|
1
|
Nakano M, Shimada Y, Ozeki H, Matsumoto A, Nakano M, Kondo S, Goto R, Yachida N, Yoshihara K, Wakai T. A case of deep endometriosis with cyst formation as a differential diagnosis of rectal duplication cyst in the presacral space. Clin J Gastroenterol 2025; 18:330-336. [PMID: 39937201 DOI: 10.1007/s12328-025-02100-7] [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: 12/26/2024] [Accepted: 01/23/2025] [Indexed: 02/13/2025]
Abstract
Cysts occurring in the presacral space may become malignant and therefore require surgical removal. A wide variety of cystic lesions can occur in the presacral space, such as tailgut cysts, dermoid cysts, and duplication cysts. However, deep endometriosis with cyst formation in the presacral space is extremely rare. Here, we report a case of deep endometriosis that presented characteristic imaging and pathological findings and required a differential diagnosis of rectal duplication cyst. A 49-year-old female was referred with a chief complaint of lower abdominal pain. Magnetic resonance imaging (MRI) revealed a cystic lesion with a three-layered wall structure on the right side of the rectum, suggesting a rectal duplication cyst. The lesion had a maximum diameter of 8 cm and extended from the lower end of the second sacral vertebra to the levator ani muscle. The cystic lesion was removed laparoscopically, and intraoperative findings revealed no communication between the cystic lesion and the rectum. We found that the wall of the deep endometriosis with cyst formation had a histopathological three-layered structure and considered that the layered structure closely resembled the intestinal wall on MRI. Deep endometriosis should be recognized as a differential diagnosis of cystic lesions in the presacral space.
Collapse
Affiliation(s)
- Masato Nakano
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 9518510, Japan
| | - Yoshifumi Shimada
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 9518510, Japan.
| | - Hikaru Ozeki
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 9518510, Japan
| | - Akio Matsumoto
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 9518510, Japan
| | - Mae Nakano
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 9518510, Japan
| | - Shuhei Kondo
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Ryosuke Goto
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Nozomi Yachida
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 9518510, Japan
| |
Collapse
|
|
2
|
Tsarkov P, Barkhatov S, Shlyk D, Safyanov L, Balaban V, He M. Risk factors for rectal perforation during presacral cyst removal: a comparison between transabdominal, perineal, and combined surgical approaches. Tech Coloproctol 2024; 29:23. [PMID: 39699618 DOI: 10.1007/s10151-024-03071-6] [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: 05/08/2024] [Accepted: 11/21/2024] [Indexed: 12/20/2024]
Abstract
BACKGROUND This study aimed to evaluate the risk factors associated with rectal perforation during various surgical interventions for presacral cysts. METHODS This retrospective study included 73 participants from 2013 to 2023 who met the inclusion criteria. Participants underwent surgical treatments through transabdominal, perineal, or combined approaches. Preoperative assessments of presacral cysts were performed using computed tomography (CT) and magnetic resonance imaging (MRI). Biannual postoperative follow-ups involved ultrasound, CT, or MRI scans. Data analysis was conducted using RStudio software. RESULTS The incidence of rectal perforation did not differ significantly across surgical approaches [combined 2 (18%) vs. perineal 3 (8.8%) vs. transabdominal 4 (14%), P = 0.7]. Cyst capsule rupture was more frequent in the transabdominal and combined approaches [17 (61%) and 5 (45%), respectively] versus perineal approach [8 (24%), P = 0.011]. The laparoscopic subgroup experienced a higher rate of cyst rupture compared to the robotic subgroup, with rectum perforation cases only correlating with ruptures in the robotic subgroup. Intraoperative complications prompted conversions to open surgery in the laparoscopic group, unlike in the robotic group. Postoperative follow-up revealed no mortalities, with malignant transformation observed in two cases and local recurrences in three. While univariate analysis did not identify significant predictors of rectal wall perforation, multivariate analysis suggested that the risk of perforation increased with cyst rupture and decreased when the cyst was located further from the anal verge. CONCLUSIONS The study identifies two primary risk factors for rectal wall perforation: the cyst capsule integrity and the cyst-rectum shortest distance, with the latter being accurately determined by MRI. These findings may inform further surgical planning and risk assessment.
Collapse
Affiliation(s)
- P Tsarkov
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov University, Moscow, Russia
| | - S Barkhatov
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov University, Moscow, Russia
| | - D Shlyk
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov University, Moscow, Russia
| | - L Safyanov
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov University, Moscow, Russia
| | - V Balaban
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov University, Moscow, Russia
| | - M He
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
| |
Collapse
|
|
3
|
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.
Collapse
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
| |
Collapse
|
|
4
|
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.
Collapse
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
| |
Collapse
|
|
5
|
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.
Collapse
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.
| |
Collapse
|
|
6
|
Dsouza R, A R, Mathew A, Raghunath R. Benign ectopic prostate-a rare differential for a presacral mass. BMJ Case Rep 2024; 17:e257319. [PMID: 38649245 PMCID: PMC11043737 DOI: 10.1136/bcr-2023-257319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
A man in his mid-40s presented to the colorectal surgery clinic with complaints of chronic perianal pain for over 20 years. He had episodes of urinary incontinence associated with pain. There were no other symptoms to suspect bowel pathology. On examination, he was found to have a tender mass in the retro-rectal plane without any evidence of rectal mucosal irregularity. He underwent an MRI of the pelvis, which showed a well-defined T2 hyperintense partly cystic lesion in the presacral region abutting the mesorectal fascia and a normal prostate gland. With a suspicion of a tailgut cyst or a duplication cyst, he underwent an excision of the presacral mass. Intraoperatively, there was a 2 × 2 cm well-defined firm, cystic lesion anterior to the fifth sacral vertebra and coccyx. The lesion was adherent to the mesorectum and was excised. On histopathology, there were features of muscular stroma and bilayered glandular epithelium with clear cytoplasm conclusive of a benign ectopic prostate.
Collapse
Affiliation(s)
- Royson Dsouza
- Surgery Unit 2 and Colorectal Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Ramachandran A
- Pathology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Aleena Mathew
- Radiology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Rajat Raghunath
- Surgery Unit 2 and Colorectal Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| |
Collapse
|
|
7
|
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
| |
Collapse
|
|
8
|
Körfer D, Jentschura D. Surgical Management of Presacral Tumors: Report of 5 Cases With Video Vignette of Laparoscopic Removal. Surg Laparosc Endosc Percutan Tech 2023; 33:198-201. [PMID: 36971516 DOI: 10.1097/sle.0000000000001164] [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: 10/28/2022] [Accepted: 02/10/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Cystic tumors in the presacral space represent a rare pathology. In case of symptoms, but particularly due to the danger of malignant degeneration, surgical removal is indicated. Due to the complex position in the pelvis with its proximity to important anatomic structures, the choice of the surgical approach is decisive. METHODS To present an overview of the recent knowledge of presacral tumors, a PubMed-based literature review was performed. Subsequently, we present 5 cases where different surgical strategies were evaluated including a video of a laparoscopic removal. RESULTS Presacral tumors can be of different histopathologic origins. Complete surgical excision is the treatment of choice, with open abdominal, open abdominoperineal, and posterior accesses available, as well as minimally invasive techniques. CONCLUSION Laparoscopic resection of presacral tumors is a well-suitable option, but the decision must always be made individually.
Collapse
Affiliation(s)
- Daniel Körfer
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg
- Department of General and Visceral Surgery, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Dirk Jentschura
- Department of General and Visceral Surgery, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| |
Collapse
|
|
9
|
Laparoscopic Resection of Pelvic Schwannomas: A 9-Year Experience at a Single Center. World Neurosurg X 2023; 17:100150. [DOI: 10.1016/j.wnsx.2022.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022] Open
|
|
10
|
Zhao X, Zhou S, Liu N, Li P, Chen L. Is There Another Posterior Approach for Presacral Tumors Besides the Kraske Procedure? — A Study on the Feasibility and Safety of Surgical Resection of Primary Presacral Tumors via Transsacrococcygeal Transverse Incision. Front Oncol 2022; 12:892027. [PMID: 35692749 PMCID: PMC9179022 DOI: 10.3389/fonc.2022.892027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe aim of the present study was to explore the feasibility and safety of the surgical resection of presacral tumors via a transsacrococcygeal transverse incision.MethodsThe clinical data and prognoses of patients with presacral tumors who underwent surgery at the Chinese People’s Liberation Army (PLA) General Hospital between January 2009 and December 2018 were retrospectively reviewed and analyzed.ResultsA total of 110 patients with presacral tumors were included in this study, including 82 female patients and 28 male patients, with a female-to-male ratio of 2.9:1. A posterior approach (transsacrococcygeal transverse incision) was utilized in 105 patients, an anterior approach (transabdominal excision) was utilized in 1 patient, and a combined (posterior plus anterior) approach was utilized in 4 patients. The mean tumor size was 8.72 ± 4.28 cm. More than half of the patients (n=59/110) with presacral tumors were asymptomatic. Twenty-six pathological types were observed in our study, including 97 benign lesions and 13 malignant lesions. The intraoperative complication rate was 42.7% (n=47/110), whereas the postoperative morbidity rate was 3.6% (n=4/110). The length of hospital stay for patients treated with the posterior approach was shorter than that of patients treated with the anterior and combined approaches. After a mean follow-up of 90.13 ± 31.22 months, 11 patients had local presacral tumor recurrence, and 1 patient had distant metastasis, with a combined recurrence rate of 10.9% (n=12/110).ConclusionsThe surgical resection of primary presacral tumors via a transsacrococcygeal transverse incision is feasible and safe, with acceptable oncological therapeutic outcomes and a low postoperative morbidity rate, making it worth popularizing in clinical practice.
Collapse
|
|
11
|
Burke JR, Shetty K, Thomas O, Kowal M, Quyn A, Sagar P. The management of retrorectal tumours: tertiary centre retrospective study. BJS Open 2022; 6:zrac044. [PMID: 35441209 PMCID: PMC9019068 DOI: 10.1093/bjsopen/zrac044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/03/2022] [Accepted: 02/13/2022] [Indexed: 11/12/2022] Open
Abstract
AIM Tumours of the retrorectal space are uncommon, pathologically heterogeneous, and difficult to diagnose, with ongoing controversy over their surgical management. The aim of this study was to evaluate the surgical management of a consecutive series of patients who had undergone excision of primary retrorectal tumours (PRRTs) at a tertiary referral centre. METHOD Patients were identified from a prospectively maintained database between 1 March 2001 and 1 August 2021. Electronic patient records were reviewed for demographics, preoperative imaging, operative details, histology, and follow-up. A chi-squared test was used to assess the statistical significance of findings. RESULTS A total of 144 patients were included in the study. Of these, 103 patients were female (71.5 per cent), 46 patients (31.9 per cent) presented incidentally, and 99 of the patients had tumours located below S3 (68.7 per cent). Overall, 76 patients underwent a transperineal approach (52.7 per cent) with the most common findings of a benign tailgut cyst occurring in 59 (40.9 per cent) of cases. Preoperative MRI predicted urovascular and pelvic sidewall involvement assessed intraoperatively with a sensitivity of 83.3 and 90 per cent and a specificity of 98.1 and 98 per cent respectively. Risk of malignancy in solid tumours was 31.4 versus 8.8 per cent in cystic tumours (relative risk 3.5, 95 per cent c.i. 1.6 to 7.6, P < 0.001). Major complications (Clavien-Dindo grade III and above) occurred in eight patients (5.6 per cent) and all-cause long-term mortality was 4.8 per cent (seven patients). DISCUSSION PRRTs can be safely excised with minimal complications in specialized centres by surgical teams with the relevant expertise. This study questions the conservative management of cystic tumours and given the risk of solid tumour malignancy, supports surgical management.
Collapse
Affiliation(s)
- Joshua R. Burke
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Kunal Shetty
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Owen Thomas
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Mikolaj Kowal
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Aaron Quyn
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Peter Sagar
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| |
Collapse
|
|
12
|
Shanmugam S, Pravenkumar RR. Laparoscopic approach for malignant retrorectal tumour: Better vision and lesser morbidity. J Minim Access Surg 2022; 19:314-316. [PMID: 35915537 DOI: 10.4103/jmas.jmas_54_22] [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
The retrorectal tumours are removed by open approaches according to the type, location and size of the lesion. Malignant tumours are mostly operated by open approach owing to the fear of spillage and inability to obtain safe oncological margin. We present our recent experience of laparoscopy for a malignant retrorectal tumour. An 11 cm pre-sacral mass causing erosion of sacrum was operated with a combined approach. Transsacral approach followed laparoscopic mobilisation with the patient in prone jackknife position. Wide excision with sacrectomy was done with adequate margin. Post-operative histopathology showed dedifferentiated chordoma for which adjuvant radiotherapy was given. Laparoscopic approach provides a feasible and oncological safe alternative to the conventional approaches, especially in malignant tumour with advantages of better visualisation, minimal operative morbidity, lesser post-operative pain and shorter hospital stay. However, the surgical approach should be tailored to each patient according to patient factors, tumour characteristics and surgeon's expertise.
Collapse
|
|
13
|
Wang PP, Lin C, Zhou JL, Xu KW, Qiu HZ, Wu B. Risk factors for perioperative complications in laparoscopic surgeries of retrorectal cystic lesions. World J Gastrointest Surg 2021; 13:1685-1695. [PMID: 35070073 PMCID: PMC8727184 DOI: 10.4240/wjgs.v13.i12.1685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/14/2021] [Accepted: 10/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of retrorectal lesions is low, and no consensus has been reached regarding the most optimal surgical approach. Laparoscopic approach has the advantage of minimally invasive. The risk factors influencing perioperative complications of laparoscopic surgery are rarely discussed.
AIM To investigate the risk factors for perioperative complications in laparoscopic surgeries of retrorectal cystic lesions.
METHODS We retrospectively reviewed the medical records of patients who underwent laparoscopic excision of retrorectal cystic lesions between August 2012 and May 2020 at our hospital. All surgeries were performed in the general surgery department. Patients were divided into groups based on the lesion location and diameter. We analysed the risk factors like type 2 diabetes mellitus, hypertension, the history of abdominal surgery, previous treatment, clinical manifestation, operation duration, blood loss, perioperative complications, and readmission rate within 90 d retrospectively.
RESULTS Severe perioperative complications occurred in seven patients. Prophylactic transverse colostomy was performed in four patients with suspected rectal injury. Two patients underwent puncture drainage due to postoperative pelvic infection. One patient underwent debridement in the operating room due to incision infection. The massive-lesion group had a significantly longer surgery duration, higher blood loss, higher incidence of perioperative complications, and higher readmission rate within 90 d (P < 0.05). Univariate analysis, multivariate analysis, and logistic regression showed that lesion diameter was an independent risk factor for the development of perioperative complications in patients who underwent laparoscopic excision of retrorectal cystic lesions.
CONCLUSION The diameter of the lesion is an independent risk factor for perioperative complications in patients who undergo laparoscopic excision of retrorectal cystic lesions. The location of the lesion was not a determining factor of the surgical approach. Laparoscopic surgery is minimally invasive, high-resolution, and flexible, and its use in retrorectal cystic lesions is safe and feasible, also for lesions below the S3 level.
Collapse
Affiliation(s)
- Pei-Pei Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Chen Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jiao-Lin Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Kai-Wen Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hui-Zhong Qiu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
|
14
|
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.
Collapse
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
| |
Collapse
|
|
15
|
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.
Collapse
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
| |
Collapse
|
|
16
|
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.
Collapse
|
|
17
|
Bebobru M, Nasri FA, Niculescu-Valaenu M, Friedhoff K. [Retrorectal teratoma (dermoid cyst) of an adult - Diagnosis and treatment based on an example of a case report]. Dtsch Med Wochenschr 2021; 146:104-107. [PMID: 33465806 DOI: 10.1055/a-1265-8649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
MEDICAL HISTORY A 29 year old woman was introduced to the surgical department with a history of pain in the lower lumbar spine. CLINICAL FINDINGS AND DIAGNOSIS The cause of the pain was associated with a retrorectal presacral cystic mass. Diagnosis was made by performing a transvaginal ultrasound, a contrast CT scan and MRI of the pelvic. TREATMENT AND COURSE Open surgery was performed. The histologic findings showed a monodermal cystic teratoma. The postoperative management showed no complications. CONCLUSION Retrorectal Tumors not associated with the rectum in the small pelvic are rare. These tumors should be surgically removed.
Collapse
|
|
18
|
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.
Collapse
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
| |
Collapse
|
|
19
|
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]
|
|
20
|
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.
Collapse
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
| |
Collapse
|
|
21
|
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.
Collapse
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
| |
Collapse
|
|
22
|
Improta L, Tzanis D, Bouhadiba T, Abdelhafidh K, Bonvalot S. Overview of primary adult retroperitoneal tumours. Eur J Surg Oncol 2020; 46:1573-1579. [PMID: 32600897 DOI: 10.1016/j.ejso.2020.04.054] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/16/2020] [Accepted: 04/29/2020] [Indexed: 12/14/2022] Open
Abstract
In front of a primary retroperitoneal tumour, it is necessary to have in mind all possible diagnoses in order to specify the diagnostic strategy and the treatment. According to the World Health Organization (WHO) classification of tumours, mesenchymal benign and malignant tumours (including sarcomas and, currently, neurogenic tumours), parasympathetic tumours, extragonadal germ cell tumours, and lymphoid tumours have been identified. By definition, primary retroperitoneal tumours start independently from the retroperitoneal organs. Secondary lesions, carcinoma metastasis, and adenopathy are excluded from this definition, but they can also develop in the retroperitoneal space and lead to misdiagnoses. In the absence of positive tumour markers or an evocative biology, percutaneous biopsy is necessary. Pathological diagnosis is necessary to decide whether surgery must be done, its timing among the other treatments, and its extension. This paper summarizes all the diagnostic possibilities.
Collapse
Affiliation(s)
- Luca Improta
- Department of General Surgery, Università Campus Bio-Medico, 200 Via Alvaro del Portillo, Rome, Italy.
| | - Dimitri Tzanis
- Department of Surgery, Institut Curie, PSL University, 26 Rue d'Ulm, Paris, France.
| | - Toufik Bouhadiba
- Department of Surgery, Institut Curie, PSL University, 26 Rue d'Ulm, Paris, France.
| | - Khoubeyb Abdelhafidh
- Department of Anesthesia, Institut Curie, PSL University, 26 Rue d'Ulm, Paris, France.
| | - Sylvie Bonvalot
- Department of Surgery, Institut Curie, PSL University, 26 Rue d'Ulm, Paris, France.
| |
Collapse
|
|
23
|
Baral JEM. Präsakrale Tumoren. COLOPROCTOLOGY 2020. [DOI: 10.1007/s00053-020-00452-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
|
24
|
Efetov SK, Picciariello A, Kochetkov VS, Puzakov KB, Alekberzade AV, Tulina IA, Tsarkov PV. Surgical Treatment of Sacral Chordoma: The Role of Laparoscopy. Case Rep Oncol 2020; 13:255-260. [PMID: 32308586 PMCID: PMC7154265 DOI: 10.1159/000506441] [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: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 11/19/2022] Open
Abstract
Sacral chordoma is a rare tumour that represents the most common malignancy of the sacral region. Its diagnosis can be delayed because of unclear clinical manifestation. This tumour can involve surrounding anatomical structure such as the rectum, and its surgical treatment is still challenging. We report on 3 patients with sacral chordoma. Two of them were successfully treated using a laparoscopic approach and one by open surgery. We present all details of the surgical technique and patients' outcome. Minimally invasive methods in the surgical treatment of chordoma allow to perform a radical dissection of the tumour, minimizing the operative trauma. A laparoscopic approach can be considered safe and radical for sacral chordoma treatment.
Collapse
Affiliation(s)
- Sergey K Efetov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Arcangelo Picciariello
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.,Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Viktor S Kochetkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Kirill B Puzakov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Aftandil V Alekberzade
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Inna A Tulina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Petr V Tsarkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| |
Collapse
|
|
25
|
Korduke O, Omar A, Viner W, Kodeda K. Pre-sacral schwannoma. ANZ J Surg 2020; 90:1805-1807. [PMID: 31944521 DOI: 10.1111/ans.15707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Olga Korduke
- Department of Surgery, Taranaki Base Hospital, New Plymouth, New Zealand
| | - Ahmed Omar
- Department of Surgery, Taranaki Base Hospital, New Plymouth, New Zealand
| | - William Viner
- Department of Obstetrics and Gynaecology, Taranaki Base Hospital, New Plymouth, New Zealand
| | - Karl Kodeda
- Department of Surgery, Taranaki Base Hospital, New Plymouth, New Zealand.,Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| |
Collapse
|
|
26
|
Wang L, Hirano Y, Ishii T, Kondo H, Hara K, Ishikawa S, Okada T, Obara N, Yamaguchi S. Laparoscopic surgical management of a mature presacral teratoma: a case report. Surg Case Rep 2019; 5:144. [PMID: 31535236 PMCID: PMC6751240 DOI: 10.1186/s40792-019-0702-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 09/02/2019] [Indexed: 12/15/2022] Open
Abstract
Background Mature presacral (retrorectal) teratoma is very rare. We report a case in which a mature retrorectal teratoma in an adult was successfully treated with laparoscopic surgery. Case presentation A 44-year-old woman was diagnosed with a presacral tumor during a physical examination. Endoscopic ultrasonography (EUS) revealed a multilocular cystic lesion; the lesion was on the left side of the posterior rectum and measured approximately 30 mm in diameter on both contrast-enhanced pelvic computed tomography (CT) and magnetic resonance imaging (MRI). The presumptive diagnosis was tailgut cyst. However, the histopathological diagnosis after laparoscopic resection was mature teratoma. It is still difficult to preoperatively diagnose mature retrorectal teratomas. Conclusions Laparoscopic resection of mature retrorectal teratomas is a feasible and promising method that is less invasive and can be adapted without extending the skin incision.
Collapse
Affiliation(s)
- Liming Wang
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan.
| | - Yasumitsu Hirano
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Toshimasa Ishii
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Hiroka Kondo
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Kiyoka Hara
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Shintaro Ishikawa
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Takuhisa Okada
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Nao Obara
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| |
Collapse
|
|
27
|
|
|
28
|
The Effect of Major Pelvic Extirpative Surgery on Lower Urinary Tract Function. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00510-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
|
29
|
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.
Collapse
|
|
30
|
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.
Collapse
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
| |
Collapse
|
|
31
|
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.
Collapse
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
| |
Collapse
|
|
32
|
Affiliation(s)
- Santosh Shenoy
- Department of Surgery, KCVA and University of Missouri Kansas City, 4801 E Linwood Blvd., Kansas City, MO, 64128, USA.
| |
Collapse
|
|
33
|
Sidiqi MM, Faruque AV, Whan E. Laparoscopic excision of retrorectal tumour in the newborn. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
|
34
|
A systematic review of minimally invasive surgery for retrorectal tumors. Tech Coloproctol 2018; 22:255-263. [PMID: 29679245 DOI: 10.1007/s10151-018-1781-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/28/2018] [Indexed: 02/06/2023]
Abstract
Retrorectal tumors are rare tumors that require resection for symptoms, malignancy and potential malignant transformation. Traditional approaches have included laparotomy, perineal excision or a combination. Multiple minimally invasive techniques are available which have the potential to minimize morbidity and enhance recovery. We performed a systematic review of the literature to determine the feasibility and surgical outcomes of retrorectal tumors approached using minimally invasive surgical techniques. Publications in which adult patients (≥ 18 years) had a minimally invasive approach (laparoscopic or robotic) for resection of a primary retrorectal tumor were included. Data were collected on approach, preoperative investigation, size and sacral level of the tumor, operating time, length of stay, perioperative complications, margins and recurrence. Thirty-five articles which included a total of 82 patients met the inclusion criteria. The majority of patients were female (n = 65; 79.2%), with a mean age of 41.7 years (range 18-89 years). Seventy-three patients (89.0%) underwent laparoscopic or combined laparoscopic-perineal resection, and 9 (10.8%) had a robotic approach. The conversion rate was 5.5%. The overall 30-day morbidity rate was 15.7%, including 1 intraoperative rectal injury (1.2%). Ninety-five percent (n = 78) of the retrorectal tumors were benign. Median length of stay was 4 days for both laparoscopic and robotic groups, with ranges of 1-8 and 2-10 days, respectively. No tumor recurrence was noted during follow-up [median 28 months (range 5-71 months)]. A minimally invasive approach for the resection of retrorectal tumors is feasible in selected patients. Careful patient selection is necessary to avoid incomplete resection and higher morbidity than traditional approaches.
Collapse
|
|
35
|
Hernandez Casanovas P, Bollo Rodriguez J, Martinez Sanchez C, Pernas Canadell JC, Targarona Soler EM. Transanal endoscopic microsurgery treatment of twice recurred tail-gut. Cir Esp 2018; 96:455-456. [PMID: 29448984 DOI: 10.1016/j.ciresp.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 12/13/2017] [Indexed: 11/26/2022]
Affiliation(s)
| | - Jesus Bollo Rodriguez
- Unidad de Coloproctología, Servicio de Cirugía General, Hospital Sant Pau, Barcelona, España
| | - Carmen Martinez Sanchez
- Unidad de Coloproctología, Servicio de Cirugía General, Hospital Sant Pau, Barcelona, España
| | | | | |
Collapse
|
|
36
|
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]
|
|
37
|
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.
Collapse
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.
| |
Collapse
|
|
38
|
Manabe T, Koba R, Nagayoshi K, Sadakari Y, Fujita H, Nagai S, Ueki T, Nagai E, Nakamura M. Laparoscopic excision of neurogenic retrorectal tumors. Asian J Endosc Surg 2017; 10:223-226. [PMID: 28547931 DOI: 10.1111/ases.12337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/05/2016] [Accepted: 09/11/2016] [Indexed: 12/22/2022]
Abstract
Retrorectal tumors (RT) are uncommon and usually managed by open surgical excision. Laparoscopic excision for RT has been reported in only a small number of papers. We aimed to assess the laparoscopic approach for RT and to discuss the factors that made this procedure difficult. We performed laparoscopic excision using a five-trocar technique for neurogenic RT in three patients. Tumors were successfully excised laparoscopically in two patients. However, the third patient required open conversion because the tumor was strongly adhered to the sacrum and could not be mobilized by dissection, resulting in poor visualization of the dissected site. Laparoscopic excision for RT provides excellent intraoperative visualization and good cosmesis in selected patients, but firm adherence to the sacrum may cause difficulty with this procedure.
Collapse
Affiliation(s)
- Tatsuya Manabe
- Department of Surgery and Oncology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Ryo Koba
- Department of Surgery and Oncology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Kinuko Nagayoshi
- Department of Surgery and Oncology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Sadakari
- Department of Surgery and Oncology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Hayato Fujita
- Department of Surgery and Oncology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Shuntaro Nagai
- Department of Surgery and Oncology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Takashi Ueki
- Department of Surgery, Hamanomachi Hospital, Fukuoka, Japan
| | - Eishi Nagai
- Department of Surgery and Oncology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| |
Collapse
|
|
39
|
Tailgut cysts: Presentation of four cases. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 41:103-105. [PMID: 28359549 DOI: 10.1016/j.gastrohep.2017.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/26/2017] [Accepted: 02/03/2017] [Indexed: 01/17/2023]
|
|
40
|
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.
Collapse
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
| |
Collapse
|
|
41
|
Volk A, Plodeck V, Toma M, Saeger HD, Pistorius S. Treatment of tailgut cysts by extended distal rectal segmental resection with rectoanal anastomosis. Surg Today 2016; 47:457-462. [PMID: 27549774 DOI: 10.1007/s00595-016-1403-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 07/05/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE Complete surgical resection is the treatment of choice for tailgut cysts, because of their malignant potential and tendency to regrow if incompletely resected. We report our experience of treating patients with tailgut cysts, and discuss diagnostics, surgical approaches, and follow-up. METHODS We performed extended distal rectal segmental resection of the tailgut cyst, with rectoanal anastomosis. We report the clinical, radiological, pathological, and surgical findings, describe the procedures performed, and summarize follow-up data. RESULTS Two patients underwent en-bloc resection of a tailgut cyst, the adjacent part of the levator muscle, and the distal rectal segment, followed by an end-to-end rectoanal anastomosis. There was no evidence of anastomotic leakage postoperatively. At the time of writing, our patients were relapse-free with no, or non-limiting, symptoms of anal incontinence, respectively. CONCLUSIONS This surgical approach appears to have a low complication rate and good recovery outcomes. Moreover, as the sphincter is preserved, so is the postoperative anorectal function. This approach could result in a low recurrence rate.
Collapse
Affiliation(s)
- Andreas Volk
- Department of Visceral-, Thoracic- and Vascular Surgery, University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Verena Plodeck
- Institute of Diagnostic Radiology, University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Marieta Toma
- Institute for Pathology, University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Hans-Detlev Saeger
- Department of Visceral-, Thoracic- and Vascular Surgery, University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Steffen Pistorius
- Department of Visceral-, Thoracic- and Vascular Surgery, University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
- University Cancer Center Dresden (UCC), University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| |
Collapse
|
|
42
|
Buchs N, Gosselink M, Scarpa C, Ris F, Saiji E, Bloemendaal A, van Onkelen R, Guy R, Schouten W, Roche B, George B. A multicenter experience with peri-rectal tumors: The risk of local recurrence. Eur J Surg Oncol 2016; 42:817-22. [DOI: 10.1016/j.ejso.2016.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 01/11/2016] [Accepted: 02/11/2016] [Indexed: 12/31/2022] Open
|
|
43
|
Hopper L, Eglinton TW, Wakeman C, Dobbs BR, Dixon L, Frizelle FA. Progress in the management of retrorectal tumours. Colorectal Dis 2016; 18:410-7. [PMID: 26367385 DOI: 10.1111/codi.13117] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/22/2015] [Indexed: 02/08/2023]
Abstract
AIM Tumours in the retrorectal space are rare and pathologically heterogeneous. The roles of imaging and preoperative biopsy, nonoperative management and the indications for surgical resection are controversial. This study investigated a series of retrorectal tumours treated in a single institution with the aim of producing a modern improved management algorithm. METHOD A retrospective analysis was conducted of the management of all retrorectal lesions identified between 1998 and 2013 from a radiology database search. Patient demographics, presenting symptoms, imaging, biopsy, management and the results were recorded. Descriptive statistics were used and Kaplan-Meier survival analysis was performed. RESULTS Sixty-nine patients with a confirmed retrorectal tumour were identified. The median age was 50 (36-67 interquartile range) and 42 (56%) were female. Twenty (29%) of the tumours were malignant: 4 of 41 cystic lesions were malignant (12.9%) vs. 16 of 28 solid (or heterogeneous) lesions (57.1%) (P < 0.0001). Imaging demonstrated a 95% sensitivity and 64% specificity for differentiating benign from malignant tumours. Magnetic resonance imaging (MRI) was significantly better at distinguishing between benign and malignant tumours than computed tomography (94% vs. 64%, P = 0.03). Percutaneous biopsy was performed in 16 patients and only 27 underwent resection. There was no evidence of local recurrence associated with biopsy. Solid lesions were associated with a nonsignificant decreased overall survival (P = 0.348). CONCLUSION This study demonstrated that MRI should be the investigation of choice for retrorectal lesions. Biopsy of solid lesions is safe and useful for guiding neoadjuvant and surgical therapy. Cystic lesions without suspicious radiological features can be followed by serial imaging without resection.
Collapse
Affiliation(s)
- L Hopper
- Department of Colorectal Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - T W Eglinton
- Department of Colorectal Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - C Wakeman
- Department of Colorectal Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - B R Dobbs
- Department of Colorectal Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - L Dixon
- Department of Colorectal Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - F A Frizelle
- Department of Colorectal Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| |
Collapse
|
|
44
|
[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]
|
|
45
|
Patel N, Maturen KE, Kaza RK, Gandikota G, Al-Hawary MM, Wasnik AP. Imaging of presacral masses--a multidisciplinary approach. Br J Radiol 2016; 89:20150698. [PMID: 26828969 DOI: 10.1259/bjr.20150698] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Our objective is to describe an approach for retrorectal/presacral mass evaluation on imaging with attention to imaging features, allowing for refinement of the differential diagnosis of these masses. Elaborate on clinically relevant features that may affect biopsy or surgical approach, of which the radiologist should be aware. A review of current literature regarding the diagnosis and treatment of retrorectal/presacral masses was performed with attention to specific findings, which may lend refinement to the differential diagnosis of these masses. Cases were obtained by searching through a radiology database at a single institution after Institutional Review Board approval. Recent advances in imaging and treatment methods have led to the increased role of radiology in both imaging and tissue diagnosis of retrorectal masses. Surgical philosophies surrounding the treatment of these masses have not significantly changed in recent years, but there are a few key factors of which the radiologist must be aware. The radiologist can offer refinement of the differential diagnosis of retrorectal masses and can elaborate on salient findings which could alter the need for neoadjuvant chemoradiation therapy, pre-surgical tissue diagnosis and surgical approach. This article presents an imaging approach to retrorectal/presacral masses with emphasis on findings which can dictate the ultimate need for neoadjuvant therapy and pre-surgical tissue diagnosis and alter the preferred surgical approach. This article consolidates key findings, so radiologists can become more clinically relevant in the evaluation of these masses.
Collapse
Affiliation(s)
- Nishant Patel
- Department of Radiology, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA
| | - Katherine E Maturen
- Department of Radiology, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA
| | - Ravi K Kaza
- Department of Radiology, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA
| | - Girish Gandikota
- Department of Radiology, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA
| | - Mahmoud M Al-Hawary
- Department of Radiology, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA
| | - Ashish P Wasnik
- Department of Radiology, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA
| |
Collapse
|
|
46
|
Thawait SK, Batra K, Johnson SI, Torigian DA, Chhabra A, Zaheer A. Magnetic resonance imaging evaluation of non ovarian adnexal lesions. Clin Imaging 2015; 40:33-45. [PMID: 26463742 DOI: 10.1016/j.clinimag.2015.07.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 07/17/2015] [Accepted: 07/30/2015] [Indexed: 01/10/2023]
Abstract
Differentiation of nonovarian from ovarian lesions is a diagnostic challenge. MRI (Magnetic Resonance Imaging) of the pelvis provides excellent tissue characterization and high contrast resolution, allowing for detailed evaluation of adnexal lesions. Salient MRI characteristics of predominantly cystic lesions and predominantly solid adnexal lesions are presented along with epidemiology and clinical presentation. Due to its excellent soft tissue resolution, MRI may be able to characterize indeterminate adnexal masses and aid the radiologist to arrive at the correct diagnosis, thus positively affect patient management.
Collapse
Affiliation(s)
- Shrey K Thawait
- Department of Radiology, Yale University - Bridgeport Hospital, 267 Grant Street Bridgeport, CT 06610.
| | - Kiran Batra
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287.
| | - Stephen I Johnson
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287.
| | - Drew A Torigian
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia PA 19104.
| | - Avneesh Chhabra
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287.
| | - Atif Zaheer
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287.
| |
Collapse
|
|
47
|
Tarchouli M, Zentar A, Ratbi MB, Bensal A, Khmamouche MR, Ali AA, Bounaim A, Elfahssi M, Sair K. Perineal approach for surgical treatment in a patient with retro-rectal tumor: a case report and review of the literature. BMC Res Notes 2015; 8:470. [PMID: 26404544 PMCID: PMC4581409 DOI: 10.1186/s13104-015-1457-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 09/17/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Retrorectal tumors in adults are very rare and little known condition. These tumors, often misdiagnosed or mistreated, should be completely excised because of the potential for malignancy or infection. A suitable operative approach is the key to the successful surgical management. CASE PRESENTATION We report the case of a 45-year-old Arab male who presented with chronic pelvic pain accompanied by straining to defecate and dysuria. The clinical examination showed a painless mass in the left perineal area. Pelvic magnetic resonance imaging and computed tomography scan demonstrated a huge and well-limited pelvic mass causing displacement and compression of the rectum and bladder. Although the large size of the mass (>7 cm in the greater diameter), it was successfully and completely excised through only perineal approach without undertaking coccygectomy or sacrectomy. The histopathological study revealed a low-grade leiomyosarcoma. The patient is currently in 4-years follow-up with no signs of recurrence or metastasis. CONCLUSION Even large retro-rectal tumors may be successfully excised by the perineal approach especially in carefully selected patients, but require extensive knowledge of pelvic anatomy and expertise in pelvic surgery.
Collapse
Affiliation(s)
- Mohamed Tarchouli
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco.
| | - Aziz Zentar
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco.
| | - Moulay Brahim Ratbi
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco.
| | - Abdelhak Bensal
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco.
| | - Mohamed Reda Khmamouche
- Department of Oncology, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco.
| | - Abdelmounaim Ait Ali
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco.
| | - Ahmed Bounaim
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco.
| | - Mohammed Elfahssi
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco.
| | - Khalid Sair
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco.
| |
Collapse
|
|
48
|
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.
Collapse
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
| |
Collapse
|
|
49
|
|
|
50
|
|