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Khedr EME, Tarek M, NasrEl-Din HM, Abdelsattar AH, Abdelazim O. Laparoscopic-assisted Combined Abdominal and Sacral Approach for Sacrococcygeal Teratoma Altman II/III Excision: Case Series. J Indian Assoc Pediatr Surg 2025; 30:215-219. [PMID: 40191490 PMCID: PMC11968056 DOI: 10.4103/jiaps.jiaps_174_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 10/23/2024] [Accepted: 11/14/2024] [Indexed: 04/09/2025] Open
Abstract
Context This study aims to optimize patient outcomes and surgical efficacy by integrating laparoscopic and sacral approaches for the excision of presacral teratomas, focusing on Altman type II-III classifications. Methods A case series was conducted with seven patients diagnosed with sacrococcygeal teratoma (SCT) Altman type II-III. Short- and intermediate-term surgical outcomes were assessed following a combined laparoscopic and sacral approach. The diagnosis was based on clinical examination, elevated serum alpha-fetoprotein levels, and preoperative pelvic magnetic resonance imaging classification. The study evaluates the safety and efficacy of this surgical method, emphasizing feasibility and potential benefits for treating presacral teratomas of varying complexity. Results The age of patients ranged from 8 days to 1.5 years, with a mean age of 115.93 ± 192.3 days. The average duration of surgery was 2.7 h (range: 2-3.15 h), with no intraoperative bleeding. Postoperative recovery was smooth; 71.43% of patients resumed a full diet within 3 days, while the remaining patients did so within 4 days. One patient experienced mild skin erythema, managed conservatively, and two patients had perineal wound separation, resolved with topical treatment. The median hospital stay was 7 days (range: 5-78 days). No postoperative urinary or stool incontinence was observed. Conclusions The combined laparoscopic and posterior sacral approach is a safe and reliable method for the excision of SCTs, potentially improving patient outcomes and reducing postoperative complications.
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Affiliation(s)
| | - Mahmoud Tarek
- Department of Paediatric Surgery, Cairo University Specialized Paediatric Hospital, Cairo University, Giza, Egypt
| | - Hadeer Mohamed NasrEl-Din
- Department of Paediatric Surgery, Cairo University Specialized Paediatric Hospital, Cairo University, Giza, Egypt
| | - Ayman Hussein Abdelsattar
- Department of Paediatric Surgery, Cairo University Specialized Paediatric Hospital, Cairo University, Giza, Egypt
| | - Osama Abdelazim
- Department of Paediatric Surgery, Cairo University Specialized Paediatric Hospital, Cairo University, Giza, Egypt
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Tanaka Y, Kasashima H, Fukuoka T, Yonemitsu K, Seki Y, Kuroda K, Miki Y, Yoshii M, Tamura T, Shibutani M, Toyokawa T, Ree S, Maeda K. A Case of Epidermal Cyst in the Retrorectum Safely Resected by a Combined Laparoscopic Approach. Asian J Endosc Surg 2025; 18:e70068. [PMID: 40269542 PMCID: PMC12018787 DOI: 10.1111/ases.70068] [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: 02/12/2025] [Revised: 04/07/2025] [Accepted: 04/13/2025] [Indexed: 04/25/2025]
Abstract
The surgical indications and optimal approach for retrorectal tumors remain unclear due to their rarity and the anatomical complexity of the presacral space. We report the case of a 48-year-old man in whom a retrorectal mass was incidentally detected on abdominal and pelvic computed tomography. Magnetic resonance imaging demonstrated a cystic lesion measuring 32 × 12 × 20 mm, with low signal intensity on T1-weighted and high signal intensity on T2-weighted images. Given the difficulty of establishing a definitive diagnosis and the potential risk of infection or tumor seeding with biopsy, primary surgical resection was selected. A combined laparoscopic transabdominal and trans-sacral approach enabled precise dissection under enhanced visualization of the pelvic anatomy, ensuring safe and complete tumor excision. The patient's postoperative course was uneventful, and he remained recurrence-free at the 1-year follow-up. This case highlights the pivotal role of laparoscopy in facilitating the safe resection of retrorectal tumors.
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Affiliation(s)
- Yusuke Tanaka
- Department of Gastroenterological SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
- Department of Gastroenterological SurgeryTsukazaki HospitalHimejiJapan
| | - Hiroaki Kasashima
- Department of Gastroenterological SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Tatsunari Fukuoka
- Department of Gastroenterological SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Ken Yonemitsu
- Department of Gastroenterological SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Yuki Seki
- Department of Gastroenterological SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Kenji Kuroda
- Department of Gastroenterological SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Yuichiro Miki
- Department of Gastroenterological SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Mami Yoshii
- Department of Gastroenterological SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Tatsuro Tamura
- Department of Gastroenterological SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Masatsune Shibutani
- Department of Gastroenterological SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Takahiro Toyokawa
- Department of Gastroenterological SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Shigeru Ree
- Department of Gastroenterological SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Kiyoshi Maeda
- Department of Gastroenterological SurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
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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.
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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.
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Chung JS, Kwak HD, Ju JK. Laparoscopic approach in the surgical treatment of large retrorectal tumors: a short-term experience at a single tertiary center case series in Korea. JOURNAL OF MINIMALLY INVASIVE SURGERY 2024; 27:221-226. [PMID: 39675756 DOI: 10.7602/jmis.2024.27.4.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 08/26/2024] [Accepted: 09/01/2024] [Indexed: 12/17/2024]
Abstract
Retrorectal tumors, although rare, pose diagnostic and treatment challenges due to their nonspecific symptoms and complex anatomical location. This single-center case series reports short-term outcomes of laparoscopic transabdominal resection as a surgical approach for large retrorectal tumors. Between 2017 and 2020, five patients underwent this procedure. The median patient age was 53.2 years (range, 34-60 years), and the median operating time was 130 minutes (range, 95-205 minutes). All tumors were located in the retrorectal space. The median tumor size was 5.8 × 4.3 cm (range, 3.5-7.5 cm). Biopsy results included epidermoid cysts, tailgut cyst, lipoma, and keratinous cyst. The median hospital stay was 7.8 days (range, 5-11 days), and the median follow-up duration was 78.0 days (range, 14-219 days). One patient developed a postoperative surgical site infection. Overall, laparoscopic transabdominal resection appears to be a minimally invasive and effective treatment option for retrorectal tumors.
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Affiliation(s)
- Jun Seong Chung
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Han Deok Kwak
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Kyun Ju
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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Lin C, Wang ZY, Wang PP, Xu KW, Zhou JL, Qiu HZ, Wu B. Risk factors for long-term urination and sexual function impairment following laparoscopic resection of presacral lesions. Heliyon 2024; 10:e38756. [PMID: 39512315 PMCID: PMC11541431 DOI: 10.1016/j.heliyon.2024.e38756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 09/13/2024] [Accepted: 09/29/2024] [Indexed: 11/15/2024] Open
Abstract
Background Presacral cysts are rare congenital lesions predominantly affecting females. Surgery is often recommended after diagnosis due to the risk of malignant transformation and complications associated with cyst enlargement. Laparoscopic excision is increasingly favored due to its enhanced visualization and precision. Aim To assess long-term urinary, sexual function outcomes and quality of life in female patients undergoing laparoscopic resection of presacral cysts. Methods We conducted a retrospective review of female patients who underwent laparoscopic resection of presacral cysts between August 2012 and May 2020. Patient demographics, surgical outcomes, and postoperative complications were analyzed. The urinary function was assessed using the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Module (ICIQ-FLUTS), the sexual function was evaluated using the Female Sexual Function Index (FSFI), and quality of life was assessed using the 36-item Short-Form Health Survey (SF-36). Results Among the 32 female patients included, 10 experienced postoperative urinary incontinence, predominantly of the mixed type. The risk factors for urinary incontinence included abdominal distension and the proximity of the cyst to the rectum. Notably, urinary incontinence significantly impacted the overall lower urinary tract symptoms and quality of life. Additionally, seven patients reported postoperative sexual dysfunction, with previous abdominal or pelvic surgery and cyst location under S3 identified as risk factors, affecting the mental health aspects of their quality of life. Conclusion Laparoscopic cyst resection in females poses risks of urinary and sexual dysfunction, potentially impacting quality of life. Thus, tailored management approaches are crucial.
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Affiliation(s)
| | | | - Pei-Pei Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Kai-Wen Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jiao-Lin Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Hui-Zhong Qiu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Bin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
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Gupta L. Presacral Keratinous and Dermoid Cyst Masquerading as Meningocele - A Rare Case Report. Afr J Paediatr Surg 2024; 21:271-272. [PMID: 39279621 PMCID: PMC11493232 DOI: 10.4103/ajps.ajps_153_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/11/2023] [Accepted: 10/25/2023] [Indexed: 09/18/2024] Open
Abstract
ABSTRACT Presacral tumours are rare developmental tumours associated with midline closure defects. A fifteen-month-old girl presented with pain in the lower abdomen and dysuria. After examination, the child underwent investigations and was diagnosed as a presacral mass with intergluteal extension and caudal mass in the subcutaneous tissue of the left gluteal region. Complete excision of mass along with coccygectomy was done. Histopathology showed presacral as a keratinous cyst and gluteal as a dermoid cyst. Later on, the child also developed a left facial dermoid cyst which was also excised.
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Affiliation(s)
- Lucky Gupta
- Department of Pediatric Surgery, AIIMS, Jammu, Jammu and Kashmir, India
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7
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Fechner K, Bittorf B, Langheinrich M, Weber K, Brunner M, Grützmann R, Matzel KE. The management of retrorectal tumors - a single-center analysis of 21 cases and overview of the literature. Langenbecks Arch Surg 2024; 409:279. [PMID: 39276267 PMCID: PMC11401784 DOI: 10.1007/s00423-024-03471-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 09/04/2024] [Indexed: 09/16/2024]
Abstract
AIM Retrorectal tumors are rare and heterogeneous. They are often asymptomatic or present with nonspecific symptoms, making management challenging. This study examines the diagnosis and treatment of retrorectal tumors. METHODS Between 2002 and 2022, 21 patients with retrorectal tumors were treated in our department. We analyzed patient characteristics, diagnosis and treatment modalities retrospectively. Additionally, a literature review (2002-2023, "retrorectal tumors" and "presacral tumors", 20 or more cases included) was performed. RESULTS Of the 21 patients (median age 54 years, 62% female), 17 patients (81%) suffered from benign lesions and 4 (19%) from malignant lesions. Symptoms were mostly nonspecific, with pain being the most common (11/21 (52%)). Diagnosis was incidental in eight cases. Magnetic resonance imaging was performed in 20 (95%) and biopsy was obtained in 10 (48%). Twenty patients underwent surgery, mostly via a posterior approach (14/20 (70%)). At a mean follow-up of 42 months (median 10 months, range 1-166 months), the local recurrence rate was 19%. There was no mortality. Our Pubmed search identified 39 publications. CONCLUSION Our data confirms the significant heterogeneity of retrorectal tumors, which poses a challenge to management, especially considering the often nonspecific symptoms. Regarding diagnosis and treatment, our data highlights the importance of MRI and surgical resection. In particular a malignancy rate of almost 20% warrants a surgical resection in case of the findings of a retrorectal tumour. A local recurrence rate of 19% supports the need for follow up.
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Affiliation(s)
- K Fechner
- Department of Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Krankenhausstraße 12, D-91054, Erlangen, Germany.
| | - B Bittorf
- Department of Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Krankenhausstraße 12, D-91054, Erlangen, Germany
| | - M Langheinrich
- Department of General, Thoracic and Vascular Surgery, Greifswald University, Ferdinand-Sauerbruch-Straße, Greifswald, Germany
| | - K Weber
- Department of Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Krankenhausstraße 12, D-91054, Erlangen, Germany
| | - M Brunner
- Department of Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Krankenhausstraße 12, D-91054, Erlangen, Germany
| | - R Grützmann
- Department of Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Krankenhausstraße 12, D-91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
- Comprehensive Cancer Center Alliance WERA (CCC WERA), Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - K E Matzel
- Department of Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Krankenhausstraße 12, D-91054, Erlangen, Germany
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8
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Narain JP, Mohan N, Vedhanaygam M, Swamiappan M, Rajagopalan R. Resurgence of sexually transmitted infections in India. Indian J Sex Transm Dis AIDS 2024; 45:102-109. [PMID: 39886248 PMCID: PMC11776910 DOI: 10.4103/ijstd.ijstd_120_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 10/09/2024] [Accepted: 11/15/2024] [Indexed: 02/01/2025] Open
Abstract
Sexually transmitted infections (STIs) are increasing throughout the world including India at present. In 1960s and 70s, the bacterial STIs were predominant than the viral STIs. The discovery of human immunodeficiency virus (HIV) and its rampant spread changed the situation with the increase of viral STIs in 1980s and 90s. There was a declining trend of viral and bacterial STIs in late 1990s to 2010. During the past two decades, HIV infection is on the declining trend, but other viral STIs are widely prevalent with insufficient decline. Currently, there is resurgence of syphilis and emergence of drug-resistant Neisseria gonorrhea. The interplay of various factors may have a role in this resurgence and this may act as an alarming sign of an impending epidemic. Hence, stringent monitoring of the trend of STIs including antibiotic resistance, appropriate management of STIs, and proper implementation of STI control program is needed. This will tackle the current situation and prevent the further spread of STIs.
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Affiliation(s)
- Jai Prakash Narain
- Communicable Diseases WHO Regional Office for South-East Asia, Madurai, Tamil Nadu, India
| | - Nithya Mohan
- Department of DVL, Madurai Medical College, Madurai, Tamil Nadu, India
| | | | | | - Rajesh Rajagopalan
- Department of DVL, Government Erode Medical College, Perundurai, Tamil Nadu, India
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9
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Violante T, Murphy B, Ferrari D, Graham RP, Navin P, Merchea A, Larson DW, Dozois EJ, Halfdanarson TR, Perry WR. Presacral Neuroendocrine Neoplasms: A Multi-site Review of Surgical Outcomes. Ann Surg Oncol 2024; 31:4551-4557. [PMID: 38679679 DOI: 10.1245/s10434-024-15328-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/01/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Presacral neuroendocrine neoplasms (PNENs) are rare tumors, with limited data on management and outcomes. METHODS A retrospective review of institutional medical records was conducted to identify all patients with PNENs between 2008 and 2022. Data collection included demographics, symptoms, imaging, surgical approaches, pathology, complications, and long-term outcomes. RESULTS Twelve patients were identified; two-thirds were female, averaging 44.8 years of age, and, for the most part, presenting with back pain, constipation, and abdominal discomfort. Preoperative imaging included computed tomography scans and magnetic resonance images, with somatostatin receptor imaging and biopsies being common. Half of the patients had metastatic disease on presentation. Surgical approach varied, with anterior, posterior, and combined techniques used, often involving muscle transection and coccygectomy. Short-term complications affected one-quarter of patients. Pathologically, PNENs were mainly well-differentiated grade 2 tumors with positive synaptophysin and chromogranin A. Associated anomalies were common, with tail-gut cysts prevalent. Mean tumor diameter was 6.3 cm. Four patients received long-term adjuvant therapy. Disease progression necessitated additional interventions, including surgery and various chemotherapy regimens. Skeletal, liver, thyroid, lung, and pancreatic metastases occurred during follow-up, with no mortality reported. Kaplan-Meier analysis showed a 5-year local recurrence rate of 23.8%, disease progression rate of 14.3%, and de novo metastases rate of 30%. CONCLUSION The study underscores the complex management of PNENs and emphasizes the need for multicenter research to better understand and manage these tumors. It provides valuable insights into surgical outcomes, recurrence rates, and overall survival, guiding future treatment strategies for PNEN patients.
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Affiliation(s)
- Tommaso Violante
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
- School of General Surgery, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Brenda Murphy
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Davide Ferrari
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
- School of General Surgery, Alma Mater Studiorum University of Bologna, Bologna, Italy
- General Surgery Residency Program, University of Milan, Milan, Italy
| | - Rondell P Graham
- Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Patrick Navin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Amit Merchea
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - David W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eric J Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - William R Perry
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
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10
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Kiosov O, Tkachov V, Gulevskyi S. Endoscopic Resection of Tailgut Cyst. Case Rep Gastrointest Med 2024; 2024:5538439. [PMID: 38939693 PMCID: PMC11208811 DOI: 10.1155/2024/5538439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/13/2024] [Accepted: 05/09/2024] [Indexed: 06/29/2024] Open
Abstract
Tailgut cyst or retrorectal cystic hamartoma is a rare congenital lesion, thought to arise from a portion of the embryological hindgut, usually benign, with no or unspecific symptoms, mainly diagnosed in middle-aged women. Complete surgical resection of the cyst is recommended to avoid complications and confirm the diagnosis. In this report, we present our experience in the successful endoscopic management of a tailgut cyst, outlining the endoscopic resection technique and discussing under what conditions this approach may be applicable.
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Affiliation(s)
- Oleksandr Kiosov
- Department of Faculty Surgery, Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine
- Multidisciplinary Surgical Department, University Clinic of Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine
| | - Vladyslav Tkachov
- Department of Faculty Surgery, Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine
- Multidisciplinary Surgical Department, University Clinic of Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine
| | - Sergii Gulevskyi
- Multidisciplinary Surgical Department, University Clinic of Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine
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11
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Kobayashi T, Ishida M, Miki H, Yagyu T, Hatta M, Hamada M, Hirose Y, Sekimoto M. Analysis of the clinicopathological features of tailgut cyst with emphasis on the development of neoplastic lesions. Oncol Lett 2024; 27:286. [PMID: 38736740 PMCID: PMC11083925 DOI: 10.3892/ol.2024.14419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Tailgut cyst is a rare congenital cyst occurring in the retrorectal space and development of neoplastic lesions in tailgut cyst has been reported. Due to the rarity of the tumor, the histogenesis of neoplastic lesions in tailgut cyst has remained elusive. In the present study, the clinicopathological features of tailgut cyst were analyzed with a particular focus on the development of neoplastic lesions. The clinicopathological features of four patients with tailgut cyst (one female and three males) were retrospectively reviewed. No symptoms were present in two patients. Perineal discomfort, and constipation and urinary retention, were described in the other two patients, respectively. Magnetic resonance imaging showed that the cystic lesions were hypointense on T1- and hyperintense on T2-weigted images in all patients. Histopathological analysis revealed that all lesions were multilocular, and cystic walls were covered by squamous and ciliated epithelia without nuclear atypia. The development of neoplastic lesions was noted in two patients. Dysplastic change composed of piling-up proliferation of glandular cells with mild to moderate nuclear atypia was present in one patient, and invasive adenocarcinoma with a dysplasia component was observed in another patient. Dysplasia of the glandular cells, as seen in two patients in the present series, may be a precursor lesion of invasive adenocarcinoma; therefore, adenocarcinoma arsing in tailgut cyst may show a dysplasia-carcinoma sequence. While the reported incidence of neoplastic lesions in tailgut cysts is ~9% or less, their frequency remains to be accurately determined. Therefore, complete surgical resection is important for the management of patients with tailgut cyst. Additional clinicopathological and molecular studies with large cohorts may be required to clarify the histogenesis of neoplastic lesion in tailgut cyst.
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Affiliation(s)
- Toshinori Kobayashi
- Department of Surgery, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Mitsuaki Ishida
- Department of Pathology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka 569-8686, Japan
| | - Hisanori Miki
- Department of Surgery, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Takuki Yagyu
- Department of Surgery, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Masahiko Hatta
- Department of Surgery, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Madoka Hamada
- Department of Surgery, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
- Department of Gastrointestinal Surgery, Kansai Medical University Hospital, Hirakata, Osaka 573-1010, Japan
| | - Yoshinobu Hirose
- Department of Pathology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka 569-8686, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
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12
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Otote J, Butnari V, Ravichandran PS, Mansuri A, Ahmed M, Pestrin O, Rajendran N, Kaul S. Presacral tumors: A systematic review of literature. J Clin Imaging Sci 2024; 14:17. [PMID: 38841312 PMCID: PMC11152553 DOI: 10.25259/jcis_27_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
Presacral/Retrorectal tumors (RRT) are rare lesions that comprise a multitude of histological types. Data on surgical management are limited to case reports and small case series. The aim of the study was to provide a comprehensive review of the epidemiology, pathological subtypes, surgical approaches, and clinical outcomes. A PubMed search using terms "retrorectal tumor" and "presacral tumor" was used to identify articles reporting RRT of non-urological, non-gynecologic, and non-metastatic origin. Articles included were between 2015 and 2023. A total of 68 studies were included, comprising 570 patients. About 68.2% of patients were female, and the mean overall age of both sexes was 48.6 years. Based on histopathology, 466 patients (81.8%) had benign lesions, and 104 (18.2%) were malignant. In terms of surgical approach, 191 (33.5%) were treated anteriorly, 240 (42.1%) through a posterior approach, and 66 (11.6%) combined. The mean length of stay was 7.6 days. Patients treated using the posterior approach had a shorter length of stay (5.7 days) compared to the anterior and combined approaches. RRT are rare tumors of congenital nature with prevalence among the female sex. R0 resection is crucial in its management, and minimal access surgery appears to be a safer option in appropriate case selection.
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Affiliation(s)
- Jeffrey Otote
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Valentin Butnari
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Praveen Surya Ravichandran
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Ahmer Mansuri
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Mehnaz Ahmed
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Olivia Pestrin
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Nirooshun Rajendran
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Sandeep Kaul
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
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13
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Yoshida N, Nakamura K, Shigaki T, Fujiyoshi K, Koushi K, Yoshida T, Isobe T, Mori N, Sudo T, Sakai H, Hisaka T, Ishibashi N, Akiba J, Fujita F. Laparoscopic transabdominal approach for resection of presacral epidermoid cyst in an obese man: a case report. Surg Case Rep 2024; 10:120. [PMID: 38739350 DOI: 10.1186/s40792-024-01924-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/08/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Complete resection of presacral epidermoid cysts is recommended due to the potential for infection or malignancy. Transsacral and transabdominal approaches have been used to treat presacral tumors. However, there are no standard surgical approaches to resection. We present the case of a presacral epidermoid cyst in an obese male patient who underwent laparoscopic transabdominal resection. CASE PRESENTATION A 44-year-old man was referred to our hospital for treatment of a cystic tumor on the pelvic floor. Contrast-enhanced computed tomography revealed a 45 × 40-mm tumor on the left ventral side of the rectum, right side of the ischial spine, dorsal side of the seminal vesicles, and in front of the 5th sacrum. Enhanced magnetic resonance imaging revealed a multilocular cystic tumor with high and low signal intensities on T2-weighted images. The tumor was diagnosed as an epidermoid cyst. We considered the transsacral or laparoscopic approach and decided to perform a laparoscopic-assisted transabdominal resection since the tumor was in front of away from the sacrum, and a transsacral approach would result in a larger scar due to poor visibility from the thickness of the buttocks. The entire tumor was safely resected under laparoscopic guidance, because the laparoscopic transabdominal approach can provide a good and magnified field of view even in a narrow pelvic cavity with small skin incisions, allowing safe resection of the pelvic organs, vessels, and nerves while observing the tumor contour. CONCLUSIONS The laparoscopic transabdominal approach is an effective method for treating presacral tumors in obese patients.
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Affiliation(s)
- Naohiro Yoshida
- Department of Surgery, Kurume University School of Medicine, 67, Asahi-machi, Kurume-shi, Fukuoka, 8300011, Japan.
| | - Koki Nakamura
- Department of Surgery, Kurume University School of Medicine, 67, Asahi-machi, Kurume-shi, Fukuoka, 8300011, Japan
| | - Takahiro Shigaki
- Department of Surgery, Kurume University School of Medicine, 67, Asahi-machi, Kurume-shi, Fukuoka, 8300011, Japan
| | - Kenji Fujiyoshi
- Department of Surgery, Kurume University School of Medicine, 67, Asahi-machi, Kurume-shi, Fukuoka, 8300011, Japan
| | - Kenichi Koushi
- Department of Surgery, Kurume University School of Medicine, 67, Asahi-machi, Kurume-shi, Fukuoka, 8300011, Japan
| | - Takefumi Yoshida
- Department of Surgery, Kurume University School of Medicine, 67, Asahi-machi, Kurume-shi, Fukuoka, 8300011, Japan
| | - Taro Isobe
- Department of Surgery, Kurume University School of Medicine, 67, Asahi-machi, Kurume-shi, Fukuoka, 8300011, Japan
| | - Naoki Mori
- Department of Surgery, Kurume University School of Medicine, 67, Asahi-machi, Kurume-shi, Fukuoka, 8300011, Japan
| | - Tomoya Sudo
- Department of Surgery, Kurume University School of Medicine, 67, Asahi-machi, Kurume-shi, Fukuoka, 8300011, Japan
| | - Hisamune Sakai
- Department of Surgery, Kurume University School of Medicine, 67, Asahi-machi, Kurume-shi, Fukuoka, 8300011, Japan
| | - Toru Hisaka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi-machi, Kurume-shi, Fukuoka, 8300011, Japan
| | - Nobuya Ishibashi
- Department of Surgery, Kurume University School of Medicine, 67, Asahi-machi, Kurume-shi, Fukuoka, 8300011, Japan
| | - Jun Akiba
- Department of Diagnostic Pathology, Kurume University Hospital, 67, Asahi-machi, Kurume-shi, Fukuoka, 8300011, Japan
| | - Fumihiko Fujita
- Department of Surgery, Kurume University School of Medicine, 67, Asahi-machi, Kurume-shi, Fukuoka, 8300011, Japan
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14
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Bilkhu AS, Wild J, Sagar PM. Management of retrorectal tumours. Br J Surg 2024; 111:znae012. [PMID: 38291005 DOI: 10.1093/bjs/znae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/06/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Amarvir S Bilkhu
- Colorectal & Peritoneal Oncology, The Christie Foundation NHS Trust, Manchester, UK
| | - Jonathan Wild
- Colorectal & Peritoneal Oncology, The Christie Foundation NHS Trust, Manchester, UK
| | - Peter M Sagar
- John Goligher Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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15
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A E, Prakash A, Ashta A, Garg A, Verma A, Padaliya P. Pediatric presacral tumors with intraspinal extension: a rare entity with diagnostic challenges. Acta Radiol 2023; 64:3056-3073. [PMID: 37753549 DOI: 10.1177/02841851231202688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
The presacral space is a potential space located between the rectum and the lumbosacral spine. It contains various primitive germ cell types that serve as the origin for a range of tumors. Imaging is crucial in characterizing, assessing the extent of and evaluating the treatment response to these tumors. We report a series of six cases of pediatric presacral tumors with intraspinal extension, including an immature sacrococcygeal teratoma (Altman type II), a malignant sacrococcygeal teratoma (Altman type IV), a neuroblastoma, a rhabdomyosarcoma, a clear cell sarcoma and an Ewing's sarcoma of the ilium. These tumors can be broadly categorized as tumors of germ cell, neuroblastic, mesenchymal and osteogenic origin. Despite overlapping imaging features, a review of the existing literature and careful retrospective observation revealed several distinctive features that aid in the optimal characterization of tumors. These include the tumor's epicenter, the pattern and degree of bone involvement, the status of sacral foramina and neural elements, and internal tumor characteristics such as the presence of fat, calcification, hemorrhage and necrosis.
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Affiliation(s)
- Ebinesh A
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Anjali Prakash
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Aanchal Ashta
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Anju Garg
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Abhishek Verma
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Prerna Padaliya
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
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16
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Bulisani BM, Gomes LGL, Leite MADO, Moreno R, Rodrigues MR, Rossi FMB, Silva RBFD, Carmo LCBD, Waisberg J. Robotic approach to remove four tailgut cyst cases in Brazil: a case series. EINSTEIN-SAO PAULO 2023; 21:eRC0544. [PMID: 37970955 DOI: 10.31744/einstein_journal/2023rc0544] [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: 04/04/2023] [Accepted: 08/14/2023] [Indexed: 11/19/2023] Open
Abstract
Tailgut cysts are rare congenital lesions that are remnants of the embryonic hindgut. This abnormality presents with non-specific symptoms or no symptoms; therefore, misdiagnosis is common. Here, we present four cases of tailgut cysts that were successfully removed using a robotic surgical approach. A 42-year-old woman with tenesmus, pain in the right gluteal region, and discomfort in the rectal region during evacuation was referred to our medical center. Another patient was a 28-year-old woman who presented with the same symptoms to our general practitioner. Both patients underwent upper abdominal and pelvic magnetic resonance imaging that revealed a tailgut cyst. Further, a 36-year-old woman was referred with coccyx and hypogastric pain. Magnetic resonance imaging revealed two pararectal cystic formations. She underwent robot-assisted surgery, and after analysis by a pathologist, the conclusion was that the tailgut cyst was associated with scarring fibrosis. A 55-year-old woman with posterior epigastric pelvic pain associated with heartburn underwent robot-assisted surgery to resect a retroperitoneal tumor. These cases highlighted the importance of tailgut cysts in the differential diagnosis of rectal lesions. Surgical treatment is preferred because malignant transformations can occur. The difference between laparoscopic and robotic approaches is the better visualization and stability of the latter, inducing less tissue damage. Robotic resection is a safe procedure, especially in patients with a narrow pelvis, because it reduces tissue damage.
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Affiliation(s)
| | | | | | - Ricardo Moreno
- RR Médicos Cirurgiões , São Bernardo do Campo , SP , Brazil
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17
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Salameh F, Gilshtein H, Abramov R, Ashkenazi I, Duek D. Transanal endoscopic microsurgery technique: an acceptable approach for retrorectal tumors. Tech Coloproctol 2023; 27:673-678. [PMID: 36645584 DOI: 10.1007/s10151-023-02753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Retrorectal lesions (RRLs) are rare lesions that originate from the tissue present in the retrorectal space. The gold standard of care is complete resection regardless of pathology. The traditional approaches (anterior, posterior, and combined) are relatively well described. Transanal Endoscopic Microsurgery (TEM) is a minimally invasive technique offered as an alternative approach for RRLs. AIM To evaluate the outcomes of patients diagnosed with RRL and treated by the TEM approach, especially postoperative complications, and the recurrence rate. METHODS Patients with RRLs treated with the TEM technique in one medical center between 2000 and 2020 were identified. Their postoperative outcomes were compared with historical controls. RESULTS Thirty-nine patients diagnosed with RRL were operated on using the TEM platform. Thirty-seven RRLs were benign, and two were malignant. Their median size (IQR) was 20 mm (15, 32.5). The median distance (IQR) from the anal verge was 50 mm (50, 72.5). The median operative time (IQR) was 48.5 min (41.75, 60). All, except one lesion, were completely resected. The median length of stay (IQR) was one day (1, 1 day). Postoperative complications were diagnosed in three patients, two of which resolved following a second operation. CONCLUSIONS The implementation of TEM for the resection of RRLs demonstrated excellent overall results with acceptable complication and recurrence rate and represented a viable alternative surgical approach.
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Affiliation(s)
- F Salameh
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel.
| | - H Gilshtein
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
| | - R Abramov
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
| | - I Ashkenazi
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
| | - D Duek
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
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18
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Wang G, Miao C. Chinese expert consensus on standardized treatment for presacral cysts. Gastroenterol Rep (Oxf) 2023; 11:goac079. [PMID: 37655176 PMCID: PMC10468046 DOI: 10.1093/gastro/goac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/13/2022] [Accepted: 12/01/2022] [Indexed: 09/02/2023] Open
Abstract
Presacral cysts are cystic or cyst-solid lesions between the sacrum and rectum, almost involving adjacent pelvic floorstructures including sacrococcygeal fascia, rectum, and anal sphincter. Presacral cysts are usually benign, currently believed to arise from aberrant embryogenesis. Presacral cysts are clinically rare and the true incidence is unknown. Surgical resection remains the major treatment for presacral cysts. Unless the cysts are completely resected, recurrence is unavoidable. Recurrent cysts or hard-to-heal sinuses in the sacrococcyx cause patients extreme pain. However, the current knowledge of presacral cysts is insufficient. They are occasionally confused with other diseases such as ovarian cysts and perianal abscesses. Moreover, lack of the correct surgical concept and skills leads to palliative treatment for complex presacral cysts and serious complications such as impairing the function of the anal sphincter or important blood vessels and nerves. The consensus summarizes the opinions and experiences of multidisciplinary experts in presacral cysts and aims to provide clinicians with a more defined concept of the treatment, standardize the surgical approach, and improve the efficacy of presacral cysts.
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Affiliation(s)
- Gangcheng Wang
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou
University, Henan Cancer Hospital, Zhengzhou, Henan, P. R. China
| | - Chengli Miao
- Department of Retroperitoneal Tumor Surgery, Peking University
International Hospital, Beijing, China
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19
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Tos SM, Jobran AW, Alasafrah A, Bakri I, Jubran F. A report of presacral epidermoid cyst in perimenopausal women: An extremely rare site and an unusual cause of chronic constipation. Int J Surg Case Rep 2023; 103:107880. [PMID: 36634501 PMCID: PMC9843274 DOI: 10.1016/j.ijscr.2023.107880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Epidermoid cyst is rare congenital lesion of ectodermal origin that arises from the remnants of the embryonic tissues. Although epidermal cysts are frequently observed throughout the body, they are rarely found in the presacral regions. It more commonly occurs in women of reproductive age as an asymptomatic, incidental finding during routine physical examination or imaging studies, or during obstetric and gynecologic events. CASE PRESENTATION A 48-year-old female patient presented with intermittent constipation, lower abdominal and pelvic pain that had developed progressively during the previous six months, which was temporarily relieved with regular laxatives. Magnetic resonance imaging showed a presacral cystic tumor with a high signal intensity on T1-weighted images and, low signal on T2-weighted images with no significant enhancement post-contrast administration. The mass pushed the rectum laterally by external compression. This tumor was diagnosed as a developmental cyst, and total mass resection with negative margins was performed. After that, tumor was histopathologically diagnosed as an epidermoid cyst. DISCUSSION AND CONCLUSION Epidermoid cyst is a common entity but is rare at presacral space. Also, an epidermoid cyst is an uncommon entity among cystic pathologies found in the presacral region, which includes benign and malignant pathologies. Due to the potential of subsequent infection or cancer, a meticulous clinical examination with correlated radiographic imaging, followed by total mass excision and histopathological evaluation are crucial.
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Affiliation(s)
- Salem M. Tos
- Faculty of Medicine, Al Quds University, Jerusalem, Palestine,Corresponding author at: Al-Quds University, Main Campus, Abu Dis, P.O. Box 89, Palestine.
| | | | | | - Izzeddin Bakri
- Pathology department, Al Ahli hospital, Hebron, Palestine
| | - Fahmi Jubran
- Faculty of Medicine, Al Quds University, Jerusalem, Palestine,Al Ahli Hospital, Hebron, Palestine
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20
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Brown IS, Sokolova A, Rosty C, Graham RP. Cystic lesions of the retrorectal space. Histopathology 2023; 82:232-241. [PMID: 35962741 DOI: 10.1111/his.14769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 12/24/2022]
Abstract
Cysts of the retrorectal space comprise a heterogeneous group of rare lesions. Most develop from embryological remnants and include tailgut cysts, dermoid cysts, rectal duplication cysts, anal canal duplication cysts, sacrococcygeal teratomas and anterior meningocoele. Tailgut cyst is the most common cyst of developmental origin, usually presenting as a multilocular cystic mass with mucoid content and lined by multiple epithelial types. Compared with tailgut cysts, rectal duplication cysts display all layers of the large bowel wall including a well-defined muscularis propria. Retrorectal cysts of non-developmental origin are far less common and represent lesions that either infrequently involve the retrorectal space or undergo extensive cystic change. This review provides an overview of the various histological types of cystic lesions of the retrorectal space, divided into cysts of developmental origin and those of non-developmental origin. A practical pathological and multidisciplinary approach to diagnosing these lesions is presented.
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Affiliation(s)
- Ian S Brown
- Envoi Specialist Pathologists, Brisbane, Queensland, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Anna Sokolova
- Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Christophe Rosty
- Envoi Specialist Pathologists, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
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21
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Ji ZX, Yan S, Gao XC, Lin LF, Li Q, Yao Q, Wang D. Perirectal epidermoid cyst in a patient with sacrococcygeal scoliosis and anal sinus: A case report. World J Clin Cases 2022; 10:11139-11145. [PMID: 36338219 PMCID: PMC9631153 DOI: 10.12998/wjcc.v10.i30.11139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/09/2022] [Accepted: 09/20/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Perirectal epidermoid cysts are rare masses arising from the ectodermal germ cell layer of the hindgut and are predominantly found in middle-aged women. It is often difficult to make an accurate diagnosis of these cysts and it is equally challenging to distinguish it from other developmental cysts.
CASE SUMMARY We report the case of an 18-year-old female patient with a perirectal mass who presented to the hospital with constipation. The patient experienced sacrococcygeal falls and burns on the left buttocks during growth. Three-dimensional computed tomography scans indicated abnormal sacral vertebrae with the sacral canal partially enlarged and opened. Pelvic magnetic resonance imaging showed a 55 mm × 40 mm × 35 mm unilocular cystic mass in the perirectal space and a solitary sinus in the left ischiorectal fossa. The cyst was completely resected posteriorly using the sacrococcygeal approach. The pathology was verified to be an epidermoid cyst. The patient remained recurrence-free after 6 mo of follow-up.
CONCLUSION Successful treatment of perirectal epidermoid cysts depends on comprehensive evaluation. This is significant for the surgical approach and prognosis.
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Affiliation(s)
- Zhou-Xin Ji
- Department of Anorectal Surgery, Shenzhen People's Hospital, Shenzhen 518000, Guangdong Province, China
| | - Song Yan
- Department of Anorectal Surgery, Shenzhen People's Hospital, Shenzhen 518000, Guangdong Province, China
| | - Xu-Can Gao
- Department of Anorectal Surgery, Shenzhen People's Hospital, Shenzhen 518000, Guangdong Province, China
| | - Li-Fen Lin
- Department of Anorectal Surgery, Shenzhen People's Hospital, Shenzhen 518000, Guangdong Province, China
| | - Qiang Li
- Department of Anorectal Surgery, Shenzhen People's Hospital, Shenzhen 518000, Guangdong Province, China
| | - Qi Yao
- Department of Anorectal Surgery, Shenzhen People's Hospital, Shenzhen 518000, Guangdong Province, China
| | - Dong Wang
- Department of Anorectal Surgery, Shenzhen People's Hospital, Shenzhen 518000, Guangdong Province, China
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22
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Gong J, Xu Y, Zhang Y, Qiao L, Xu H, Zhu P, Yang B. Primary malignant tumours and malignant transformation of cysts in the retrorectal space: MRI diagnosis and treatment outcomes. Gastroenterol Rep (Oxf) 2022; 10:goac048. [PMID: 36157328 PMCID: PMC9491843 DOI: 10.1093/gastro/goac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 06/11/2022] [Accepted: 07/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are no clear guidelines for the diagnosis and treatment of malignant retrorectal tumours. The purpose of this study was to increase preoperative diagnostic knowledge and to describe the outcomes of treatment for these patients. METHODS This retrospective study was conducted on patients who underwent complete retrorectal tumour resection between May 2006 and July 2018, and had confirmed post-operative pathology reports. Demographic and clinical data (including imaging, perioperative, pathological, and prognostic data) were collected and analysed. RESULTS Malignant lesions were identified in 15 (9 [60%], female) patients. The median age of the patients was 59 years (range, 34-72 years). Primary malignant tumours were identified in seven patients with solid tumours, in which gastrointestinal stromal tumours accounted for 71.4% (five of seven) and the remainder were chordoma or mucinous adenocarcinoma. Malignant transformation of cysts occurred in another eight patients with heterogeneous tumours, while histopathological features were present in 75% (six of eight) of patients with mucinous adenocarcinoma, and the remainder were squamous-cell carcinoma or neuroendocrine tumour (Grade 2). The malignant characteristics of the solid portions observed using magnetic resonance imaging (MRI) were as follows: the cyst wall of the tumour was irregularly thickened; the surface was convex or lobed; the solid tumour had no capsule, or the capsule was destroyed; and the surface had a gyrus-like morphology. At a median follow-up time of 52 months (range, 13-100 months), the overall recurrence-free survival rate was 40.0% and the survival rate was 46.7%. CONCLUSION Some MRI features can be used to distinguish malignant retrorectal tumours from benign retrorectal tumours. The survival rate of patients with malignant retrorectal tumours is poor.
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Affiliation(s)
- Jing Gong
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Yumeng Xu
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Yan Zhang
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Lichao Qiao
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Haixia Xu
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Ping Zhu
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Bolin Yang
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
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23
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Arshad R, Khalid N, Rafique M, Mushtaq R, Sial FM. Perianal Tailgut Cyst: An Unusual Presentation. Cureus 2022; 14:e27512. [PMID: 36060408 PMCID: PMC9424791 DOI: 10.7759/cureus.27512] [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] [Accepted: 07/31/2022] [Indexed: 11/24/2022] Open
Abstract
A tailgut cyst (TGC) is a rare congenital lesion that occurs due to failure of involution of the distal hindgut, leading to the development of a mucus-secreting cyst. The clinical presentation is nonspecific, and often the diagnosis can be missed. We present the case of a 20-year-old female with a TGC in the perianal region. Surgical excision of the cyst was performed, followed by an uneventful recovery. The young age of our patient and the anatomical location of the TGC make our case a rare entity, highlighting the need for practicing surgeons to keep TGC as a differential in mind while examining masses in the perianal region.
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Sakurai T, Mukai T, Kawachi H, Hiyoshi Y, Yamaguchi T, Nagasaki T, Akiyoshi T, Fukunaga Y. Laparoscopic resection for a relapsed presacral epidermoid cyst penetrating the ischiorectal fossa. Asian J Endosc Surg 2022; 15:656-659. [PMID: 35199471 DOI: 10.1111/ases.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 11/26/2022]
Abstract
An epidermoid cyst occurring in the presacral region is a rare congenital cystic tumor. Complete surgical excision is recommended because of the possibility of infection and malignancy. Depending on the size and location, several approaches, such as anterior, posterior, combined, and laparoscopic approaches, have been described. Here, we have reported a rare case of relapsed epidermoid cyst after emergency laparotomy and transvaginal drainage. Although the cyst penetrated the levator ani muscle and was densely adhered to the vagina and rectum, complete laparoscopic resection was successfully performed. This approach is a useful technique as it is minimally invasive and minimizes tissue destruction of the pelvic floor.
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Affiliation(s)
- Tsubasa Sakurai
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiki Mukai
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroshi Kawachi
- Department of Pathology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yukiharu Hiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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25
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Poudel D, Shrestha S, Poddar E, Pacchai P, Kandel BP, Lakhey PJ. Retrorectal schwannoma in a middle-aged female: A case report. Int J Surg Case Rep 2022; 96:107270. [PMID: 35696818 PMCID: PMC9194842 DOI: 10.1016/j.ijscr.2022.107270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/29/2022] [Accepted: 05/29/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary sacral and presacral lesions are uncommon and pose a significant diagnostic dilemma. Retrorectal schwannoma is a benign primary presacral lesion that is extremely rare and presents with non-specific symptoms. CASE PRESENTATION A 42-years-old, female patient was admitted for lower-back pain for seven days. The retrorectal mass was detected on imaging, and she underwent laparoscopic excision. Pathological examination revealed a rare retrorectal schwannoma. CLINICAL DISCUSSION Retrorectal location of schwannomas is rare and the preoperative diagnosis is very difficult as the clinical features and the radiological features are non-specific. In addition, these tumors can be found incidentally on routine rectal or pelvic examinations. As these tumors are benign, encapsulated, and non-invasive, this entity has an excellent prognosis. Despite the tumors' rarity and variety, we concur with the literature that surgical management is required to obtain a clear diagnosis and avoid consequences such as malignant transformation. CONCLUSION Retrorectal Schwannoma presents a diagnostic and therapeutic challenge. Identification is important because surgical excision, either open or laparoscopic, is curative.
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Affiliation(s)
- Diptee Poudel
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Nepal
| | - Suraj Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Nepal
| | - Elisha Poddar
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Nepal
| | - Prarthana Pacchai
- Department of Surgical Gastroenterology, Tribhuvan University Teaching Hospital, Maharajgunj, Nepal
| | - Bishnu Prasad Kandel
- Department of Surgical Gastroenterology, Tribhuvan University Teaching Hospital, Maharajgunj, Nepal.
| | - Paleswan Joshi Lakhey
- Department of Surgical Gastroenterology, Tribhuvan University Teaching Hospital, Maharajgunj, Nepal
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Hamdy O, Emile SH, Ali NM, Sabry AM, Deniwar MA. Retrospective cohort study of the characteristics and outcome of surgical treatment of pelvic neurogenic and presacral tumors. INTERDISCIPLINARY NEUROSURGERY 2022; 28:101496. [DOI: 10.1016/j.inat.2022.101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Ghannouchi M, Khalifa MB, Zoukar O, Nacef K, Chakka A, Boudokhan M. Retrorectal epidermoid mistaken for perirectal swelling: A case report. Int J Surg Case Rep 2022; 95:107187. [PMID: 35569309 PMCID: PMC9112110 DOI: 10.1016/j.ijscr.2022.107187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/07/2022] [Accepted: 05/08/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Olfa Zoukar
- Monastir Maternity Center and Neonatal Center, Tunisia
| | - Karim Nacef
- Department of Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
| | - Amina Chakka
- Department of Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
| | - Moez Boudokhan
- Department of Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
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Zhao X, Zhou S, Liu N, Li P, Chen L. Is There Another Posterior Approach for Presacral Tumors Besides the Kraske Procedure? — A Study on the Feasibility and Safety of Surgical Resection of Primary Presacral Tumors via Transsacrococcygeal Transverse Incision. Front Oncol 2022; 12:892027. [PMID: 35692749 PMCID: PMC9179022 DOI: 10.3389/fonc.2022.892027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe aim of the present study was to explore the feasibility and safety of the surgical resection of presacral tumors via a transsacrococcygeal transverse incision.MethodsThe clinical data and prognoses of patients with presacral tumors who underwent surgery at the Chinese People’s Liberation Army (PLA) General Hospital between January 2009 and December 2018 were retrospectively reviewed and analyzed.ResultsA total of 110 patients with presacral tumors were included in this study, including 82 female patients and 28 male patients, with a female-to-male ratio of 2.9:1. A posterior approach (transsacrococcygeal transverse incision) was utilized in 105 patients, an anterior approach (transabdominal excision) was utilized in 1 patient, and a combined (posterior plus anterior) approach was utilized in 4 patients. The mean tumor size was 8.72 ± 4.28 cm. More than half of the patients (n=59/110) with presacral tumors were asymptomatic. Twenty-six pathological types were observed in our study, including 97 benign lesions and 13 malignant lesions. The intraoperative complication rate was 42.7% (n=47/110), whereas the postoperative morbidity rate was 3.6% (n=4/110). The length of hospital stay for patients treated with the posterior approach was shorter than that of patients treated with the anterior and combined approaches. After a mean follow-up of 90.13 ± 31.22 months, 11 patients had local presacral tumor recurrence, and 1 patient had distant metastasis, with a combined recurrence rate of 10.9% (n=12/110).ConclusionsThe surgical resection of primary presacral tumors via a transsacrococcygeal transverse incision is feasible and safe, with acceptable oncological therapeutic outcomes and a low postoperative morbidity rate, making it worth popularizing in clinical practice.
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Thompson DT, Wilkinson N, Hrabe JE, Arshava EV. Surgical management of large, connected perineal and pelvic epidermal inclusion cysts mimicking a dumbbell-shaped lesion in an adult male. Int J Surg Case Rep 2022; 93:106932. [PMID: 35286977 PMCID: PMC8924638 DOI: 10.1016/j.ijscr.2022.106932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Epidermal inclusion cysts are a common benign finding, and they are predominantly asymptomatic. They can rarely form in the pelvis or abdomen, however, and may cause symptoms secondary to mass effect. This case highlights management of an anterectal epidermal inclusion cyst connected to the perineal cyst, mimicking a dumbbell-shaped lesion, found in a male. CASE PRESENTATION This is a unique case of a 21-year-old Caucasian male with a palpable perineal mass, lower extremity hypoesthesia, and constipation who was found to have a complex-shaped cyst on computed tomography and magnetic resonance imaging. This was ultimately managed with a two-stage perineal and transabdominal resection. CLINICAL DISCUSSION This case highlights that perineal epidermal inclusion cysts may have pelvic extension, especially in patients with additional new-onset neurologic, gastrointestinal, or urologic symptoms. These symptoms should completely resolve after resection. Additionally, resection is recommended to prevent complications including malignant degeneration and fistulization. CONCLUSION This is the first reported case of an anterectal, epidermal inclusion cyst connected to a perineal cyst found in a male. Perineal and pelvic cysts may be synchronous and may be connected through the pudendal canal. These masses can be safely removed via a combined perineal and transabdominal resection. The connecting portion of lesions that have both pelvic and perineal components should be meticulously identified and dissected because even a thin, patent segment - if left unresected - may result in lesion recurrence.
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Affiliation(s)
- Dakota T Thompson
- Department of Surgery, University of Iowa Carver College of Medicine, 375 Newton Rd, Iowa City, IA 52242, USA
| | - Neal Wilkinson
- Department of Surgical Oncology, Kalispell Regional Medical Center, 310 Sunnyview Lane, Kalispell, MT, USA
| | - Jennifer E Hrabe
- Department of Surgery, University of Iowa Carver College of Medicine, 375 Newton Rd, Iowa City, IA 52242, USA
| | - Evgeny V Arshava
- Department of Surgery, University of Iowa Carver College of Medicine, 375 Newton Rd, Iowa City, IA 52242, USA.
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Burke JR, Shetty K, Thomas O, Kowal M, Quyn A, Sagar P. The management of retrorectal tumours: tertiary centre retrospective study. BJS Open 2022; 6:zrac044. [PMID: 35441209 PMCID: PMC9019068 DOI: 10.1093/bjsopen/zrac044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/03/2022] [Accepted: 02/13/2022] [Indexed: 11/12/2022] Open
Abstract
AIM Tumours of the retrorectal space are uncommon, pathologically heterogeneous, and difficult to diagnose, with ongoing controversy over their surgical management. The aim of this study was to evaluate the surgical management of a consecutive series of patients who had undergone excision of primary retrorectal tumours (PRRTs) at a tertiary referral centre. METHOD Patients were identified from a prospectively maintained database between 1 March 2001 and 1 August 2021. Electronic patient records were reviewed for demographics, preoperative imaging, operative details, histology, and follow-up. A chi-squared test was used to assess the statistical significance of findings. RESULTS A total of 144 patients were included in the study. Of these, 103 patients were female (71.5 per cent), 46 patients (31.9 per cent) presented incidentally, and 99 of the patients had tumours located below S3 (68.7 per cent). Overall, 76 patients underwent a transperineal approach (52.7 per cent) with the most common findings of a benign tailgut cyst occurring in 59 (40.9 per cent) of cases. Preoperative MRI predicted urovascular and pelvic sidewall involvement assessed intraoperatively with a sensitivity of 83.3 and 90 per cent and a specificity of 98.1 and 98 per cent respectively. Risk of malignancy in solid tumours was 31.4 versus 8.8 per cent in cystic tumours (relative risk 3.5, 95 per cent c.i. 1.6 to 7.6, P < 0.001). Major complications (Clavien-Dindo grade III and above) occurred in eight patients (5.6 per cent) and all-cause long-term mortality was 4.8 per cent (seven patients). DISCUSSION PRRTs can be safely excised with minimal complications in specialized centres by surgical teams with the relevant expertise. This study questions the conservative management of cystic tumours and given the risk of solid tumour malignancy, supports surgical management.
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Affiliation(s)
- Joshua R. Burke
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Kunal Shetty
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Owen Thomas
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Mikolaj Kowal
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Aaron Quyn
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Peter Sagar
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
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Aubert M, Mege D. Kraske approach to retrorectal tumors: Surgical technique. J Visc Surg 2022; 159:229-233. [DOI: 10.1016/j.jviscsurg.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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.
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Affiliation(s)
- Pei-Pei Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Chen Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jiao-Lin Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Kai-Wen Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hui-Zhong Qiu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Balci B, Yildiz A, Leventoğlu S, Mentes B. Retrorectal tumors: A challenge for the surgeons. World J Gastrointest Surg 2021; 13:1327-1337. [PMID: 34950423 PMCID: PMC8649566 DOI: 10.4240/wjgs.v13.i11.1327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/26/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
Retrorectal or presacral tumors are rare lesions located in the presacral area and considered as being derived from multiple embryological remnants. These tumors are classified as congenital, neurogenic, osseous, inflammatory, or miscellaneous. The most common among these are congenital benign lesions that present with non-specific symptoms, such as lower back pain and change in bowel habit. Although congenital and developmental tumors occur in younger patients, the median age of presentation is reported to be 45 years. Magnetic resonance imaging plays a crucial role in treatment management through accurate diagnosis of the lesion, the evaluation of invasion to adjacent structures, and the decision of appropriate surgical approach. The usefulness of preoperative biopsy is still debated; currently, it is only indicated for solid or heterogeneous tumors if it will alter the treatment management. Surgical resection with clear margins is considered the optimal treatment; described approaches are transabdominal, perineal, combined abdominoperineal, and minimally invasive. Benign retrorectal tumors have favorable long-term outcomes with a low incidence of recurrence, whereas malignant tumors have a potential for distant organ metastasis in addition to local recurrence.
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Affiliation(s)
- Bengi Balci
- Department of General Surgery, Ankara Oncology Training and Research Hospital, Ankara 06060, Turkey
| | - Alp Yildiz
- Department of General Surgery, Ankara Yenimahalle Training and Research Hospital, Ankara 06370, Turkey
| | - Sezai Leventoğlu
- Department of Surgery, Gazi University Medical School, Ankara 06530, Turkey
| | - Bulent Mentes
- Department of General Surgery, Memorial Ankara Hospital, Ankara 06060, Turkey
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Mastoraki A, Giannakodimos I, Panagiotou K, Frountzas M, Chrysikos D, Kykalos S, Theodoropoulos GE, Schizas D. Epidemiology, diagnostic approach and therapeutic management of tailgut cysts: A systematic review. Int J Clin Pract 2021; 75:e14546. [PMID: 34137134 DOI: 10.1111/ijcp.14546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/16/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Tailgut cysts (TGCs) are benign congenital abnormalities that usually present with non-specific symptoms, constituting a diagnostic dilemma for physicians. The aim of this study was to systematically review the literature concerning clinical manifestations, diagnostic modalities and histologic findings of TGCs and highlight current knowledge on therapeutic management of this rare entity. METHODS PubMed and Embase databases were systematically searched by two independent investigators (last search 18 February 2021) for studies concerning TGCs published in the past two decades. RESULTS Totally, 144 articles, including 135 case reports and 9 case series, met our inclusion criteria. One hundred eighty-four patients were included (3:1/female:male) with an age of 42.3 ± 18.7 years (mean, SD), while 5 cases concerned new-born infants. Pain was the prevailing clinical manifestation (41.8%), whereas 16.8% were asymptomatic. MRI and CT were utilized for diagnosis in 58.7% and 54.7% of cases, respectively. The majority of cysts were multilocular, while ciliated columnar epithelium and smooth muscles of the cyst wall were the prevailed histological findings. Malignant degeneration of TGCs was reported in 32.1% of cases, while carcinoid tumours were the most frequent malignancies. Surgical resection was performed in 155 cases, while laparoscopic and robotic approach was preferred in 18 and 2 cases, respectively. A posterior approach was implemented in 80.9%, anterior technique in 9% and combined technique in 6.7% of cases. Postoperative complications and recurrence of the cystic lesion were reported in 17.4% and 7.6% of cases, respectively. CONCLUSIONS TGCs constitute a dilemma for the physicians. Surgical resection comprises the ultimate treatment to avoid complications or malignant transformation of the cyst. Concrete follow-up strategies and optimal therapeutic options should be outlined through consensus guidelines and at the time being, such decisions can be made only on the basis of extrapolation and on a case-by-case approach.
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Affiliation(s)
- Aikaterini Mastoraki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ilias Giannakodimos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Karmia Panagiotou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maximos Frountzas
- First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - Dimosthenis Chrysikos
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Kykalos
- Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Georgios E Theodoropoulos
- First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Gould LE, Pring ET, Corr A, Fletcher J, Warusavitarne J, Burling D, Northover JMA, Jenkins JT. Evolution of the management of retrorectal masses: A retrospective cohort study. Colorectal Dis 2021; 23:2988-2998. [PMID: 34459085 DOI: 10.1111/codi.15893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/25/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023]
Abstract
AIM Retrorectal masses are abnormalities located anatomically in the retrorectal space. A significant proportion are asymptomatic with no malignant potential while others cause symptoms due to mechanical pressure or malignant infiltration. We reviewed and categorised the retrorectal masses encountered over a 30-year time period in a specialist colorectal hospital and describe our management algorithm for consideration by other multidisciplinary teams (MDT). METHODS This was a retrospective analysis of consecutive patients referred between 1984-2019. A detailed review of clinical presentation, imaging features, postoperative histology and impact on morbidity and anorectal function is reported. RESULTS A total of 143 patients with median age of 46 years and female preponderance (74%) were reviewed. The commonest presenting symptom was pain (46%) and all malignant cases had symptoms (n = 17). Over the last decade, more asymptomatic patients have presented with a retrorectal mass (33%, p = 0.04) and more patients are opting for surveillance rather than resection (33%, p = 0.013). Increasing age and lesion size were associated with malignancy (p < 0.05). Radiological features associated with malignancy included: solid/heterogeneous component, lobulated borders or locally invasive. Following surgery, complications included chronic pain (40%), poor wound healing (23%) and bowel dysfunction (10%). CONCLUSIONS The management of retrorectal masses remains complex. There are features, both clinical and radiological, that can help determine the best management strategy. Management should be in a high-volume tertiary centre and preferably through a complex rectal cancer MDT. Long-term sequelae such as chronic pain must be highlighted to patients. We advocate the establishment of an international registry to further record and characterise these rare, potentially troublesome lesions.
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Affiliation(s)
- Laura E Gould
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Edward T Pring
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Alison Corr
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Jordan Fletcher
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | | | - David Burling
- Department of Surgery and Cancer, Imperial College, London, UK
| | - John M A Northover
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - John T Jenkins
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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Poudel D, Shrestha BM, Kandel BP, Shrestha S, Kansal A, Joshi Lakhey P. Presacral dermoid cyst in a young female patient: A case report. Clin Case Rep 2021; 9:e05062. [PMID: 34795897 PMCID: PMC8582024 DOI: 10.1002/ccr3.5062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/30/2021] [Accepted: 10/26/2021] [Indexed: 11/12/2022] Open
Abstract
Presacral dermoid cysts are rare, benign tumors of developmental origin that primarily affect women. Surgical resection is the mainstay of treatment for these cysts, even if asymptomatic, with the laparoscopic approach being safer and more efficient.
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Affiliation(s)
- Diptee Poudel
- Maharajgunj Medical Campus, Institute of MedicineMaharajgunjNepal
| | | | - Bishnu Prasad Kandel
- Department of Surgical GastroenterologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Suraj Shrestha
- Maharajgunj Medical Campus, Institute of MedicineMaharajgunjNepal
| | - Ankush Kansal
- Department of Surgical GastroenterologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Paleswan Joshi Lakhey
- Department of Surgical GastroenterologyTribhuvan University Teaching HospitalMaharajgunjNepal
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Nair SP, Chandnani S, Debnath P, Rathi PM, Junare P, Zanwar V, Kini S. "The Innate Tail": An Unusual Cause of Rectal Bleeding in an Adult Male. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 28:349-353. [PMID: 34604466 DOI: 10.1159/000510783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/12/2020] [Indexed: 11/19/2022]
Abstract
Retrorectal cystic hamartomas or tailgut cysts are infrequent congenital lesions presenting as presacral masses originating from the embryonic hindgut. They are commonly diagnosed in middle-aged women. Physicians must have a high index of suspicion to diagnose this rare tumor. We report a case of retrorectal hamartoma in a 70-year-old male presenting as rectal bleeding instead of the usual compressive symptoms. The utility of imaging modalities and the paramount importance of histopathology has been described. The treatment modality is surgical excision to prevent the potential malignant transformation.
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Affiliation(s)
- Sujit Padmanabhan Nair
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
| | - Sanjay Chandnani
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
| | - Prasanta Debnath
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
| | - Pravin M Rathi
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
| | - Parmeshwar Junare
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
| | - Vinay Zanwar
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
| | - Sangeeta Kini
- Department of Pathology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
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Zhang D, Sun Y, Lian L, Hu B, Zhang H, Zou Q, Huang D, Ren D. Long-term surgical outcomes after resection of presacral tumours and risk factors associated with recurrence. Colorectal Dis 2021; 23:2301-2310. [PMID: 33900009 DOI: 10.1111/codi.15691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 12/22/2022]
Abstract
AIM The incidence of presacral tumours is low and pertinent data on the management and outcomes after surgery are sparse. The aim of this study was to identify the risk factors for recurrence in patients with presacral tumours undergoing surgery at our institution. METHOD Patients undergoing resection of a presacral tumour between 2009 and 2019 were identified from a prospectively maintained database. Demographics, clinicopathological features, preoperative imaging, operative details, morbidity, mortality, recurrence and survival were investigated. RESULTS A total of 122 patients were identified. There were 95 women (77.9%) and the median age was 34 years. The most common presenting symptoms included pelvic pain (n = 60, 49.2%) and recurrent abscesses or fistulas (n = 40, 32.8%). The accuracy of preoperative magnetic resonance imaging (MRI) in distinguishing malignant from benign tumours was 93.9%. Six patients underwent three-dimensional computed tomography angiography (3D-CTA) and preoperative interventional embolization. Procedures were performed using transabdominal (n = 9), posterior (n = 99) and combined abdominal and posterior (n = 14) approaches. There were 21 (17.2%) malignant and 101 (82.8%) benign tumours. The local recurrence rate was 33.3% for malignant tumours and 9.9% for benign tumours. Multivariate analysis revealed that recurrence of malignant tumours was associated with R1 resection while recurrence of benign tumours was associated with secondary resections and intraoperative lesion rupture. CONCLUSION Presacral tumours continue to be a diagnostic and therapeutic challenge. A multidisciplinary team, informed by modern imaging modalities, is essential for the management of presacral tumours.
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Affiliation(s)
- Di Zhang
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yizhou Sun
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lei Lian
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bang Hu
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Heng Zhang
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qi Zou
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dandan Huang
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Donglin Ren
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Surgical Management of Retrorectal Tumors: A French Multicentric Experience of 270 Consecutives Cases. Ann Surg 2021; 274:766-772. [PMID: 34334645 DOI: 10.1097/sla.0000000000005119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report the largest multicentric experience on surgical management of retrorectal tumors (RRT). SUMMARY BACKGROUND DATA Literature data on RRT is limited. There is no consensus concerning the best surgical approach for the management of RRT. METHODS Patients operated for RRT in 18 academic French centers were retrospectively included (2000-2019). RESULTS 270 patients were included. Surgery was performed through abdominal (n=72, 27%), bottom (n=190, 70%) or combined approach (n=8, 3%). Abdominal approach was laparoscopic in 53/72 (74%) and bottom approach was a Kraske modified procedures in 169/190 (89%) patients. In laparoscopic abdominal group, tumors were more frequently symptomatic (37/53, 70% vs 88/169, 52%, p=0.02), larger (mean diameter = 60.5 ± 24 (range, 13-107) vs 51 ± 26 (20-105) mm, p=0.02) and located above S3 vertebra (n=3/42, 7% vs 0, p=0.001) than those from Kraske modified group. Laparoscopy was associated with a higher risk of postoperative ileus (n=4/53, 7.5% vs 0%, p=0.002) and rectal fistula (n=3/53, 6% vs 0%, p=0.01) but less wound abscess (n=1/53, 2% vs 24/169, 14%, p=0.02) than Kraske modified procedures. RRT was malignant in 8%. After a mean follow up of 27 ±39 (1-221) months, local recurrence was noted in 8% of the patients. After surgery, chronic pain was observed in 17% of the patients without significant difference between the 2 groups (15/74, 20% vs 3/30, 10%; p=0.3). CONCLUSIONS Both laparoscopic and Kraske modified approaches can be used for surgical treatment of RRT (according to their location and their size), with similar long-term results.
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El Yamine O, Fatine A, Boufettal R, Errguibi D, Hajri A, Rifki El Jay S, Chehab F. Retrorectal cystic hamartoma: A case report. Ann Med Surg (Lond) 2021; 66:102362. [PMID: 34040764 PMCID: PMC8141499 DOI: 10.1016/j.amsu.2021.102362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 11/03/2022] Open
Abstract
Introduction and importance: Retrorectal cystic hamartoma (RCH) is a rare congenital lesion of the presacral space, which is part of the vestigial cystic tumors often benign and predominantly in women. Generally asymptomatic, the appearance of symptoms such as pain or neurological disorders should raise suspicion of degeneration. Case presentation We report an unusual observation of a 62-year-old patient admitted for perineal pain evolving for 2 months associated with tenesma and chronic constipation. The digital rectal examination found a posterior bulge at 4 cm from the anal margin, without intraluminal lesion. Rectosigmoidoscopy had noted posterior extrinsic compression but no rectal tumor. Pelvic CT and MRI had shown a solidocystic formation of the retro-rectal and presacral spaces, related to an enteric cyst. The operation was performed by abdominal approach and the surgical exploration had found a bilobed cystic formation. The cystic mass was removed and the anatomopathological examination concluded that it was a cystic hamartoma with no sign of malignancy. Clinical discussion Retrorectal tumors develop in the space bounded anteriorly by the propria fascia of the rectum and posteriorly by the presacral fascia overlying the sacrum. Common in children and then often malignant, inversely, in adults, they are rare and most often benign tumors. They are generally asymptomatic with a predominance of females, unlike our observation where the patient was male with a symptomatology dominated by perineal pain and constipation. The discovery is incidental in the majority of cases, however, in some cases, these cysts may be revealed by complications. The lesion can be explored by transrectal or suprapubic ultrasound, MRI and CT scan. Rectoscopy and fistulography may complete the exploration in case of diagnostic doubt. The resection must be thorough and in monobloc because of the risk of recurrence and the approach depends on the location and the size of the lesion. Conclusion RCH is a rare benign lesion whose morphological characteristics seem quite stereotyped. A detailed postoperative anatomopathological examination allows the diagnosis to be made and, above all, to look for a site of malignant transformation. This is why a complete surgical removal is necessary to prevent recurrence.
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Affiliation(s)
- Othmane El Yamine
- Surgical Department of Cancerology and Liver Transplantation Universitary Hospital Center Casablanca morocco, Morocco
| | - Amine Fatine
- Surgical Department of Cancerology and Liver Transplantation Universitary Hospital Center Casablanca morocco, Morocco
| | - Rachid Boufettal
- Surgical Department of Cancerology and Liver Transplantation Universitary Hospital Center Casablanca morocco, Morocco
| | - Driss Errguibi
- Surgical Department of Cancerology and Liver Transplantation Universitary Hospital Center Casablanca morocco, Morocco
| | - Amal Hajri
- Surgical Department of Cancerology and Liver Transplantation Universitary Hospital Center Casablanca morocco, Morocco
| | - Saad Rifki El Jay
- Surgical Department of Cancerology and Liver Transplantation Universitary Hospital Center Casablanca morocco, Morocco
| | - Farid Chehab
- Surgical Department of Cancerology and Liver Transplantation Universitary Hospital Center Casablanca morocco, Morocco
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Ujaimi R. Adenocarcinoma in a Recurrent Retrorectal Cyst: A Case Report. Int Med Case Rep J 2021; 14:223-228. [PMID: 33854384 PMCID: PMC8039191 DOI: 10.2147/imcrj.s294090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/11/2021] [Indexed: 11/25/2022] Open
Abstract
I present a case of an adenocarcinoma in a retrorectal cyst in a 63-year-old female with a prior history of a congenital cyst excised as a newborn. The patient had a resection with positive margins, followed by chemotherapy and radiotherapy at progression. Her disease did not respond to chemotherapy or radiotherapy and she died with systemic manifestations related to her disease 28 months after diagnosis.
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Affiliation(s)
- Reem Ujaimi
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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42
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Li Z, Lu M. Presacral Tumor: Insights From a Decade's Experience of This Rare and Diverse Disease. Front Oncol 2021; 11:639028. [PMID: 33796466 PMCID: PMC8008122 DOI: 10.3389/fonc.2021.639028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background Presacral tumors are a group of rare and heterogeneous tumors that arise from the potential presacral space between the rectum and sacrum. The low occurrence and diverse origins make the diagnosis and treatment of these tumors a challenge. The aim of the study was to retrospectively review patient demographics and to identify advantages and disadvantages in the diagnosis and treatment of these tumors. Methods Retrospectively collected and reviewed data from patients who received treatment of presacral tumors at the First Affiliated Hospital of China Medical University between August 2009 and June 2019. Results The data from forty-four patients (33 females) with a median age of 50 years who were diagnosed with a presacral/retrorectal tumor were analyzed. The majority of tumors were congenital (61.4%) and benign tumors are more common (59.1%). The median age of patients with benign tumor was significantly higher than that of malignant tumor. The most common symptoms were sacrococcygeal/perianal pain (56.8%) and mass (36.4%), and 8 out of 9 patients having lower limb symptoms diagnosed with malignant tumor. The tumor detection rate of digital rectal examination was 75% and more than 90% of all patients underwent one or more radiology imaging exams for tumor diagnosis. Every patient had a biopsy result. The most common type of tumor was presacral cyst (40.9%) with overall tumor median size of 5.6 cm. Thirty-one (70.5%) patients underwent surgery, most often via the posterior route (83.9%). Posterior route surgery had significantly shorter operation time and tumors operated via posterior route were significantly smaller. The survival rate after surgery was 100%. The median course of disease was 6 months and median follow-up was 25 months. Conclusions Presacral tumors have low occurrence and are more frequently observed in females in their 30s and 50s indicating a possible link between tumor occurrence and hormonal changes. Patients with lower limb symptoms were more likely to have a malignant presacral tumor. Posterior route was the most commonly utilized surgical approach. Supplementary iodine tincture treatment of cysts ruptured in operation could potentially be helpful in reducing the chance of recurrence.
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Affiliation(s)
- Zeyu Li
- Department of Colorectal Surgery, First Affiliated Hospital of China Medical University, Shenyang, China.,Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Min Lu
- Department of Colorectal Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
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Alyousef Z, Aleissa M, Alaamer O, Alselaim N. Combined laparoscopic and posterior approach resection of large sacrococcygeal cystic teratoma. Surg Case Rep 2021; 7:20. [PMID: 33438088 PMCID: PMC7803854 DOI: 10.1186/s40792-020-01104-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/28/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Teratoma is a true neoplasm and originates from the three germ cell layers and it can contain any tissue derived from these layers. The location of teratoma is variable according to the age group. In adults, sacrococcygeal teratoma is rare and carries a low risk of malignant transformation. Surgical resection is the mainstay of treatment and is challenging due to tumor location. CASE PRESENTATION We are presenting a case report of a 16-year old female referred to our hospital with recurrent attacks of urine retention. Imaging study showed a large sacrococcygeal tumor. It was successfully resected by a combined laparoscopic and posterior approach without any major complication. CONCLUSION The combined laparoscopic and posterior approach is a safe surgical technique for resection of the large sacrococcygeal tumor. This surgical method has been published around 10 times in separated reports around the world and for first time in our region.
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Affiliation(s)
- Ziyad Alyousef
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maryam Aleissa
- Prince Noura Bin Abdulrahman University, Riyadh, Saudi Arabia. .,Department of Surgery, King Faisal Specialist Hospital & Research Center, , Riyadh, Saudi Arabia.
| | - Ohood Alaamer
- Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nahar Alselaim
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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Rompen IF, Scheiwiller A, Winiger A, Metzger J, Gass JM. Robotic-Assisted Laparoscopic Resection of Tailgut Cysts. JSLS 2021; 25:JSLS.2021.00035. [PMID: 34354334 PMCID: PMC8325480 DOI: 10.4293/jsls.2021.00035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: Tailgut cysts are rare remnants of the embryological hindgut. Resections are difficult to perform due to the narrow and delicate presacral space where they are usually located. Many different approaches have been described, but to date, no studies have been performed concerning robotic assisted surgery for this entity. Therefore, we conducted a retrospective analysis to evaluate the feasibility and outcome parameters of the robotic anterior approach for resection of tailgut cysts and to compare our results with available literature. Material and Methods: Data was retrospectively obtained from hospital records of all patients who underwent robotic assisted resection of tailgut cysts between January 1, 2017 and June 30, 2020. Outcomes include baseline characteristics, pre-operative radiological workup, operative time, intra- and postoperative complications, and histopathological results. Results: Between January 1, 2017 and June 30, 2020, five patients underwent robotic resection of tailgut cysts. All patients were female and mean age was 47.2 years (range 31.6–63.1 years). Only one patient reported to have local symptoms that could be attributed to the tailgut cyst. Median tumor size was 42 mm (range 30–64 mm). There was no conversion and median operating time was 235 minutes (range 184–331 minutes). Four patients had additional procedures. Intra- and postoperative complications included one intra-operative injury of the rectal wall, which was immediately oversewn, and one postoperative presacral hematoseroma with mild neurological symptoms. None of the specimens showed signs of malignant transformation in histopathological workup. Conclusion: This retrospective analysis shows that robotic resections of tailgut cysts are feasible and safe. Regarding the localization of tailgut cysts in the presacral space, the robotic assisted anterior approach is excellently suited, especially if the cysts are localized above the levator muscle. Longer operative times and higher material costs are outweighed by precise and safe preparation with a robotic platform in this delicate region and confined space. We recommend the robotic assisted anterior approach for the resection of tailgut cysts and retrorectal lesions in general.
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Affiliation(s)
- Ingmar F Rompen
- Department of General Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Andreas Scheiwiller
- Department of General Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Alain Winiger
- Department of Radiology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Jürg Metzger
- Department of General Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Jörn-Markus Gass
- Department of General Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
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Stewart MK, Kavalukas SL, Bonfield CM, Ciombor KK, Shi C, Kachnic LA, Hawkins AT. Rectothecal Fistula Secondary to a Tailgut Cyst With Malignant Transformation: An Abnormal Connection and Unusual Pathology. Am Surg 2020; 87:1126-1128. [PMID: 33338389 DOI: 10.1177/0003134820940733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Melissa K Stewart
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sandra L Kavalukas
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Kristen K Ciombor
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chanjuan Shi
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lisa A Kachnic
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander T Hawkins
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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La Greca G, Trombatore G, Basile G, Conti P. Retrorectal tumors: Case report and review of literature. Int J Surg Case Rep 2020; 77:726-729. [PMID: 33395883 PMCID: PMC7718133 DOI: 10.1016/j.ijscr.2020.11.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Retrorectal tumors are rare diseases and they can be challenging to diagnose and to manage. Usually they have a slow growth and they are asymptomatic. When present, symptoms depends on the dimensions of the tumor and their position. Inside the retrorectal space may develope a wide variety of benign and malignant masses. CASE REPORT A 70-years-old, obese, female patient was admitted to our hospital referring pelvic and lower-back pain for six months. The retrorectal mass was incidentally detected on imaging, and treated with a modified Kraske procedure.
Pathological examination revealed a rare retrorectal epidermoid cyst. We also reviewed the informations present in the scientific literature about the incidence, diagnosis and treatment options of retrorectal tumors. CONCLUSIONS Even though the rarity and heterogeneity of these tumors, we agree with literature that their surgical management is mandatory in order to achieve a definitive diagnosis and to avoid complications including malignant transformation. The surgical approach should be tailored for each patient and according to tumor's features.
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Affiliation(s)
- Giorgio La Greca
- Division of General Surgery, Civil Hospital of Lentini, C/da Colle Roggio, 96016 Lentini, SR, Italy.
| | - Giovanni Trombatore
- Division of General Surgery, Civil Hospital of Lentini, C/da Colle Roggio, 96016 Lentini, SR, Italy
| | - Guido Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, via S. Sofia, 78, 95123 Catania, Italy
| | - Pietro Conti
- Division of General Surgery, Civil Hospital of Lentini, C/da Colle Roggio, 96016 Lentini, SR, Italy
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Murphy A, O'Sullivan H, Stirling A, Fenlon H, Cronin C. Integrated multimodality and multi-disciplinary team approach to pre-sacral lesions. Clin Imaging 2020; 67:255-263. [DOI: 10.1016/j.clinimag.2020.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/28/2020] [Accepted: 08/18/2020] [Indexed: 01/17/2023]
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Merchea A. Role of preoperative biopsy in the management of presacral tumors. SEMINARS IN COLON AND RECTAL SURGERY 2020. [DOI: 10.1016/j.scrs.2020.100761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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49
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Brown KG, Lee PJ. Algorithms for the surgical management of benign and malignant presacral tumors. SEMINARS IN COLON AND RECTAL SURGERY 2020. [DOI: 10.1016/j.scrs.2020.100762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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50
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Yalav O, Topal U, Eray İC, Deveci MA, Gencel E, Rencuzogullari A. Retrorectal tumor: a single-center 10-years' experience. Ann Surg Treat Res 2020; 99:110-117. [PMID: 32802816 PMCID: PMC7406398 DOI: 10.4174/astr.2020.99.2.110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/09/2020] [Accepted: 05/30/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose Retrorectal tumors (RTs) are a rare incidence and recommendations on the ideal surgical approaches are lacking. This study aimed to evaluate outcomes and follow-up results of patients undergoing excision of RTs at our institution. Methods A retrospective review was conducted for undergoing surgery for RT between January 2009 and January 2019. Demographic characteristics, presenting symptoms, preoperative diagnostic tests, surgical procedures, histopathological results, intraoperative and postoperative complications, postoperative hospital stay, postoperative 30-day mortality, 90-day unplanned readmission rate, and long-term outcomes were evaluated. Results Twenty patients with a mean age of 48.3 ± 14.2 were analyzed. The most common presenting complaint was perineal pain (35.0%). Magnetic resonance imaging and computed tomography was preferred in 18 and 2 patients, respectively. Tumor localization was below the level of the third sacral vertebrae in 14 patients for whom the posterior surgical approach was used. No postoperative mortality was recorded at the end of follow-up of 53.8 ± 40 months. Mean length of postoperative hospital stay was 8.6 ± 9.4 days. Ten percent of the patients had unplanned hospital readmission within 90 days after discharge. Recurrence developed in 1 patient, for whom pathology were reported as chordoma. Conclusion RT should be managed by a multidisciplinary team given the complexity and heterogeneity of these tumors despite the fact that the majority are benign. A good understanding of pelvic anatomy and characterization of lesions through detailed radiological imaging is crucial to optimize surgical planning. Complete surgical resection is key for prolonged disease-free and overall survival of patients diagnosed with RTs.
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Affiliation(s)
- Orçun Yalav
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Uğur Topal
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - İsmail Cem Eray
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Mehmet Ali Deveci
- Department of Orthopedics and Traumatology, Çukurova University Faculty of Medicine, Adana, Turkey.,Department of Orthopedics and Traumatology, Koç University Faculty of Medicine, Istanbul, Turkey
| | - Eyüphan Gencel
- Department of Plastic and Reconstructive Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Ahmet Rencuzogullari
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
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