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Romero-Marcos JM, Cuenca-Gómez C, González-Abós S, Sampson-Dávila JG, Altet-Torne J, Llopis-Mestre S, Delgado-Rivilla S. Transanal Excision of a Retrorectal Tumor. Dis Colon Rectum 2025; 68:e48. [PMID: 39847801 DOI: 10.1097/dcr.0000000000003576] [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: 01/25/2025]
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Kubetsky YE, Labzina EE, Kosimshoev MA, Kholtobin DP, Khalepa RV, Nabiev AO, Rzaev DA. [Laparoscopic resection of neurogenic presacral tumors]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2025; 89:59-67. [PMID: 39907668 DOI: 10.17116/neiro20258901159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2025]
Abstract
Laparoscopic approach is common in pelvic tumor surgery. Several small samples of patients after laparoscopic resection of presacral neurogenic tumors were described. Safety and advantages of this intervention are interesting. OBJECTIVE To analyze clinical outcomes of laparoscopic resection of presacral neurogenic tumors. MATERIAL AND METHODS Eleven patients including 2 children aged 11 and 17 years underwent laparoscopic tumor resection between 2021 and 2024. We estimated tumor size and localization, surgery time, blood loss, complications, postoperative hospital-stay, histological diagnosis and continued growth or recurrence in the follow-up period. The median follow-up was 19.2 (3-36) months. RESULTS Tumor size ranged from 4 to 10 cm, mean surgery time - 153.6 min, blood loss - 356.4 ml. Postoperative complications developed in 7 patients, including acute urinary retention, neuropathic pain syndrome, hematomas and dynamic intestinal obstruction. Total resection was achieved in 8 (72.7%) patients, subtotal resection - 2 (18.2%), partial resection - 1 (9.1%) case. Tumors were predominantly neurogenic: 6 (54.5%) - sacral nerve schwannomas, 1 (9%) - NF1-related schwannomatosis, 1 (9%) - meningioma, 1 (9%) - ganglioneuroma, 1 (9%) - fibromyxoid sarcoma, 1 (9%) - solitary fibrous tumor. There were no recurrences, continued growth or recurrence of preoperative symptoms in the follow-up period. CONCLUSION Laparoscopic resection of presacral neurogenic tumors is an effective surgical technique with good visualization of surgical field and possible gross total resection.
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Affiliation(s)
- Y E Kubetsky
- Federal Neurosurgical Center, Novosibirsk, Russia
| | - E E Labzina
- Novosibirsk National Research State University, Novosibirsk, Russia
| | | | | | - R V Khalepa
- Federal Neurosurgical Center, Novosibirsk, Russia
- Novosibirsk State Medical University, Novosibirsk, Russia
| | - A O Nabiev
- Avicenna Medical Center, Novosibirsk, Russia
| | - D A Rzaev
- Federal Neurosurgical Center, Novosibirsk, Russia
- Novosibirsk National Research State University, Novosibirsk, Russia
- Novosibirsk State Medical University, Novosibirsk, Russia
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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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Bardol T, Souche R, Druet C, Bertrand MM, Ferrandis C, Prudhomme M, Borie F, Fabre JM. Minimally invasive approach for retrorectal tumors above and below S3: a multicentric tertiary center retrospective study (MiaRT study). Tech Coloproctol 2024; 28:67. [PMID: 38860990 PMCID: PMC11166785 DOI: 10.1007/s10151-024-02938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/15/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Retrorectal tumors are uncommon lesions developed in the retrorectal space. Data on their minimally invasive resection are scarce and the optimal surgical approach for tumors below S3 remains debated. METHODS We performed a retrospective review of consecutive patients who underwent minimally invasive resection of retrorectal tumors between 2005 and 2022 at two tertiary university hospital centers, by comparing the results obtained for lesions located above or below S3. RESULTS Of over 41 patients identified with retrorectal tumors, surgical approach was minimally invasive for 23 patients, with laparoscopy alone in 19, with transanal excision in 2, and with combined approach in 2. Retrorectal tumor was above S3 in 11 patients (> S3 group) and below S3 in 12 patients (< S3 group). Patient characteristics and median tumor size were not significantly different between the two groups (60 vs 67 mm; p = 0.975). Overall median operative time was 131.5 min and conversion rate was 13% without significant difference between the two groups (126 vs 197 min and 18% vs 8%, respectively; p > 0.05). Final pathology was tailgut cyst (48%), schwannoma (22%), neural origin tumor (17%), gastrointestinal stromal tumor (4%), and other (19%). The 90-day complication rates were 27% and 58% in the > S3 and < S3 groups, respectively, without severe morbidity or mortality. After a median follow-up of 3.3 years, no recurrence was observed in both groups. Three patients presented chronic pain, three anal dysfunction, and three urinary dysfunction. All were successfully managed without reintervention. CONCLUSIONS Minimally invasive surgery for retrorectal tumors can be performed safely and effectively with low morbidity and no mortality. Laparoscopic and transanal techniques alone or in combination may be recommended as the treatment of choice of benign retrorectal tumors, even for lesions below S3, in centers experienced with minimally invasive surgery.
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Affiliation(s)
- T Bardol
- Digestive and Minimally Invasive Surgery Unit, Montpellier University Hospital, University of Montpellier-Nîmes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France.
| | - R Souche
- Digestive and Minimally Invasive Surgery Unit, Montpellier University Hospital, University of Montpellier-Nîmes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - C Druet
- Department of Digestive and Oncological Surgery, Nîmes University Hospital, Montpellier-Nîmes University, Montpellier, France
| | - M M Bertrand
- Department of Digestive and Oncological Surgery, Nîmes University Hospital, Montpellier-Nîmes University, Montpellier, France
| | - C Ferrandis
- Digestive and Minimally Invasive Surgery Unit, Montpellier University Hospital, University of Montpellier-Nîmes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - M Prudhomme
- Department of Digestive and Oncological Surgery, Nîmes University Hospital, Montpellier-Nîmes University, Montpellier, France
| | - F Borie
- Department of Digestive and Oncological Surgery, Nîmes University Hospital, Montpellier-Nîmes University, Montpellier, France
| | - J-M Fabre
- Digestive and Minimally Invasive Surgery Unit, Montpellier University Hospital, University of Montpellier-Nîmes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
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Otote J, Butnari V, Ravichandran PS, Mansuri A, Ahmed M, Pestrin O, Rajendran N, Kaul S. Presacral tumors: A systematic review of literature. J Clin Imaging Sci 2024; 14:17. [PMID: 38841312 PMCID: PMC11152553 DOI: 10.25259/jcis_27_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
Presacral/Retrorectal tumors (RRT) are rare lesions that comprise a multitude of histological types. Data on surgical management are limited to case reports and small case series. The aim of the study was to provide a comprehensive review of the epidemiology, pathological subtypes, surgical approaches, and clinical outcomes. A PubMed search using terms "retrorectal tumor" and "presacral tumor" was used to identify articles reporting RRT of non-urological, non-gynecologic, and non-metastatic origin. Articles included were between 2015 and 2023. A total of 68 studies were included, comprising 570 patients. About 68.2% of patients were female, and the mean overall age of both sexes was 48.6 years. Based on histopathology, 466 patients (81.8%) had benign lesions, and 104 (18.2%) were malignant. In terms of surgical approach, 191 (33.5%) were treated anteriorly, 240 (42.1%) through a posterior approach, and 66 (11.6%) combined. The mean length of stay was 7.6 days. Patients treated using the posterior approach had a shorter length of stay (5.7 days) compared to the anterior and combined approaches. RRT are rare tumors of congenital nature with prevalence among the female sex. R0 resection is crucial in its management, and minimal access surgery appears to be a safer option in appropriate case selection.
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Affiliation(s)
- Jeffrey Otote
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Valentin Butnari
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Praveen Surya Ravichandran
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Ahmer Mansuri
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Mehnaz Ahmed
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Olivia Pestrin
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Nirooshun Rajendran
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Sandeep Kaul
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
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Ferrari D, Violante T, Addison P, Perry WRG, Merchea A, Kelley SR, Mathis KL, Dozois EJ, Larson DW. Robotic resection of presacral tumors. Tech Coloproctol 2024; 28:49. [PMID: 38653930 DOI: 10.1007/s10151-024-02922-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/16/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Presacral tumors are a rare entity typically treated with an open surgical approach. A limited number of minimally invasive resections have been described. The aim of the study is to evaluate the safety and efficacy of roboticresection of presacral tumors. METHODS This is a retrospective single system analysis, conducted at a quaternary referral academic healthcare system, and included all patients who underwent a robotic excision of a presacral tumor between 2015 and 2023. Outcomes of interest were operative time, estimated blood loss, complications, length of stay, margin status, and recurrence rates. RESULTS Sixteen patients (11 females and 5 males) were included. The median age of the cohort was 51 years (range 25-69 years). The median operative time was 197 min (range 98-802 min). The median estimated blood loss was 40 ml, ranging from 0 to 1800 ml, with one patient experiencing conversion to open surgery after uncontrolled hemorrhage. Urinary retention was the only postoperative complication that occurred in three patients (19%) and was solved within 30 days in all cases. The median length of stay was one day (range 1-6 days). The median follow-up was 6.7 months (range 1-110 months). All tumors were excised with appropriate margins, but one benign and one malignant tumor recurred (12.5%). Ten tumors were classified as congenital (one was malignant), two were mesenchymal (both malignant), and five were miscellaneous (one malignant). CONCLUSIONS Robotic resection of select presacral pathology is feasible and safe. Further studies must be conducted to determine complication rates, outcomes, and long-term safety profiles.
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Affiliation(s)
- D Ferrari
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
- General Surgery Residency Program, University of Milan, Milan, Italy
| | - T Violante
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
- School of General Surgery, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - P Addison
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - W R G Perry
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - A Merchea
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - S R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - K L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - E J Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - D W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA.
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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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Bilkhu AS, Wild J, Sagar PM. Management of retrorectal tumours. Br J Surg 2024; 111:znae012. [PMID: 38291005 DOI: 10.1093/bjs/znae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/06/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Amarvir S Bilkhu
- Colorectal & Peritoneal Oncology, The Christie Foundation NHS Trust, Manchester, UK
| | - Jonathan Wild
- Colorectal & Peritoneal Oncology, The Christie Foundation NHS Trust, Manchester, UK
| | - Peter M Sagar
- John Goligher Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Brown KGM, D'Souza N, Solomon MJ. How to access the presacral space using a posterior trans-sacral approach. ANZ J Surg 2023; 93:2993-2994. [PMID: 37872728 DOI: 10.1111/ans.18750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/03/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023]
Abstract
This article describes a posterior trans-sacral approach to the presacral space. This is an important technique in contemporary colorectal surgical practice for resection of presacral tumours, and less commonly to allow access for rectal sleeve advancement, segmental resection of the lower rectum (rarely indicated in the era of total mesorectal excision and trans-anal techniques), drainage of supralevator sepsis and resection of extensive ischiorectal fossa tumours.
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Affiliation(s)
- Kilian G M Brown
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
| | - Nigel D'Souza
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael J Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
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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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Salameh F, Gilshtein H, Abramov R, Ashkenazi I, Duek D. Transanal endoscopic microsurgery technique: an acceptable approach for retrorectal tumors. Tech Coloproctol 2023; 27:673-678. [PMID: 36645584 DOI: 10.1007/s10151-023-02753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Retrorectal lesions (RRLs) are rare lesions that originate from the tissue present in the retrorectal space. The gold standard of care is complete resection regardless of pathology. The traditional approaches (anterior, posterior, and combined) are relatively well described. Transanal Endoscopic Microsurgery (TEM) is a minimally invasive technique offered as an alternative approach for RRLs. AIM To evaluate the outcomes of patients diagnosed with RRL and treated by the TEM approach, especially postoperative complications, and the recurrence rate. METHODS Patients with RRLs treated with the TEM technique in one medical center between 2000 and 2020 were identified. Their postoperative outcomes were compared with historical controls. RESULTS Thirty-nine patients diagnosed with RRL were operated on using the TEM platform. Thirty-seven RRLs were benign, and two were malignant. Their median size (IQR) was 20 mm (15, 32.5). The median distance (IQR) from the anal verge was 50 mm (50, 72.5). The median operative time (IQR) was 48.5 min (41.75, 60). All, except one lesion, were completely resected. The median length of stay (IQR) was one day (1, 1 day). Postoperative complications were diagnosed in three patients, two of which resolved following a second operation. CONCLUSIONS The implementation of TEM for the resection of RRLs demonstrated excellent overall results with acceptable complication and recurrence rate and represented a viable alternative surgical approach.
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Affiliation(s)
- F Salameh
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel.
| | - H Gilshtein
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
| | - R Abramov
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
| | - I Ashkenazi
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
| | - D Duek
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
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12
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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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13
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Gould LE, Pring ET, Corr A, Fletcher J, Warusavitarne J, Burling D, Northover JMA, Jenkins JT. Evolution of the management of retrorectal masses: A retrospective cohort study. Colorectal Dis 2021; 23:2988-2998. [PMID: 34459085 DOI: 10.1111/codi.15893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/25/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023]
Abstract
AIM Retrorectal masses are abnormalities located anatomically in the retrorectal space. A significant proportion are asymptomatic with no malignant potential while others cause symptoms due to mechanical pressure or malignant infiltration. We reviewed and categorised the retrorectal masses encountered over a 30-year time period in a specialist colorectal hospital and describe our management algorithm for consideration by other multidisciplinary teams (MDT). METHODS This was a retrospective analysis of consecutive patients referred between 1984-2019. A detailed review of clinical presentation, imaging features, postoperative histology and impact on morbidity and anorectal function is reported. RESULTS A total of 143 patients with median age of 46 years and female preponderance (74%) were reviewed. The commonest presenting symptom was pain (46%) and all malignant cases had symptoms (n = 17). Over the last decade, more asymptomatic patients have presented with a retrorectal mass (33%, p = 0.04) and more patients are opting for surveillance rather than resection (33%, p = 0.013). Increasing age and lesion size were associated with malignancy (p < 0.05). Radiological features associated with malignancy included: solid/heterogeneous component, lobulated borders or locally invasive. Following surgery, complications included chronic pain (40%), poor wound healing (23%) and bowel dysfunction (10%). CONCLUSIONS The management of retrorectal masses remains complex. There are features, both clinical and radiological, that can help determine the best management strategy. Management should be in a high-volume tertiary centre and preferably through a complex rectal cancer MDT. Long-term sequelae such as chronic pain must be highlighted to patients. We advocate the establishment of an international registry to further record and characterise these rare, potentially troublesome lesions.
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Affiliation(s)
- Laura E Gould
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Edward T Pring
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Alison Corr
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Jordan Fletcher
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | | | - David Burling
- Department of Surgery and Cancer, Imperial College, London, UK
| | - John M A Northover
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - John T Jenkins
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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14
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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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15
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Gu L, Berkowitz CL, Stratigis JD, Collins LK, Mostyka M, Spigland NA. Presacral epidermoid cyst in a pediatric patient. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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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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17
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Ramwani R, Bassi D, Velasco A. Incidental Discovery of a Presacral Extradural Myxopapillary Ependymoma. Clin Med Res 2021; 19:94-98. [PMID: 33985980 PMCID: PMC8231692 DOI: 10.3121/cmr.2021.1561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 11/18/2022]
Abstract
Ependymoma is a malignant central nervous system tumor arising from the lining of the ventricles or central canal of the spinal cord. Extradural spinal ependymomas arise from heterotopic ependymal cells or the coccygeal medullary vestige and are extremely infrequent. We present a rare case of presacral extradural ependymoma. Extradural ependymomas typically demonstrate an extraneural spread and, thus, surveillance of the entire central nervous system is not typically recommended. A radiograph of the chest, liver profile, and attention to palpable lymphadenopathy (especially inguinal) on physical examination are vital for surveillance. Obtaining an R0 resection is the most important prognostic factor in survival and local recurrence.
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Affiliation(s)
- Roshini Ramwani
- Department of General Surgery, Marshfield Medical Center, Marshfield, WI USA
| | - Deepa Bassi
- Department of Pathology, Marshfield Clinic Health System, Marshfield, WI USA
| | - Alfonso Velasco
- Department of General Surgery, Marshfield Medical Center, Marshfield, WI USA
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18
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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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19
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Alyousef Z, Aleissa M, Alaamer O, Alselaim N. Combined laparoscopic and posterior approach resection of large sacrococcygeal cystic teratoma. Surg Case Rep 2021; 7:20. [PMID: 33438088 PMCID: PMC7803854 DOI: 10.1186/s40792-020-01104-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/28/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Teratoma is a true neoplasm and originates from the three germ cell layers and it can contain any tissue derived from these layers. The location of teratoma is variable according to the age group. In adults, sacrococcygeal teratoma is rare and carries a low risk of malignant transformation. Surgical resection is the mainstay of treatment and is challenging due to tumor location. CASE PRESENTATION We are presenting a case report of a 16-year old female referred to our hospital with recurrent attacks of urine retention. Imaging study showed a large sacrococcygeal tumor. It was successfully resected by a combined laparoscopic and posterior approach without any major complication. CONCLUSION The combined laparoscopic and posterior approach is a safe surgical technique for resection of the large sacrococcygeal tumor. This surgical method has been published around 10 times in separated reports around the world and for first time in our region.
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Affiliation(s)
- Ziyad Alyousef
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maryam Aleissa
- Prince Noura Bin Abdulrahman University, Riyadh, Saudi Arabia. .,Department of Surgery, King Faisal Specialist Hospital & Research Center, , Riyadh, Saudi Arabia.
| | - Ohood Alaamer
- Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nahar Alselaim
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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20
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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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21
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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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22
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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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Yalav O, Topal U, Eray İC, Deveci MA, Gencel E, Rencuzogullari A. Retrorectal tumor: a single-center 10-years' experience. Ann Surg Treat Res 2020; 99:110-117. [PMID: 32802816 PMCID: PMC7406398 DOI: 10.4174/astr.2020.99.2.110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/09/2020] [Accepted: 05/30/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose Retrorectal tumors (RTs) are a rare incidence and recommendations on the ideal surgical approaches are lacking. This study aimed to evaluate outcomes and follow-up results of patients undergoing excision of RTs at our institution. Methods A retrospective review was conducted for undergoing surgery for RT between January 2009 and January 2019. Demographic characteristics, presenting symptoms, preoperative diagnostic tests, surgical procedures, histopathological results, intraoperative and postoperative complications, postoperative hospital stay, postoperative 30-day mortality, 90-day unplanned readmission rate, and long-term outcomes were evaluated. Results Twenty patients with a mean age of 48.3 ± 14.2 were analyzed. The most common presenting complaint was perineal pain (35.0%). Magnetic resonance imaging and computed tomography was preferred in 18 and 2 patients, respectively. Tumor localization was below the level of the third sacral vertebrae in 14 patients for whom the posterior surgical approach was used. No postoperative mortality was recorded at the end of follow-up of 53.8 ± 40 months. Mean length of postoperative hospital stay was 8.6 ± 9.4 days. Ten percent of the patients had unplanned hospital readmission within 90 days after discharge. Recurrence developed in 1 patient, for whom pathology were reported as chordoma. Conclusion RT should be managed by a multidisciplinary team given the complexity and heterogeneity of these tumors despite the fact that the majority are benign. A good understanding of pelvic anatomy and characterization of lesions through detailed radiological imaging is crucial to optimize surgical planning. Complete surgical resection is key for prolonged disease-free and overall survival of patients diagnosed with RTs.
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Affiliation(s)
- Orçun Yalav
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Uğur Topal
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - İsmail Cem Eray
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Mehmet Ali Deveci
- Department of Orthopedics and Traumatology, Çukurova University Faculty of Medicine, Adana, Turkey.,Department of Orthopedics and Traumatology, Koç University Faculty of Medicine, Istanbul, Turkey
| | - Eyüphan Gencel
- Department of Plastic and Reconstructive Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Ahmet Rencuzogullari
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
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24
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Ramalingam K, Fiser C, Sabih Q, Rajput A. Retrorectal cyst: proteus in the backyard-case series and literature review. BMJ Case Rep 2020; 13:13/6/e231080. [PMID: 32487521 DOI: 10.1136/bcr-2019-231080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Retrorectal cysts are cystic lesions located in the retrorectal space and are a distinct subset of retrorectal tumours, which are often misdiagnosed due to their rarity and mimicry of symptoms caused by common diseases. We have described the presentation and management of four patients who were diagnosed with retrorectal cysts from a 10-year retrospective chart review at our institute, a tertiary care centre. In middle-aged women, the following should raise suspicion of retrorectal cyst: gastrointestinal or urinary obstructive features, mass or fullness palpable on the posterior wall on digital rectal examination, presacral dimple, perianal fistula and/or recurrent disease. Such features should prompt an MRI evaluation of the pelvis for definitive diagnosis.
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Affiliation(s)
- Kirithiga Ramalingam
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Caroline Fiser
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Quratulain Sabih
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ashwani Rajput
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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25
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Wu X, Chen C, Yang M, Yuan X, Chen H, Yin L. Squamous Cell Carcinoma Malignantly Transformed From Frequent Recurrence of a Presacral Epidermoid Cyst: Report of a Case. Front Oncol 2020; 10:458. [PMID: 32318346 PMCID: PMC7146309 DOI: 10.3389/fonc.2020.00458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/13/2020] [Indexed: 01/01/2023] Open
Abstract
Backgroud: Presacral tumors are rare space occupying lesions that arise in the presacral space. The incidence of presacral tumor has been reported to be 1 in 40,000 to 63,000 patients. An even rarer occurrence is the transformation of a presacral tumor into a squamous cell carcinoma (SCC). Case Summary: A 61 years old man was referred to our hospital for a palpable mass near anus and appeared repeatedly in last 10 years. The patient previously underwent two surgeries at another hospital. A posterior approach was implemented in the first two surgeries, and the diagnosis was benign presacral epidermoid cyst. Two months before his admission to our department in 2017, the patient complained of a mass measuring ~2 cm around his anus. Physical examination revealed a 2 cm mass at the 12 o'clock direction in chest-knee position. A digital rectal examination indicated a rubbery lesion located in the presacral space. The Pre-operative pelvic magnetic resonance imaging (MRI) confirmed the presence of a 6.8 cm * 5.2 cm * 7.3 cm mass located at the presacral space. In contrast phase, the center of the lesion exhibited homogenous density without enhancement. The mass was then excised via posterior para-sacral approach with pathological report showing a benign epidermoid cyst after operation. The patient was discharged with full recovery without fecal incontinence. Fifteen months after being discharged from our hospital, the patient discovered a recurrence at the original site of where the mass previously appeared. Unlike the previous instance, the mass was accompanied with swelling, pain, and localized increased skin temperature. Pelvic MRI showed a 3.2 cm * 7.2 cm * 5.8 cm located at the same place, with no enhance in the core of mass. However, a speckled enhancement was observed on the margin of the lesion. The lesion was completely resected using the same procedure as before with a pathological diagnosis of SCC. The patient underwent chemoradiation therapy and remained disease free for more than 1 year. Conclusion: Although very rare, benign cyst from presacral space can become malignant transformation. This highlights the importance of pre-operative diagnostic tests and evaluation to correctly identify the source of the primary cancer, which is crucial prior to starting adjuvant therapy.
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Affiliation(s)
- Xiaocai Wu
- Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Chunqiu Chen
- Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Muqing Yang
- Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Xiaoqi Yuan
- Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Hong Chen
- Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Lu Yin
- Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
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Hegazi TM, Al-Sharydah AM, Lee KS, Mortele K. Retroperitoneal cystic masses: magnetic resonance imaging features. Abdom Radiol (NY) 2020; 45:499-511. [PMID: 31583446 DOI: 10.1007/s00261-019-02246-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The objective of this review is to discuss the clinical and histopathologic features, MRI characteristics, and management options of retroperitoneal cystic masses. Radiologists should be familiar with the MR imaging characteristics of retroperitoneal cystic masses to allow for a refined differential diagnosis, assist with lesion management, and prevent unnecessary invasive procedures.
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Affiliation(s)
- Tarek M Hegazi
- Department of Radiology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | | | - Karen S Lee
- Division of Abdominal Imaging/Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Koenraad Mortele
- Division of Abdominal Imaging/Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
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Seo GJ, Seo JH, Cho KJ, Cho HS. Anal Gland/Duct Cyst: A Case Report. Ann Coloproctol 2020; 36:204-206. [PMID: 31958940 PMCID: PMC7392575 DOI: 10.3393/ac.2018.09.06.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/06/2018] [Indexed: 11/17/2022] Open
Abstract
Anal gland/duct cyst (AGC) is rare and observed in only 0.05% of patients undergoing anal surgery. AGC is thought to be a retention cyst in the anal gland and arises when an obstruction of the anal duct causes fluid collection in the anal gland. We report a case of AGC in a 66-year-old woman without anal symptoms. Found by colonoscopy, the AGC was excised transanally. The histopathology of the specimen confirmed AGC. Colonoscopists should include AGC in the differential diagnosis of anal canal mass and rule out of malignancy. Excision is recommended for definitive diagnosis and treatment.
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Affiliation(s)
| | - Ju Heon Seo
- Geochang International School, Geochang, Korea
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Martins P, Canotilho R, Peyroteo M, Afonso M, Moreira A, de Sousa A. Tailgut cyst adenocarcinoma. AUTOPSY AND CASE REPORTS 2019; 10:e2019115. [PMID: 32039057 PMCID: PMC6945306 DOI: 10.4322/acr.2019.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 02/22/2019] [Indexed: 12/14/2022] Open
Abstract
Tailgut cysts (TGCs) are rare congenital entities arising from remnants of the embryological postanal primitive gut. Malignancy in TGCs is rare, with the majority being adenocarcinomas and carcinoid tumors. A search of the published literature yielded only 27 cases of adenocarcinoma developing in TGCs. We described the case of a 54-year-old female who presented with complaints of pelvic and perineal pain of several weeks. After the initial work-up, a mass in the right presacral location was diagnosed. She underwent radical resection of the tumor, using a posterior approach. The lesion was removed en bloc with the middle rectum, coccyx, and sacrum (S4-S5). The histopathologic examination revealed an adenocarcinoma arising in a TGC, and the patient received adjuvant chemoradiotherapy. Our case underlines that diagnosing a TGC is difficult as it is a rare congenital lesion. Clinical examination may be challenging as TGCs present with various symptoms, which can mimic other commonly proctologic disorders. Patients should be referred to a tertiary center with experience in pelvic surgery and must be managed by a multidisciplinary approach to maximize successful treatment. The recommended treatment is surgical excision given the malignant potential of TGCs and their risk of causing local complications.
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Affiliation(s)
- Pedro Martins
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal
| | - Rita Canotilho
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal
| | - Mariana Peyroteo
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal
| | - Mariana Afonso
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Anatomic Pathology Service. Porto, Portugal
| | - Augusto Moreira
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal
| | - Abreu de Sousa
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal
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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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Poškus E, Račkauskas R, Danys D, Valančienė D, Poškus T, Strupas K. Does a retrorectal tumour remain a challenge for surgeons? Acta Chir Belg 2019; 119:289-293. [PMID: 30270764 DOI: 10.1080/00015458.2018.1515397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/12/2018] [Indexed: 12/28/2022]
Abstract
Background: Retrorectal tumours are lesions with a wide range of histological differentiation that are often diagnostic and clinical challenges due to their rare occurrence. Many cases of this pathology are treated in regional hospitals, which results in serious complications because physicians fail to recognize this pathology. We present our experience in treating these tumours. Methods: A retrospective analysis of a prospectively maintained database was performed using the Vilnius University Hospital Santaros Clinics patient database. Thirty-five cases were identified. Results: Occurrence of retrorectal tumours was higher in women than in men and accounted for 82.86% and 17.14%, respectively. Computer tomography and magnetic resonance imaging were the main methods used to confirm diagnosis and plan surgical treatment. We have used a laparotomy, perineal or combined approach for tumour extirpation. The laparotomy approach was the most used, followed by perineal extirpation. The most common histological type was cystic hamartoma, accounting for 20% of cases. In 80% of cases, the histological findings greatly varied. Hospital stays varied from 3 to 21 days with a mean of 11.6 ± 5.83 days. The postoperative complication rate was 17.14% and was present in six cases. Overall survival was 85.17%, with an average follow-up period of 71.83 months. There were no recurrent tumours diagnosed during follow-up. Conclusion: Retrorectal tumours are a very rare pathology with high histological heterogeneity and problematic diagnostics. Patients should be referred to a tertiary centre that has experience and diagnostic capabilities for the best diagnostic and treatment options.
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Affiliation(s)
- Eligijus Poškus
- Center of Abdominal Surgery, Vilnius University , Vilnius , Lithuania
| | - Rokas Račkauskas
- Center of Abdominal Surgery, Vilnius University , Vilnius , Lithuania
| | - Donatas Danys
- Center of Abdominal Surgery, Vilnius University , Vilnius , Lithuania
| | - Dileta Valančienė
- Center of Radiology and Nuclear Medicine, Vilnius University Hospital Santaros Klinikos , Vilnius , Lithuania
| | - Tomas Poškus
- Center of Abdominal Surgery, Vilnius University , Vilnius , Lithuania
| | - Kęstutis Strupas
- Center of Abdominal Surgery, Vilnius University , Vilnius , Lithuania
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Neuroendocrine tumour developing within a long-standing tailgut cyst: case report and review of the literature. Clin J Gastroenterol 2019; 12:539-551. [PMID: 31147970 DOI: 10.1007/s12328-019-00998-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022]
Abstract
A tailgut cyst is a rare congenital lesion that can develop in the presacral space from the remnants of an embryonic hindgut. It is unusual for malignant change to occur in a tailgut cyst. We report a case of a large long-standing tailgut cyst, which was removed during a laparotomy. Histopathology showed a well-differentiated neuroendocrine tumour (primary carcinoid tumour) arising in a tailgut cyst. We reviewed the English literature for all adult cases with this condition. All original articles were reviewed, and data were compiled and tabulated. Including this report, 29 cases of NET developing in a tailgut cyst were found in the English literature. Tailgut cysts have been reported as more common in females, with a mean age of presentation in the fifth decade (Devine, in: Zbar A, Wexner S (eds) Coloproctology. Springer specialist surgery series, Springer, London, 2010; Hjermstad and Helwig in Am J Clin Pathol 89:139-147, 1988). Tailgut cysts may undergo malignant change including adenocarcinoma, sarcoma, and NET (Mathis et al. Br J Surg 97:575-579, 2010; Messick in Dis Colon Rectum 61:151-153, 2018; Patsouras et al. in Colorectal Dis 17:724-729, 2015; Chereau et al in Colorectal Dis 15:e476-e482, 2013). It is difficult to estimate the true incidence of malignant change in a tailgut cyst, with the literature reports only limited to case reports and small-case series. Although rare, our case confirms need to consider the possibility of a malignant component, even in a benign process such as a tailgut cyst. This prompts consideration for upfront definitive management.
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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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Dziki Ł, Włodarczyk M, Sobolewska-Włodarczyk A, Saliński A, Salińska M, Tchórzewski M, Mik M, Trzciński R, Dziki A. Presacral tumors: diagnosis and treatment - a challenge for a surgeon. Arch Med Sci 2019; 15:722-729. [PMID: 31110540 PMCID: PMC6524179 DOI: 10.5114/aoms.2016.61441] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/27/2016] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Presacral tumors are a rare group of heterogeneous lesions located in a potential space referred to as the retrorectal or presacral space. Lack of characteristic symptomatology and difficult anatomical localization make the diagnosis and management challenging for a surgeon. The aim of this study was to analyze cases of presacral tumors that underwent surgical treatment with regard to diagnostics, methods and outcomes. MATERIAL AND METHODS The study enrolled patients who underwent surgical treatment at the Department of General and Colorectal Surgery, Medical University of Lodz. The data was analyzed for age, gender, clinical symptoms, type of diagnostic procedures conducted, histopathology results, type of treatment implemented, intra- and perioperative complications as well as early and long-term treatment outcomes. RESULTS The study enrolled 29 patients who underwent surgical treatment for presacral tumors. Malignant tumors accounted for 34% of all cases (n = 10), and 80% of them occurred in men. Benign cases accounted for 66% of cases (n = 19), and they occurred predominantly in women (58%). Malignant lesions were more common in men (p < 0.05). The average age of patients with benign tumors was lower than that of patients with malignant tumors (p < 0.05). The transsacral approach was used in 51% of patients, abdominal laparotomy in 41% and a combined approach in 7%. Cure was achieved in 72% of patients, including 67% who were cured after their initial surgery. CONCLUSIONS Presacral tumors are more common in men and more commonly are malignant tumors in this group. The success rate of surgical treatment is 72%, and selection of the surgical approach does not affect the final treatment outcome.
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Affiliation(s)
- Łukasz Dziki
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Marcin Włodarczyk
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | | | - Aleksander Saliński
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Magdalena Salińska
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Marcin Tchórzewski
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Michał Mik
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Radzisław Trzciński
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Adam Dziki
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
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Yu G, Cao F, Gong H, Liu P, Sun G, Zhang W. Embolization of blood-supply artery followed by surgery for treatment of mesorectal Castleman's disease: case report and literature review. Gastroenterol Rep (Oxf) 2019; 7:141-145. [PMID: 28057712 PMCID: PMC6454847 DOI: 10.1093/gastro/gow040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/17/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022] Open
Abstract
A 23-year-old male patient was diagnosed as having a hypervascular pelvic mass by ultrasonography and magnetic resonance examination. A pathology puncture showed vitreous vascular Castleman's disease. Because of concerns about tumor blood supply, embolization under digital subtraction angiography (DSA) was performed on the artery of the pelvic tumor before resection of the mass and surrounding rectum. Castleman's disease of pelvic lymph node (mixed type, mainly hyaline vascular type) was confirmed pathologically from postoperative biopsy. Embolization of the blood-supply artery of a hypervascular mass should be considered before surgery is performed.
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Affiliation(s)
- Guanyu Yu
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Fuao Cao
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Haifeng Gong
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Peng Liu
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Ge Sun
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Wei Zhang
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
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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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Aihole J, Aruna G, Deepak J, Supriya S. Precoccygeal epidermoid cyst in a child — A unique case report. AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Zhou J, Zhao B, Qiu H, Xiao Y, Lin G, Xue H, Xiao Y, Niu B, Sun X, Lu J, Xu L, Zhang G, Wu B. Laparoscopic resection of large retrorectal developmental cysts in adults: Single-centre experiences of 20 cases. J Minim Access Surg 2018; 16:152-159. [PMID: 30416141 PMCID: PMC7176010 DOI: 10.4103/jmas.jmas_214_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Context Retrorectal tumours are rare with developmental cysts being the most common type. Conventionally, large retrorectal developmental cysts (RRDCs) require the combined transabdomino-sacrococcygeal approach. Aims This study aims to investigate the surgical outcomes of the laparoscopic approach for large RRDCs. Settings and Design A retrospective case series analysis. Subjects and Methods Data of patients with RRDCs of 10 cm or larger in diameter who underwent the laparoscopic surgery between 2012 and 2017 at our tertiary centre were retrospectively analyzed. Statistical Analysis Used Results are presented as median values or mean ± standard deviation for continuous variables and numbers (percentages) for categorical variables. Results Twenty consecutive cases were identified (19 females; median age, 36 years). Average tumour size was 10.9 ± 1.1 cm. Cephalic ends of lesions ranged from S1/2 junction to S4 level. Caudally, 18 cysts extended to the sacrococcygeal hypodermis. Seventeen patients underwent the pure laparoscopy; three patients received a combined laparoscopic-posterior approach. The operating time was 167.1 ± 57.3 min for the pure laparoscopic group and 212.0 ± 24.5 min for the combined group. The intraoperative haemorrhage was 68.2 ± 49.7 and 66.7 ± 28.9 (mL), respectively. Post-operative complications included one trocar site hernia, one wound infection and one delayed rectal wall perforation. The median post-operative hospital stay was 7 days. With a median follow-up period of 36 months, 1 lesions recurred. Conclusions The laparoscopic approach can provide a feasible and effective alternative for large RRDCs, with advantages of the minimally invasive surgery. For lesions with ultra-low caudal ends, especially those closely clinging to the rectum, a combined posterior approach is still necessary.
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Affiliation(s)
- Jiaolin Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bangbo Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Huizhong Qiu
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Xiao
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Guole Lin
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yu Xiao
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Beizhan Niu
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiyu Sun
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Junyang Lu
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Lai Xu
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Guannan Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Coco C, Manno A, Mattana C, Verbo A, Sermoneta D, Franceschini G, De Gaetano A, Larocca LM, Petito L, Pedretti G, Rizzo G, Lodoli C, D'Ugo D. Congenital Tumors of the Retrorectal Space in the Adult: Report of Two Cases and Review of the Literature. TUMORI JOURNAL 2018; 94:602-7. [DOI: 10.1177/030089160809400428] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background To describe and discuss, on the basis of the authors’ experience and a review of the literature, the main aspects regarding the etiology, diagnosis, treatment and prognosis of congenital tumors of the retrorectal space. Methods We present 2 cases of congenital retrorectal tumors, a sacrococcygeal teratoma and a dermoid cyst, which represent, from the pathogenetic point of view, the most frequent presentation of the rare tumors of the retrorectal space. Results The reported cases are typical. The teratoma presented as an encapsulated, mixed mass located in the pelvic cavity behind the rectum and the vaginal canal, without signs of sacral involvement. The dermoid cyst appeared as a unilocular lesion filled with sebum and hair, which extended laterally to the iliopubic branch, medially to the urethra and anal canal, and posteriorly to the adipose tissue of the right buttock. Pelvic MRI produced a precise picture of the extension of the lesion and of the relationship between the mass and the pelvic organs and surrounding bony structures. Both lesions were completely removed via the perineal approach without coccygectomy. No recurrences were observed at 2 years of follow-up. Conclusions Congenital retrorectal tumors are rare. MRI is crucial for diagnosis and preoperative planning. Complete surgical removal is the treatment of choice. Resection of the coccyx is necessary only in case of its involvement by the neoplastic mass or suspected malignant transformation.
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Affiliation(s)
- Claudio Coco
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Manno
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Mattana
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Verbo
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniel Sermoneta
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | - Luigi Petito
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Pedretti
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianluca Rizzo
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Lodoli
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico D'Ugo
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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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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Perungo T, John Grifson J, Amudhan A, Devy Gounder K. An elusive cause of perianal pain in a patient with Hirschsprung's disease. BMJ Case Rep 2016; 2016:bcr-2016-215173. [PMID: 27733417 DOI: 10.1136/bcr-2016-215173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 23-year-old woman presented to the outpatients department with symptoms of acute onset perianal pain of 2 weeks' duration and constipation. She was a known case of Hirschsprung's disease and was operated on in infancy. Rectal examination ruled out acute fissure or perianal sepsis, and subsequent colonoscopy was normal. Because of persistent symptoms, she was evaluated further by imaging which revealed a presacral lesion closely abutting the nerve roots, suggesting the possibility of a nerve sheath tumour. The tumour was excised by the perineal route, and surprisingly the histopathology report revealed an epidermoid (sebaceous) cyst. Presacral tumours are very rare lesions which most colorectal surgeons never come across in their careers. Tumours range from indolent, to benign, to more aggressive malignant lesions. Usually the symptoms are non-specific and surgical excision remains the best treatment. Multidisciplinary team work is needed for most of these cases.
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Affiliation(s)
| | - Johnrose John Grifson
- Department of Surgical Gastroenterology, Madras Medical College, Chennai, Tamilnadu, India
| | - Anbazhagan Amudhan
- Madras Medical College, Institute of Surgical Gastroenterology, Chennai, Tamilnadu, India
| | - Kannan Devy Gounder
- Madras Medical College, Institute of Surgical Gastroenterology, Chennai, Tamilnadu, India
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45
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Abstract
A tailgut cyst is an uncommon congenital developmental cyst that arises from the postnatal remnants of the primitive gut. These cysts are generally located in the retrorectal space. The rarity of this lesion and its anatomical position frequently lead to difficulties in its diagnosis and surgical management. Complete surgical resection remains the cornerstone of treatment, and numerous surgical approaches to achieve this objective have been described in the literature. We present 2 cases of tailgut cysts that were resected using a trans-sacral approach. We discuss the surgical management of these cases, including the operative approach that was adopted. Two cases of tailgut cysts that presented as incidentally detected retrorectal tumors are described here. A pelvic magnetic resonance imaging scan revealed a retrorectal multicystic tumor consistent with a tailgut cyst. The patients underwent surgery via a trans-sacral approach with coccygectomy. The histopathologic diagnosis for each patient was a tailgut cyst with no evidence of malignancy. Surgical approaches for tailgut cysts depend on the exact locations of the cysts and suspicions regarding the malignancies of the cysts. En bloc organ resection, including coccygectomy, is required if malignancy is suspected. We endorse the trans-sacral approach as a feasible, easy to perform, minimally invasive, and safe option for treating relatively low-lying tailgut cysts.
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46
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Single-site laparoscopic approach of Kraske procedure for a presacral local recurrence of rectal adenocarcinoma. Surg Endosc 2016. [DOI: 10.1007/s00464-015-4431-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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47
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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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48
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[Retrorectal space-occupying lesion: a rare differential diagnosis]. Chirurg 2016; 87:785-789. [PMID: 26960335 DOI: 10.1007/s00104-016-0161-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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49
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Hiller DJ, Waters GS, Bohl JL. Incidence and Operative Excision of Presacral Masses: An Institutional Analysis. Am Surg 2015. [DOI: 10.1177/000313481508101224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Presacral masses are rare lesions that encompass a broad range of pathologic findings. Most presacral masses are benign. The aim of this study was to analyze the clinical presentation, pathology, and surgical treatment of presacral masses at a single academic institution over a decade. In this retrospective study, we reviewed all surgically excised presacral tumors between 2003 and 2013. Clinical and pathologic data were recorded. Thirteen patients had surgical excision of a presacral mass. The median age was 42 years (standard deviation ± 19.7) and average follow-up was 11.9 months (standard deviation ± 17.5). The majority of patients were symptomatic. Forty-six per cent (6/13) had sacral or rectal pain. Thirty-eight per cent (5/13) of patients had a palpable mass on digital rectal examination. Sixty-nine per cent of patients had an MRI, 84.6 per cent a CT, and 61.5 per cent multimodality imaging. Most presacral masses were benign (10/13,77%). Twenty-three per cent (3/13) were malignant. A majority were excised via posterior approach (9/13, 69%), but 31 per cent (4/13) required an anterior or combined approach. Presacral masses are rare, even at a high-volume tertiary care center. They are commonly evaluated with a multiple imaging modalities, are most likely benign, and can be excised via posterior approach.
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Affiliation(s)
- David J. Hiller
- Department of Surgery, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Gregory S. Waters
- Department of Surgery, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Jaime L. Bohl
- Department of Surgery, Wake Forest University School of Medicine, Winston Salem, North Carolina
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50
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Patsouras D, Pawa N, Osmani H, Phillips RKS. Management of tailgut cysts in a tertiary referral centre: a 10-year experience. Colorectal Dis 2015; 17:724-9. [PMID: 25683585 DOI: 10.1111/codi.12919] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 12/31/2014] [Indexed: 12/19/2022]
Abstract
AIM Tailgut cysts are rare congenital lesions typically presenting as presacral masses. A variable clinical presentation often leads to misdiagnosis and unsuccessful operations. METHOD A retrospective analysis was performed of tailgut cysts presenting to one surgeon at St Mark's hospital between 2003 and 2013. The patient demographic data and clinicopathological and radiological features, together with perioperative details and recurrence, were reviewed. RESULTS A total of 17 patients (15 women) with a median age of 35 (21-64) years were included in the study. The mean duration of symptoms before referral was 40 months, with sepsis predominating in 12 cases. Fifteen of the patients had previously undergone surgery (mean 2.9 procedures). A posterior surgical approach was adopted in all patients with a coccygectomy performed in 13. A loop colostomy was formed in three patients. Two of them went on to have a secondary pull-through operation after an initial failed local repair of rectal injury. One case was reported to show malignant degeneration on histological examination. There was one recurrence during a median follow-up period of 13 (3-36) months. CONCLUSION Tailgut cysts are an uncommon yet important cause of chronic perianal sepsis. Suspicion should be raised in a patient, usually female, presenting with a history of unsuccessful procedures. Diagnosis can be made by clinical assessment and MRI. Complete excision usually resolves the problem.
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Affiliation(s)
- D Patsouras
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK
| | - N Pawa
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK
| | - H Osmani
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK
| | - R K S Phillips
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK
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