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Jian L, Wang Y, Hao Y, Zhao D, Songlin W, Qun Q, Daojiang L. Development of Pseudosacral Cyst Following Surgery for Primary Presacral Neuroendocrine Tumors With Liver Metastasis: A Case Report. Clin Case Rep 2024; 12:e9672. [PMID: 39629039 PMCID: PMC11612513 DOI: 10.1002/ccr3.9672] [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] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 10/19/2024] [Accepted: 11/04/2024] [Indexed: 12/06/2024] Open
Abstract
Presacral neuroendocrine tumor (PSNET) is a rare disease that currently lacks a standardized treatment approach. In this report, we present a unique case of PSNET with liver metastasis that progressed into a pseudosacral cyst following complete surgical resection and sulfatinib treatment with radiofrequency ablation. Before undergoing surgical treatment for presacral neuroendocrinology, it is important to consider the potential risks of poor healing of the presacral incision and formation of pseudocysts. These complications may be caused by various factors, including the procedure itself and the use of targeted drugs.
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Affiliation(s)
- Li Jian
- Department of Colorectal and Anal SurgeryZhongnan Hospital of Wuhan UniversityWuhanHubeiChina
- Clinical Center of Intestinal and Colorectal Diseases of Hubei ProvinceHubeiChina
- Hubei Key Laboratory of Intestinal and Colorectal DiseasesZhongnan Hospital of Wuhan UniversityWuhanHubeiChina
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei ProvinceHubeiChina
| | - Youheng Wang
- Department of Colorectal and Anal SurgeryZhongnan Hospital of Wuhan UniversityWuhanHubeiChina
- Clinical Center of Intestinal and Colorectal Diseases of Hubei ProvinceHubeiChina
- Hubei Key Laboratory of Intestinal and Colorectal DiseasesZhongnan Hospital of Wuhan UniversityWuhanHubeiChina
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei ProvinceHubeiChina
| | - Yu Hao
- Department of RadiologyZhongnan Hospital of Wuhan UniversityWuhanHubeiChina
| | - Ding Zhao
- Department of Colorectal and Anal SurgeryZhongnan Hospital of Wuhan UniversityWuhanHubeiChina
- Clinical Center of Intestinal and Colorectal Diseases of Hubei ProvinceHubeiChina
- Hubei Key Laboratory of Intestinal and Colorectal DiseasesZhongnan Hospital of Wuhan UniversityWuhanHubeiChina
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei ProvinceHubeiChina
| | - Wan Songlin
- Department of Colorectal and Anal SurgeryZhongnan Hospital of Wuhan UniversityWuhanHubeiChina
- Clinical Center of Intestinal and Colorectal Diseases of Hubei ProvinceHubeiChina
- Hubei Key Laboratory of Intestinal and Colorectal DiseasesZhongnan Hospital of Wuhan UniversityWuhanHubeiChina
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei ProvinceHubeiChina
| | - Qian Qun
- Department of Colorectal and Anal SurgeryZhongnan Hospital of Wuhan UniversityWuhanHubeiChina
- Clinical Center of Intestinal and Colorectal Diseases of Hubei ProvinceHubeiChina
- Hubei Key Laboratory of Intestinal and Colorectal DiseasesZhongnan Hospital of Wuhan UniversityWuhanHubeiChina
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei ProvinceHubeiChina
| | - Li Daojiang
- Department of Colorectal and Anal SurgeryZhongnan Hospital of Wuhan UniversityWuhanHubeiChina
- Clinical Center of Intestinal and Colorectal Diseases of Hubei ProvinceHubeiChina
- Hubei Key Laboratory of Intestinal and Colorectal DiseasesZhongnan Hospital of Wuhan UniversityWuhanHubeiChina
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei ProvinceHubeiChina
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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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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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Violante T, Murphy B, Ferrari D, Graham RP, Navin P, Merchea A, Larson DW, Dozois EJ, Halfdanarson TR, Perry WR. Presacral Neuroendocrine Neoplasms: A Multi-site Review of Surgical Outcomes. Ann Surg Oncol 2024; 31:4551-4557. [PMID: 38679679 DOI: 10.1245/s10434-024-15328-3] [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: 03/01/2024] [Accepted: 04/01/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Presacral neuroendocrine neoplasms (PNENs) are rare tumors, with limited data on management and outcomes. METHODS A retrospective review of institutional medical records was conducted to identify all patients with PNENs between 2008 and 2022. Data collection included demographics, symptoms, imaging, surgical approaches, pathology, complications, and long-term outcomes. RESULTS Twelve patients were identified; two-thirds were female, averaging 44.8 years of age, and, for the most part, presenting with back pain, constipation, and abdominal discomfort. Preoperative imaging included computed tomography scans and magnetic resonance images, with somatostatin receptor imaging and biopsies being common. Half of the patients had metastatic disease on presentation. Surgical approach varied, with anterior, posterior, and combined techniques used, often involving muscle transection and coccygectomy. Short-term complications affected one-quarter of patients. Pathologically, PNENs were mainly well-differentiated grade 2 tumors with positive synaptophysin and chromogranin A. Associated anomalies were common, with tail-gut cysts prevalent. Mean tumor diameter was 6.3 cm. Four patients received long-term adjuvant therapy. Disease progression necessitated additional interventions, including surgery and various chemotherapy regimens. Skeletal, liver, thyroid, lung, and pancreatic metastases occurred during follow-up, with no mortality reported. Kaplan-Meier analysis showed a 5-year local recurrence rate of 23.8%, disease progression rate of 14.3%, and de novo metastases rate of 30%. CONCLUSION The study underscores the complex management of PNENs and emphasizes the need for multicenter research to better understand and manage these tumors. It provides valuable insights into surgical outcomes, recurrence rates, and overall survival, guiding future treatment strategies for PNEN patients.
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Affiliation(s)
- Tommaso Violante
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
- School of General Surgery, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Brenda Murphy
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Davide Ferrari
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
- School of General Surgery, Alma Mater Studiorum University of Bologna, Bologna, Italy
- General Surgery Residency Program, University of Milan, Milan, Italy
| | - Rondell P Graham
- Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Patrick Navin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Amit Merchea
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - David W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eric J Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - William R Perry
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
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Li R, Yu Z, Ye J, Liu X, Li P, Zhao X. Surgical outcomes after reoperation for patients with recurrent presacral tumors: a retrospective study. World J Surg Oncol 2024; 22:53. [PMID: 38355538 PMCID: PMC10867989 DOI: 10.1186/s12957-024-03332-6] [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: 12/03/2023] [Accepted: 02/06/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Relevant reports on the surgical resection and prognosis of recurrent presacral tumors are limited. The objective of this study was to explore the outcomes associated with surgical resection of recurrent presacral tumors. METHODS The data of patients with recurrent presacral tumors who received surgical resection in our hospital between June 2009 and November 2018 were retrospectively analyzed. RESULTS Thirty-one patients, comprising 22 females and 9 males, with recurrent presacral lesions were included in our study. A posterior approach was utilized in 27 patients, an anterior approach in 1 patient, and a combined approach in 3 patients. Intraoperative complications occurred in 13 patients (41.9%), while postoperative complications occurred in 6 patients (19.4%). The length of hospital stay was significantly shorter in patients who underwent the posterior approach compared to those who underwent the anterior and combined approaches (P = 0.002). The operative time for the posterior approach was significantly shorter compared to both the anterior and combined approaches (P = 0.006). Temporary tamponade was performed for hemostasis in 4 patients, while staged resection was performed in 2 patients during the surgical treatment process. After a median follow-up period of 115.5 months, 5 patients with recurrent malignant presacral tumors succumbed to tumor recurrence after reoperation in our hospital. CONCLUSIONS Surgical resection remains the mainstream treatment for recurrent presacral tumors. The outcomes for recurrent benign presacral tumors after surgery demonstrate favorable results, whereas further enhancements are required to improve the outcomes for recurrent malignant presacral tumors after surgery.
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Affiliation(s)
- Rui Li
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, Tianjin, China
| | - Zhiyuan Yu
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, Tianjin, China
| | - Jiahu Ye
- Outpatient Department of Hongshankou, Jingbei Medical District, Chinese PLA General Hospital, Beijing, China
| | - Xin Liu
- Outpatient Department of Hongshankou, Jingbei Medical District, Chinese PLA General Hospital, Beijing, China
| | - Peiyu Li
- Medical School of Chinese PLA, Beijing, China.
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
- School of Medicine, Nankai University, Tianjin, China.
| | - Xudong Zhao
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
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A E, Prakash A, Ashta A, Garg A, Verma A, Padaliya P. Pediatric presacral tumors with intraspinal extension: a rare entity with diagnostic challenges. Acta Radiol 2023; 64:3056-3073. [PMID: 37753549 DOI: 10.1177/02841851231202688] [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] [Indexed: 09/28/2023]
Abstract
The presacral space is a potential space located between the rectum and the lumbosacral spine. It contains various primitive germ cell types that serve as the origin for a range of tumors. Imaging is crucial in characterizing, assessing the extent of and evaluating the treatment response to these tumors. We report a series of six cases of pediatric presacral tumors with intraspinal extension, including an immature sacrococcygeal teratoma (Altman type II), a malignant sacrococcygeal teratoma (Altman type IV), a neuroblastoma, a rhabdomyosarcoma, a clear cell sarcoma and an Ewing's sarcoma of the ilium. These tumors can be broadly categorized as tumors of germ cell, neuroblastic, mesenchymal and osteogenic origin. Despite overlapping imaging features, a review of the existing literature and careful retrospective observation revealed several distinctive features that aid in the optimal characterization of tumors. These include the tumor's epicenter, the pattern and degree of bone involvement, the status of sacral foramina and neural elements, and internal tumor characteristics such as the presence of fat, calcification, hemorrhage and necrosis.
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Affiliation(s)
- Ebinesh A
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Anjali Prakash
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Aanchal Ashta
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Anju Garg
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Abhishek Verma
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Prerna Padaliya
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
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Aytac E, Sokmen S, Aktas MK, Colak T, Mentes B, Balik E, Demirbas S, Akyol C, Sungurtekin U, Oncel M, Ozturk E, Obuz F, Ucaroglu B, Leventoglu S, Ozerhan IH, Baca B, Ozgen U, Haksal M, Tumay V, Geçim E, Bugra D. Factors affecting operative morbidity and long-term outcomes in patients undergoing surgery for presacral tumours: a multicentric cohort study from the Turkish Collaborative Group for Quality Improvement in Colorectal and Pelvic Surgery. Colorectal Dis 2023; 25:1795-1801. [PMID: 37547974 DOI: 10.1111/codi.16697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/29/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023]
Abstract
AIM Data regarding the operative management of presacral tumours present various dilemmas due to their rarity and heterogeneous nature. The aim of this study was to evaluate the management strategy, factors associated with operative morbidity and long-term postoperative outcomes in a large group of patients undergoing surgery for presacral tumours. METHOD This study was designed as a multicentre retrospective cohort study. Records of patients who underwent surgery for presacral tumours at 10 tertiary colorectal centres between 1996 and 2017 were evaluated. RESULTS One hundred and twenty seven patients (44 men) with a mean age of 46 years and body mass index of 27 kg/m2 were included. Fifty eight per cent of the patients had low sacral lesions (below S3). The operative approaches were transabdominal (17%), transsacral (65%) and abdominosacral (17%). The postoperative morbidity was 19%. Thirty per cent of the patients had a malignant tumour. Longer duration of symptoms (p = 0.001), higher American Society of Anesthesiologists score (p = 0.01), abdominosacral operations (p = 0.0001) and presacral tumours located above S3 (p = 0.004) were associated with an increased risk of postoperative morbidity. Overall long-term postoperative recurrence and mortality were 6% and 5%, respectively, within a 3-year mean follow-up period in patients with presacral malignant tumours. CONCLUSION Reduced physical condition, omission of symptoms prior to surgery, combined resections and high sacral tumours are the risk factors associated with postoperative complications in patients undergoing surgery for presacral tumours. Meticulous planning of the operation and intensified perioperative care may improve the outcomes in high-risk patients.
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Affiliation(s)
- Erman Aytac
- Acibadem University Atakent Hospital, Istanbul, Turkey
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bilgi Baca
- Acibadem Altunizde Hospital, Istanbul, Turkey
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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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Zhao X, Zhou S, Liu N, Li P, Chen L. Is There Another Posterior Approach for Presacral Tumors Besides the Kraske Procedure? — A Study on the Feasibility and Safety of Surgical Resection of Primary Presacral Tumors via Transsacrococcygeal Transverse Incision. Front Oncol 2022; 12:892027. [PMID: 35692749 PMCID: PMC9179022 DOI: 10.3389/fonc.2022.892027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe aim of the present study was to explore the feasibility and safety of the surgical resection of presacral tumors via a transsacrococcygeal transverse incision.MethodsThe clinical data and prognoses of patients with presacral tumors who underwent surgery at the Chinese People’s Liberation Army (PLA) General Hospital between January 2009 and December 2018 were retrospectively reviewed and analyzed.ResultsA total of 110 patients with presacral tumors were included in this study, including 82 female patients and 28 male patients, with a female-to-male ratio of 2.9:1. A posterior approach (transsacrococcygeal transverse incision) was utilized in 105 patients, an anterior approach (transabdominal excision) was utilized in 1 patient, and a combined (posterior plus anterior) approach was utilized in 4 patients. The mean tumor size was 8.72 ± 4.28 cm. More than half of the patients (n=59/110) with presacral tumors were asymptomatic. Twenty-six pathological types were observed in our study, including 97 benign lesions and 13 malignant lesions. The intraoperative complication rate was 42.7% (n=47/110), whereas the postoperative morbidity rate was 3.6% (n=4/110). The length of hospital stay for patients treated with the posterior approach was shorter than that of patients treated with the anterior and combined approaches. After a mean follow-up of 90.13 ± 31.22 months, 11 patients had local presacral tumor recurrence, and 1 patient had distant metastasis, with a combined recurrence rate of 10.9% (n=12/110).ConclusionsThe surgical resection of primary presacral tumors via a transsacrococcygeal transverse incision is feasible and safe, with acceptable oncological therapeutic outcomes and a low postoperative morbidity rate, making it worth popularizing in clinical practice.
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Aubert M, Mege D. Kraske approach to retrorectal tumors: Surgical technique. J Visc Surg 2022; 159:229-233. [DOI: 10.1016/j.jviscsurg.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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12
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Poudel D, Shrestha BM, Kandel BP, Shrestha S, Kansal A, Joshi Lakhey P. Presacral dermoid cyst in a young female patient: A case report. Clin Case Rep 2021; 9:e05062. [PMID: 34795897 PMCID: PMC8582024 DOI: 10.1002/ccr3.5062] [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: 06/06/2021] [Revised: 09/30/2021] [Accepted: 10/26/2021] [Indexed: 11/12/2022] Open
Abstract
Presacral dermoid cysts are rare, benign tumors of developmental origin that primarily affect women. Surgical resection is the mainstay of treatment for these cysts, even if asymptomatic, with the laparoscopic approach being safer and more efficient.
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Affiliation(s)
- Diptee Poudel
- Maharajgunj Medical Campus, Institute of MedicineMaharajgunjNepal
| | | | - Bishnu Prasad Kandel
- Department of Surgical GastroenterologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Suraj Shrestha
- Maharajgunj Medical Campus, Institute of MedicineMaharajgunjNepal
| | - Ankush Kansal
- Department of Surgical GastroenterologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Paleswan Joshi Lakhey
- Department of Surgical GastroenterologyTribhuvan University Teaching HospitalMaharajgunjNepal
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Zhang D, Sun Y, Lian L, Hu B, Zhang H, Zou Q, Huang D, Ren D. Long-term surgical outcomes after resection of presacral tumours and risk factors associated with recurrence. Colorectal Dis 2021; 23:2301-2310. [PMID: 33900009 DOI: 10.1111/codi.15691] [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: 11/05/2020] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 12/22/2022]
Abstract
AIM The incidence of presacral tumours is low and pertinent data on the management and outcomes after surgery are sparse. The aim of this study was to identify the risk factors for recurrence in patients with presacral tumours undergoing surgery at our institution. METHOD Patients undergoing resection of a presacral tumour between 2009 and 2019 were identified from a prospectively maintained database. Demographics, clinicopathological features, preoperative imaging, operative details, morbidity, mortality, recurrence and survival were investigated. RESULTS A total of 122 patients were identified. There were 95 women (77.9%) and the median age was 34 years. The most common presenting symptoms included pelvic pain (n = 60, 49.2%) and recurrent abscesses or fistulas (n = 40, 32.8%). The accuracy of preoperative magnetic resonance imaging (MRI) in distinguishing malignant from benign tumours was 93.9%. Six patients underwent three-dimensional computed tomography angiography (3D-CTA) and preoperative interventional embolization. Procedures were performed using transabdominal (n = 9), posterior (n = 99) and combined abdominal and posterior (n = 14) approaches. There were 21 (17.2%) malignant and 101 (82.8%) benign tumours. The local recurrence rate was 33.3% for malignant tumours and 9.9% for benign tumours. Multivariate analysis revealed that recurrence of malignant tumours was associated with R1 resection while recurrence of benign tumours was associated with secondary resections and intraoperative lesion rupture. CONCLUSION Presacral tumours continue to be a diagnostic and therapeutic challenge. A multidisciplinary team, informed by modern imaging modalities, is essential for the management of presacral tumours.
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Affiliation(s)
- Di Zhang
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yizhou Sun
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lei Lian
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bang Hu
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Heng Zhang
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qi Zou
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dandan Huang
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Donglin Ren
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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14
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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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15
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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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16
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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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17
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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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18
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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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Robotic approach to large tailgut cyst with malignant transformation: A case report. Int J Surg Case Rep 2020; 77S:S57-S60. [PMID: 33041256 PMCID: PMC7876925 DOI: 10.1016/j.ijscr.2020.09.025] [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: 06/08/2020] [Accepted: 09/05/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction Tailgut cysts (TGC) are rare congenital retrorectal lesions deriving from vestiges of the hindgut. The risk of malignant transformation is relatively high. Thus early diagnosis and a complete removal of the mass are of paramount importance. We present a case of successful robotic exeresis of a large TGC adenocarcinoma. Presentation of case A healthy 35-year-old woman was found to have a retrorectal TGC with suspected malignant transformation. The patient underwent complete robotic resection of the mass and pathology confirmed a TGC adenocarcinoma. The patient’s post-operative course was unremarkable. At 24 months, the patient has not experienced any recurrence nor complained functional disorders. Discussion The current case highlights the importance of TGC as a differential diagnosis of presacral masses, underscoring that malignant transformation can occur and may result in mortality and morbidity if radical surgery is not performed. Diagnosing TGC adenocarcinoma can be challenging because of its relatively low incidence. Biopsy is not recommended while magnetic resonance imaging (MRI) is indispensable in the evaluation of this lesion as the presence of intracystic vegetations could indicate a malignant transformation. Surgery is the mainstay of treatment and minimally invasive techniques have the potential to minimize morbidity and enhance recovery. Amongst these, the robotic approach can make the dissection of large lesions easier, reducing their manipulation and preventing nerve injuries. Conclusion Robot-assisted resection of a TGC adenocarcinoma is safe and feasible. This approach can be particularly useful in the pelvis providing acceptable functional and oncological outcomes.
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20
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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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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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22
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Nougaret S, Nikolovski I, Paroder V, Vargas HA, Sala E, Carrere S, Tetreau R, Hoeffel C, Forstner R, Lakhman Y. MRI of Tumors and Tumor Mimics in the Female Pelvis: Anatomic Pelvic Space-based Approach. Radiographics 2020; 39:1205-1229. [PMID: 31283453 DOI: 10.1148/rg.2019180173] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pelvic masses can present a diagnostic challenge owing to the difficulty in assessing their origin and the overlap in imaging features. The majority of pelvic tumors arise from gastrointestinal or genitourinary organs, with less common sites of origin including the connective tissues, nerves, and lymphovascular structures. Lesion evaluation usually starts with clinical assessment followed by imaging, or the lesion may be an incidental finding at imaging performed for other clinical indications. Since accurate diagnosis is essential for optimal management, imaging is useful for suggesting the correct diagnosis or narrowing the differential possibilities and distinguishing tumors from their mimics. Some masses may require histologic confirmation of the diagnosis with biopsy and/or up-front surgical resection. In this case, imaging is essential for presurgical planning to assess mass size and location, evaluate the relationship to adjacent pelvic structures, and narrow differential possibilities. Pelvic US is often the first imaging modality performed in women with pelvic symptoms. While US is often useful to detect a pelvic mass, it has significant limitations in assessing masses located deep in the pelvis or near gas-filled organs. CT also has limited value in the pelvis owing to its inferior soft-tissue contrast. MRI is frequently the optimal imaging modality, as it offers both multiplanar capability and excellent soft-tissue contrast. This article highlights the normal anatomy of the pelvic spaces in the female pelvis and focuses on MRI features of common tumors and tumor mimics that arise in these spaces. It provides an interpretative algorithm for approaching an unknown pelvic lesion at MRI. It also discusses surgical management, emphasizing the value of MRI as a road map to surgery and highlighting anatomic locations where surgical resection may present a challenge. ©RSNA, 2019.
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Affiliation(s)
- Stephanie Nougaret
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Ines Nikolovski
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Viktoriya Paroder
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Hebert A Vargas
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Evis Sala
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Sebastien Carrere
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Raphael Tetreau
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Christine Hoeffel
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Rosemarie Forstner
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Yulia Lakhman
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
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Korduke O, Omar A, Viner W, Kodeda K. Pre-sacral schwannoma. ANZ J Surg 2020; 90:1805-1807. [PMID: 31944521 DOI: 10.1111/ans.15707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Olga Korduke
- Department of Surgery, Taranaki Base Hospital, New Plymouth, New Zealand
| | - Ahmed Omar
- Department of Surgery, Taranaki Base Hospital, New Plymouth, New Zealand
| | - William Viner
- Department of Obstetrics and Gynaecology, Taranaki Base Hospital, New Plymouth, New Zealand
| | - Karl Kodeda
- Department of Surgery, Taranaki Base Hospital, New Plymouth, New Zealand.,Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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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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Kearney D, Valente M. Excision of a recurrent retrorectal tailgut cyst after 58 years. BMJ Case Rep 2019; 12:12/5/e230286. [PMID: 31092499 DOI: 10.1136/bcr-2019-230286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- David Kearney
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Michael Valente
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Abstract
Due to the rarity and large diversity of the primary retrorectal tumors (RTs), the diagnoses are often difficult and they can be misdiagnosed. We present our experience in light of scarce information available on the clinical manifestations of RTs. The retrospective study included 17 patients diagnosed as RTs between January 2004 and January 2014. Demographic characteristics, length of symptoms, clinical findings, diagnostic methods, evaluations on the treatment procedures and postoperative periods, pathology, complications, and length of hospital stay were recorded. A mean of 1.7 of patients were diagnosed with RTs annually in our hospital. Patients comprised 12 females and 5 males. Pain and discomfort were the most common symptoms at presentation. All the lesions were evaluated by using magnetic resonance imaging (MRI) and computed tomography (CT), and all the patients were treated operatively. Based on the preoperative MRI or CT findings, an anterior approach was performed in 7 patients, a posterior approach in 6 patients, and combined approach in 4 patients. Mean size of tumors was 9.2 ± 4.3 cm. Epidermoid cyst (n = 8) was the most common tumor. Except for 1 case of liposarcoma, 16 tumors were confirmed to be of benign nature in histologic examination. Mean length of hospital stay 12.4 ± 6.8 days. Retrorectal tumors are heterogeneous and lead to diagnostic difficulties. A high index of clinical suspicion is needed for diagnosis. Preoperative imaging may be helpful in determining the course of treatment. Total excision of a retrorectal tumor may alleviate pressure symptoms and confirm the diagnosis.
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Abstract
BACKGROUND Ischiorectal fossa tumors are rare. OBJECTIVE This study reviews a single institution's series of ischiorectal tumors with comparison against presacral tumors and assesses the utility of preoperative biopsy and angioembolization. DESIGN This is a retrospective study. SETTINGS This study was conducted at a quaternary referral center. PATIENTS All patients with ischiorectal tumor treated between February 1995 and April 2017 were retrospectively reviewed. Tumors extending secondarily into the ischiorectal fossa and inflammatory pathologies were excluded. INTERVENTIONS Preoperative biopsy, neoadjuvant therapy, angioembolization, and surgical excision of these tumors were reviewed. MAIN OUTCOME MEASURES Demographic, perioperative, pathological, and oncologic outcomes were evaluated. RESULTS Twenty-four patients (15 female; median age 54) were identified. Two-thirds were symptomatic. Forty-six percent had a palpable mass. All patients had CT and/or MRI. Fifty percent had a preoperative biopsy, of which 83% were diagnostic, and management was altered in 50%. All patients underwent surgical excision. Fifty-five percent had local excision, 38% had radical pelvic excision, and 8% had total mesorectal excision. Two patients had preoperative angioembolization. Both had successful R0 local excision. Morbidity occurred in 25%, with 1 major complication. There was no 30-day mortality. Histopathology demonstrated 17 soft tissue tumors (3 malignant), 2 GI stromal tumors, 1 neuroendocrine tumor, 1 Merkel cell carcinoma, 1 basaloid carcinoma, 1 epidermal cyst, and 1 lipoma. R0 resection was achieved in 75%. All patients were alive after a median follow-up of 33 months. Four patients developed recurrence at a median 10 months postoperatively. All recurrences were malignant, and 75% had had a R1 resection. LIMITATIONS This study is limited by its small numbers. The quaternary institution source may introduce bias. CONCLUSIONS Ischiorectal fossa tumors are heterogeneous and more likely to be malignant than presacral tumors. Biopsy can be useful if a malignant diagnosis is suspected and changes management in 50% of cases. Preoperative embolization may be useful for large vascular tumors. R0 resection is important to minimize recurrence. See Video Abstract at http://links.lww.com/DCR/A779.
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Robotic extralevator excision of a retrorectal giant aggressive angiomyxoma. Obstet Gynecol Sci 2018; 61:693-697. [PMID: 30474017 PMCID: PMC6236091 DOI: 10.5468/ogs.2018.61.6.693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 12/17/2022] Open
Abstract
Aggressive angiomyxoma (AA) is a very rare mesenchymal tumor most commonly found in the pelvic and perineal regions. For the complete excision of retrorectal tumors, with extension through the levator muscle into the ischioanal space, open anterior and posterior approaches are typically required. Herein, we report our experience with robotic excision of a giant presacral AA with extralevator extension into the ischioanal space and extraction via Pfannenstiel incision, which we found to be technically feasible, efficacious, and safe to perform. Mayo Clinic Institutional Review Board exemption status was obtained for this study.
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The Authors Reply. Dis Colon Rectum 2018; 61:e352. [PMID: 29878958 DOI: 10.1097/dcr.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Alharbi MB. Pre-sacral (retrorectal) abnormal tissue and tumours may be described by a new classification – A review article. INTERNATIONAL JOURNAL OF SURGERY OPEN 2018. [DOI: 10.1016/j.ijso.2017.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Baek SK, Hwang GS, Vinci A, Jafari MD, Jafari F, Moghadamyeghaneh Z, Pigazzi A. Retrorectal Tumors: A Comprehensive Literature Review. World J Surg 2017; 40:2001-15. [PMID: 27083451 DOI: 10.1007/s00268-016-3501-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
IMPORTANCE Retrorectal tumors are rare lesions that comprise a multitude of histologic types. Reports are limited to small single-institution case series, and recommendations on the ideal surgical approaches are lacking. OBJECTIVE The purpose of the study was to provide a comprehensive review of the epidemiology, pathologic subtypes, surgical approaches, and clinical outcomes of retrorectal tumors. EVIDENCE REVIEW We conducted a review of the literature using PubMed and searched the reference lists of published studies. RESULTS A total of 341 studies comprising 1708 patients were included. Overall, 68 % of patients were female. The mean age was 44.6 ± 13.7 years. Of all patients, 1194 (70 %) had benign lesions, and 514 patients (30 %) had malignant tumors. Congenital tumors (60.5 %) were the most frequent histologic type. Other pathologic types were neurogenic tumors (14.8 %), osseous tumors (3.1 %), inflammatory tumors (2.6 %), and miscellaneous tumors (19.1 %). Biopsy was performed in 27 % of the patients. Of these patients, incorrect diagnoses occurred in 44 %. An anterior surgical approach (AA) was performed in 299 patients (35 %); a posterior approach (PA) was performed in 443 (52 %), and a combined approach (CA) was performed in 119 patients (14 %). The mean length of stay (LOS) of PA was 7 ± 5 days compared to 8 ± 7 days for AA and 11 ± 7 days for CA (p < 0.05). The overall morbidity rate was 13.2 %: 19.3 % associated with anterior approach, 7.2 % associated with posterior approach, and 24.7 % after a combined approach (p < 0.05). Overall postoperative recurrence rate was 21.6 %; 6.7 % after an anterior approach, 26.6 % after a posterior approach, and 28.6 % after a combined approach (p < 0.05). A minimally invasive approach (MIS) was employed in 83 patients. MIS provided shorter hospital stays than open surgery (4 ± 2 vs. 9 ± 7 days; p < 0.05). Differences in complication rate were 19.8 % in MIS and 12.2 % in open surgery and not statistically significant. CONCLUSIONS AND RELEVANCE Retrorectal tumors are most commonly benign in etiology, of a congenital nature, and have a female predominance. Complete surgical resection is the cornerstone of retrorectal tumor management. A minimal access surgery approach, when feasible, appears to be a safe option for the management of retrorectal tumors, with shorter operative time and length of stay.
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Affiliation(s)
- Seong Kyu Baek
- Keimyung University College of Medicine, Daegu, Republic of Korea
| | - Grace Soon Hwang
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA.,Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alessio Vinci
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA
| | - Mehraneh D Jafari
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA
| | - Fariba Jafari
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA
| | - Zhobin Moghadamyeghaneh
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA
| | - Alessio Pigazzi
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA.
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Buchs N, Gosselink M, Scarpa C, Ris F, Saiji E, Bloemendaal A, van Onkelen R, Guy R, Schouten W, Roche B, George B. A multicenter experience with peri-rectal tumors: The risk of local recurrence. Eur J Surg Oncol 2016; 42:817-22. [DOI: 10.1016/j.ejso.2016.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 01/11/2016] [Accepted: 02/11/2016] [Indexed: 12/31/2022] Open
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Toh JWT, Morgan M. Management approach and surgical strategies for retrorectal tumours: a systematic review. Colorectal Dis 2016; 18:337-50. [PMID: 26663419 DOI: 10.1111/codi.13232] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/20/2015] [Indexed: 12/11/2022]
Abstract
AIM The management strategy for retrorectal tumours is complex. Due to their rarity, few surgeons have expertise in management. METHOD A systematic literature review was conducted using the PubMed database. English language publications in the years 2011-2015 that assessed preoperative management, surgical strategies and chemoradiotherapy for presacral tumours were included. Two hundred and fifty-one abstracts were screened of which 88 met the inclusion criteria. After review of the full text, this resulted in a final list of 42 studies eligible for review. RESULTS In all, 932 patients (63.2% female, 36.8% male; P < 0.01) with a retrorectal tumour were identified. Most were benign (65.9% vs. 33.7%, P < 0.01). Imaging distinguished benign from malignant lesions in 88.1% of cases; preoperative biopsy was superior to imaging in providing an accurate definitive diagnosis (91.3% vs. 61.4%, P < 0.05) with negligible seeding risk. Biopsy should be performed in solid tumours. It is useful in guiding neoadjuvant therapy for gastrointestinal stromal tumours, sarcomas and desmoid type fibromatosis and may alter the management strategy in cases of diffuse large B-cell lymphoma and metastases. Biopsies for cystic lesions are not recommended. The gold standard in imaging is MRI. The posterior Kraske procedure is the most common surgical approach. Overall, the reported recurrence rate was 19.7%. CONCLUSION This review evaluated the management strategies for retrorectal tumours. A preoperative biopsy should be performed for solid tumours. MRI is the most useful imaging modality. Surgery is the mainstay of treatment. There is limited information on robotic surgery, single-port surgery, transanal endoscopic microsurgery, chemoradiotherapy and reconstruction.
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Affiliation(s)
- J W T Toh
- Department of Colorectal Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
| | - M Morgan
- Department of Colorectal Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
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Shetty AS, Loch R, Yoo N, Mellnick V, Fowler K, Narra V. Imaging of tailgut cysts. ACTA ACUST UNITED AC 2015; 40:2783-95. [PMID: 26017036 DOI: 10.1007/s00261-015-0463-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Merchea A, Dozois EJ. Lesions Originating within the Retrorectal Space. J Gastrointest Surg 2014; 18:2232-3. [PMID: 24838996 DOI: 10.1007/s11605-014-2536-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 05/02/2014] [Indexed: 01/31/2023]
Affiliation(s)
- A Merchea
- Colon & Rectal Surgery , Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA,
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Imboden S, Al-Fana A, Kuhn A, Mueller MD. Pandora's box and retrorectal tumors in laparoscopy: A case report and review of the literature. Int J Surg Case Rep 2014; 5:706-9. [PMID: 25194610 PMCID: PMC4189049 DOI: 10.1016/j.ijscr.2014.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 08/11/2014] [Accepted: 08/11/2014] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Retrorectal tumors are uncommon and the etiology diverse. Literature to define the preoperative diagnosis and plan the intraoperative management are uncommon. PRESENTATION OF CASE We describe a case of a 44 year old patient with a laparoscopic approach for the removal of a retrorectal tumor and emphasize on the preoperative diagnostics and the intraoperative, minimal invasive approach. DISCUSSION Especially because these tumors are rare and often an incidental finding in gynecologic surgery, it is important to know the various differential diagnoses and its consequences with the laparoscopic approach. CONCLUSION We suggest the laparoscopic approach in cases of retroperitoneal cysts of unknown origin is ideal also because anatomic structures, mostly nerves, can be easily spared.
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Affiliation(s)
- Sara Imboden
- Department of Obstetrics and Gynecology, University Hospital of Berne, Berne, Switzerland.
| | - Amal Al-Fana
- Department of Obstetrics and Gynecology, University Hospital of Berne, Berne, Switzerland
| | - Annette Kuhn
- Department of Obstetrics and Gynecology, University Hospital of Berne, Berne, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Berne, Berne, Switzerland
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