoscopically assisted approach for retrorectal mass resection in a patient with Currarino's Syndrome - video vignette. Colorectal Dis 2017; 20:261-262. [PMID: 29211327 DOI: 10.1111/codi.13983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 11/20/2017] [Indexed: 01/27/2023]
Abstract
A correct preoperative strategy is crucial when surgery is needed for retrorectal tumours (RRT).[1] Surgical approaches may be purely anterior-abdominal, posterior-sacrococcygeal or combined depending on the tumour's size and location.[2] We present the case of an 18-year-old female with Currarino Syndrome who underwent surgery by a combined abdominal laparoscopic-posterior Kraske approach for the resection of a large RRT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- J R Torres Alfonso
- Department of General Surgery. Division of Colorectal Surgery, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - P Tejedor
- Department of General Surgery. Division of Colorectal Surgery, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - C Pastor
- Department of General Surgery. Division of Colorectal Surgery, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - P de Andrés
- Department of Neurosurgery, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - M Ortega
- Department of General Surgery. Division of Colorectal Surgery, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - D Garcia-Olmo
- Department of General Surgery. Division of Colorectal Surgery, University Hospital Fundación Jiménez Díaz, Madrid, Spain
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49
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Ersan V, Kutlu R, Erdem C, Karagul S, Kayaalp C. Colorectal Stenting for Obstruction due to Retrorectal Tumor in a Patient Unsuitable for Surgery. J Transl Int Med 2017; 5:186-188. [PMID: 29164050 DOI: 10.1515/jtim-2017-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Fund of knowledge on palliative treatment of unresectable retrorectal tumors is scare. Here, we reported a non-surgical treatment of a huge retrorectal malignant tumor in an aged and debilitated patient complicated with colorectal obstruction. An 86-year-old male with severe comorbidities was admitted with acute colorectal obstruction owing to an untreated retrorectal malign epithelial tumor. There was a lobulated retrorectal mass, 20 cm × 15 cm at largest size, extending to the superior iliac bifurcation level, caused an obstruction of the rectal lumen. He was not suitable for surgical excision because of the severe comorbidities. Rectal obstruction was palliated by two self-expandable metallic stents. He tolerated the procedures well and post-procedural course was uneventful. After four months, stents were patent and the patient was continent. Stenting for colorectal obstruction owing to a retrorectal tumor can be feasible in patients who are not suitable for surgery (aged, debilitated, advanced tumor). It avoided the surgical trauma to a high-risk patient and ensured the continuity of continence. As far as we know, this was the first report on colorectal stenting for a retrorectal tumor.
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Affiliation(s)
- Veysel Ersan
- Department of Surgery, Inonu University, Malatya, Turkey
| | - Ramazan Kutlu
- Department of Radiology, Inonu University, Malatya, Turkey
| | - Ceyhun Erdem
- Department of Surgery, Inonu University, Malatya, Turkey
| | - Servet Karagul
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
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50
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Gutierrez O, Haj-Ibrahim H, Griffiths E, Olasky J. Presacral mass in the setting of an ovarian cyst and abdominal pain. BMJ Case Rep 2017; 2017:bcr-2017-219803. [PMID: 28659365 DOI: 10.1136/bcr-2017-219803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Tailgut cysts, also known as retrorectal hamartomas, are very rare neoplasms located in the presacral/retrorectal space that originate from the embryonic hindgut. Although a majority of lesions in this location are benign, 30% of the reported cases in the literature were found to be malignant. This report describes a case of a presacral mass found on CT of a 37-year-old woman who initially presented with worsening abdominal pain and a history of ovarian cyst rupture. This patient's clinical picture was complicated by an enlarging ovarian cyst. The risk of progression to malignancy warranted excision. She recovered well with resolution of her presenting symptoms. We report this case along with a brief review of the literature with a focus on the surgical considerations.
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Affiliation(s)
- Omar Gutierrez
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Huzifa Haj-Ibrahim
- Department of General Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Elzbieta Griffiths
- Department of General Surgery, Mount Auburn Hospital, Cambridge, Massachusetts, USA
| | - Jaisa Olasky
- Department of General Surgery, Mount Auburn Hospital, Cambridge, Massachusetts, USA
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