• Cyst capsule rupture
• Presacral cysts
• Rectal wall perforation
• Tailgut cyst

• Humans
• Retrospective Studies
• Male
• Risk Factors
• Female
• Middle Aged
• Intestinal Perforation/etiology
• Intestinal Perforation/surgery
• Perineum/surgery
• Perineum/injuries
• Adult
• Cysts/surgery
• Cysts/etiology
• Cysts/diagnostic imaging
• Aged
• Intraoperative Complications/etiology
• Rectum/surgery
• Rectum/injuries
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Magnetic Resonance Imaging
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods
• Tomography, X-Ray Computed
• Abdomen/surgery
• Rectal Diseases/surgery
• Rectal Diseases/etiology
• Incidence

• Laparoscopic resection
• Presacral cysts
• Quality of life
• Risk factors
• Sexual function impairment
• Urinary function impairment

• Presacral mass
• Retrorectal tumors
• Tailgut cyst
• Treatment

• Humans
• Female
• Middle Aged
• Male
• Adult
• Aged
• Retrospective Studies
• Magnetic Resonance Imaging
• Rectal Neoplasms/surgery
• Rectal Neoplasms/pathology
• Rectal Neoplasms/diagnostic imaging
• Rectal Neoplasms/therapy

• Kraske
• Perineal
• Posterior
• Tailgut cyst

• Humans
• Cysts/surgery
• Cysts/diagnostic imaging
• Sacrococcygeal Region/surgery
• Female

• Minimally invasive surgery
• Presacral tumors
• Robotic surgery
• Tailgut cysts

• Humans
• Middle Aged
• Female
• Male
• Robotic Surgical Procedures/methods
• Adult
• Aged
• Retrospective Studies
• Operative Time
• Treatment Outcome
• Length of Stay/statistics & numerical data
• Margins of Excision
• Blood Loss, Surgical/statistics & numerical data
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Neoplasm Recurrence, Local/surgery
• Neoplasm Recurrence, Local/epidemiology
• Pelvic Neoplasms/surgery

• Humans
• Rectal Neoplasms/surgery
• Rectal Neoplasms/pathology

• morbidity
• presacral
•  retrorectal
•  surgery

• clinical features
• malignant transformation
• prognosis
• retrorectal tumour
• treatment

• Priority Academic Program Development of Jiangsu Higher Education Institutions

Background: Tailgut cysts are rare congenital lesions that develop in the presacral space. As they can potentially conceal primary neuroendocrine tumors, surgical excision is suggested as the treatment of choice. However, specific management guidelines have yet to be developed. A posterior approach is usually preferred for cysts extending to the third sacral vertebral body. Conversely, a transabdominal approach is preferred for lesions extending upward to achieve an optimal view of the surgical field and avoid injuries. Case report: Here, we report a case of a 48-year-old man suffering from perianal pain and constipation. Digital rectal examination and magnetic resonance imaging revealed a presacral mass below the third sacral vertebral body. A laparoscopic transabdominal presacral tumor excision was performed. The final histological diagnosis was a rare primary neuroendocrine tumor arising from a tailgut cyst. The postoperative course was uneventful, and no signs of recurrence were observed at the six-month follow-up. Conclusions: This study may help establish more well-grounded recommendations for the surgical management of rectal tumors, demonstrating that the laparoscopic transabdominal technique is safe and feasible, even for lesions below the third sacral vertebral body. This approach provided an adequate view of the presacral space, facilitating the preservation of cyst integrity, which is essential in cases of malignant pathologies.

• malignancy
• pelvic cystic masses
• presacral mass
• retrorectal tumours
• tailgut cyst

• Databases, Factual
• Female
• Humans
• Magnetic Resonance Imaging
• Male
• Rectal Neoplasms/diagnostic imaging
• Rectal Neoplasms/surgery
• Retrospective Studies

• Royal College of Surgeons of England
• Bowel Cancer UK

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.

To investigate the risk factors for perioperative complications in laparoscopic surgeries of retrorectal cystic lesions.

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.

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.

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.

• Laparoscopic excision
• Retrorectal cystic lesions
• Minimally invasive
• Risk factors
• Perioperative complications

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.

• Retrorectal tumors
• Congenital cystic lesions
• Teratomas
• Perineal approach
• Transabdominal approach, Combined abdominoperineal approach

• congenital cysts
• developmental cyst
• presacral
• retrorectal

• 3D-CTA
• misdiagnosis
• presacral tumours
• recurrence
• risk factor
• surgical approach

• clinical presentation
• diagnosis
• presacral tumor
• retrospective cohort study
• surgical resection

The transsacrococcygeal (TSC) approach in rectal gastrointestinal stromal tumour (GIST) resection is clinically challenging and controversial, and we evaluated its value in the present study.

We enrolled patients who underwent rectal GIST resection by the TSC approach during 2008–2018. The clinicopathological index, surgical outcome, and prognosis were analysed. Prognostic information was obtained from medical records and follow-up data. Anal function was evaluated by the low anterior resection syndrome (LARS) score.

Among 88 rectal GIST patients over the 10-year study period, 17 who underwent the TSC approach were analysed. The median age was 55 (range, 26–73) years. In total, 15 patients received preoperative imatinib neoadjuvant therapy for 232 (30–690) days. The tumours were exogenous in 14 patients and intramural in 3 patients. The mean initial tumour size and preoperative tumour size were 6.4±2.2 and 4.2±1.7 cm, respectively. The operative time and blood loss were 130.2±47.4 min and 44.6±36.0 mL, respectively. Of the 17 patients 7 had postoperative complications (within 30 days postoperatively), and the complications of 5 patients were cured by conservative treatment. Only 1 patient was lost to follow-up, and the others had a good oncological prognosis at recent follow-up evaluations. All patients had LARS scores ≤9 points at 1 year after the operation.

The TSC approach can result in a good oncological prognosis, usually does not affect anal function, and is particularly suitable for exogenous middle and low rectal GISTs. However, it might cause some controlled complications. Hence, careful patient selection is necessary for this operation.

• Rectal gastrointestinal stromal tumour (rectal GIST)
• prognosis
• resection
• surgery
• transsacrococcygeal approach (TSC approach)

• Kraske technique
• Retrorectal epidermoid cyst
• Retrorectal tumors

An epidermal inclusion cyst is a benign lesion, frequently observed throughout the body. However, its presence in the retrorectal region is a rare occurrence. With a higher incidence in women and non-specific symptoms, these cysts are mostly an incidental finding. Here, we report a case of a 33-year-old female presenting with complaints of abdominal pain and sensation of incomplete and painful defecation. The patient’s history revealed that a large pelvic cyst was found incidentally during her first cesarean section (CS) owing to an arrest in labor. A presumptive diagnosis of rectal duplication cyst was made based on digital rectal exam (DRE), computed tomography (CT), and magnetic resonance imaging (MRI) findings. For cyst removal, the patient underwent a midline laparotomy. A postoperative biopsy led to the confirmed diagnosis of the retrorectal epidermal inclusion cyst. On follow-up, our patient showed a smooth recovery without any complications. We conclude that when dealing with a pregnant woman with a pelvic mass, developmental cysts should always be kept in mind. Timely diagnosis and management of a retrorectal mass is essential for effective treatment and to prevent subsequent complications.

• cyst
• epidermoid
• inclusion cyst
• presacral
• retrorectal

• Retro-rectal tumour
• clinical management
• diagnosis
• follow-up
• histology
• presacral tumour

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.

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.

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.

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.

• Chordoma
• General surgery
• Rectum
• Treatment

•

Retrorectal cysts are rare congenital cystic lesions commonly seen in middle-aged women.

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.

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.

Posterior trans-sacral resection (Kraske) is preferred for patients with posterior retrorectal cyst because it provides adequate exposure.

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.

• Posterior trans-sacral resection
• Retrorectal cyst
• Tailgut cyst

• Neuroendocrine
• Presacral cyst
• Tailgut cyst

• Tailgut cyst
• malignancy
• retro-rectal hamartoma

• Case report
• Laparoscopic surgery
• Rare tumors
• Retrorectal lipoma
• Retrorectal tumor

• Humans
• Male
• Middle Aged
• Neurilemmoma/diagnosis
• Neurilemmoma/pathology
• Neurilemmoma/surgery
• Sacrococcygeal Region

• Colorectal/anal neoplasia
• Laparoscopic
• Minimally invasive surgery
• Retrorectal tumors
• Robotic

• Presacral tumor
• colon
• intestinal obstruction
• palliative treatment
• rectum
• stent

• Adult
• Dermoid Cyst/surgery
• Female
• Humans
• Rectal Neoplasms/surgery
• Transanal Endoscopic Microsurgery/methods
• Treatment Outcome
• Young Adult

• Anterior approach
• Extended distal rectal segmental resection
• Tail gut cyst

• Aged
• Anal Canal/surgery
• Anastomosis, Surgical/methods
• Anus Diseases/pathology
• Anus Diseases/surgery
• Cysts/pathology
• Cysts/surgery
• Digestive System Surgical Procedures/methods
• Female
• Follow-Up Studies
• Hamartoma/pathology
• Hamartoma/surgery
• Humans
• Middle Aged
• Rectal Diseases/pathology
• Rectal Diseases/surgery
• Rectum/surgery
• Treatment Outcome

• MRI
• Retrorectal tumour
• presacral tumour
• surgery

• Retrorectal tumour
• presacral tumour

• Tailgut cyst
• developmental cyst
• retrorectal cystic hamartoma
• retrorectal space