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Aytac E, Sokmen S, Aktas MK, Colak T, Mentes B, Balik E, Demirbas S, Akyol C, Sungurtekin U, Oncel M, Ozturk E, Obuz F, Ucaroglu B, Leventoglu S, Ozerhan IH, Baca B, Ozgen U, Haksal M, Tumay V, Geçim E, Bugra D. Factors affecting operative morbidity and long-term outcomes in patients undergoing surgery for presacral tumours: a multicentric cohort study from the Turkish Collaborative Group for Quality Improvement in Colorectal and Pelvic Surgery. Colorectal Dis 2023; 25:1795-1801. [PMID: 37547974 DOI: 10.1111/codi.16697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/29/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023]
Abstract
AIM Data regarding the operative management of presacral tumours present various dilemmas due to their rarity and heterogeneous nature. The aim of this study was to evaluate the management strategy, factors associated with operative morbidity and long-term postoperative outcomes in a large group of patients undergoing surgery for presacral tumours. METHOD This study was designed as a multicentre retrospective cohort study. Records of patients who underwent surgery for presacral tumours at 10 tertiary colorectal centres between 1996 and 2017 were evaluated. RESULTS One hundred and twenty seven patients (44 men) with a mean age of 46 years and body mass index of 27 kg/m2 were included. Fifty eight per cent of the patients had low sacral lesions (below S3). The operative approaches were transabdominal (17%), transsacral (65%) and abdominosacral (17%). The postoperative morbidity was 19%. Thirty per cent of the patients had a malignant tumour. Longer duration of symptoms (p = 0.001), higher American Society of Anesthesiologists score (p = 0.01), abdominosacral operations (p = 0.0001) and presacral tumours located above S3 (p = 0.004) were associated with an increased risk of postoperative morbidity. Overall long-term postoperative recurrence and mortality were 6% and 5%, respectively, within a 3-year mean follow-up period in patients with presacral malignant tumours. CONCLUSION Reduced physical condition, omission of symptoms prior to surgery, combined resections and high sacral tumours are the risk factors associated with postoperative complications in patients undergoing surgery for presacral tumours. Meticulous planning of the operation and intensified perioperative care may improve the outcomes in high-risk patients.
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Affiliation(s)
- Erman Aytac
- Acibadem University Atakent Hospital, Istanbul, Turkey
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bilgi Baca
- Acibadem Altunizde Hospital, Istanbul, Turkey
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Salameh F, Gilshtein H, Abramov R, Ashkenazi I, Duek D. Transanal endoscopic microsurgery technique: an acceptable approach for retrorectal tumors. Tech Coloproctol 2023; 27:673-678. [PMID: 36645584 DOI: 10.1007/s10151-023-02753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Retrorectal lesions (RRLs) are rare lesions that originate from the tissue present in the retrorectal space. The gold standard of care is complete resection regardless of pathology. The traditional approaches (anterior, posterior, and combined) are relatively well described. Transanal Endoscopic Microsurgery (TEM) is a minimally invasive technique offered as an alternative approach for RRLs. AIM To evaluate the outcomes of patients diagnosed with RRL and treated by the TEM approach, especially postoperative complications, and the recurrence rate. METHODS Patients with RRLs treated with the TEM technique in one medical center between 2000 and 2020 were identified. Their postoperative outcomes were compared with historical controls. RESULTS Thirty-nine patients diagnosed with RRL were operated on using the TEM platform. Thirty-seven RRLs were benign, and two were malignant. Their median size (IQR) was 20 mm (15, 32.5). The median distance (IQR) from the anal verge was 50 mm (50, 72.5). The median operative time (IQR) was 48.5 min (41.75, 60). All, except one lesion, were completely resected. The median length of stay (IQR) was one day (1, 1 day). Postoperative complications were diagnosed in three patients, two of which resolved following a second operation. CONCLUSIONS The implementation of TEM for the resection of RRLs demonstrated excellent overall results with acceptable complication and recurrence rate and represented a viable alternative surgical approach.
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Affiliation(s)
- F Salameh
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel.
| | - H Gilshtein
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
| | - R Abramov
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
| | - I Ashkenazi
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
| | - D Duek
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
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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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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: 6] [Impact Index Per Article: 2.0] [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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Machi R, Hiranuma C, Suzuki H, Hattori M, Doden K, Hashidume Y. Adult sacrococcygeal teratoma excised by endoscopic surgery with a transsacral approach: a case report. Surg Case Rep 2021; 7:178. [PMID: 34357489 PMCID: PMC8346609 DOI: 10.1186/s40792-021-01263-y] [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: 05/29/2021] [Accepted: 07/31/2021] [Indexed: 11/25/2022] Open
Abstract
Background Although sacrococcygeal teratoma (SCT) is relatively common in children, it is rare in adults. The prognosis for malignant cases is poor, so prompt surgical resection is required. Transabdominal and transsacral approaches are common approaches for tumor resection. In recent years, there have been reports of tumor removal with laparoscopic assistance, but all have applied transabdominal approaches. Case presentation A 27-year-old woman visited our gynecology department because of abdominal pain and genital bleeding. Magnetic resonance imaging (MRI) revealed a 3-cm-sized cystic mass in the left retrorectal area, and she was referred to our department for detailed examinations and treatment. She was diagnosed with a presacral cystic tumor and decided to undergo surgery. We used a transsacral approach to perform tumor excision. Since it was difficult to confirm the deep part of the tumor through direct visualization, we used GelPOINT® Path (a transanal access platform) and AirSEAL® System (insufflation device) to remove the tumor endoscopically. The postoperative course was uneventful with no bladder or rectal dysfunction. Histopathological examination revealed a mature teratoma. Conclusions When the tumor is relatively small and located in the lower sacrum, the endoscopically assisted transsacral approach can establish a stable field of view by expanding the depth of the surgical field. This method is useful considering its ability to perform excision without leaving residual tumor tissue and satisfactory safety and cosmetic results.
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Affiliation(s)
- Ryosuke Machi
- Department of Surgery, Fukui Prefectural Hospital, 2‑8‑1, Yotsui, Fukui, Fukui, 910‑8526, Japan. .,Department of Surgery, Keiju Medical Center, 94, Tomioka, Nanao, Ishikawa, 926‑8605, Japan.
| | - Chikashi Hiranuma
- Department of Surgery, Fukui Prefectural Hospital, 2‑8‑1, Yotsui, Fukui, Fukui, 910‑8526, Japan
| | - Hayato Suzuki
- Department of Surgery, Fukui Prefectural Hospital, 2‑8‑1, Yotsui, Fukui, Fukui, 910‑8526, Japan
| | - Masakazu Hattori
- Department of Surgery, Fukui Prefectural Hospital, 2‑8‑1, Yotsui, Fukui, Fukui, 910‑8526, Japan
| | - Kenji Doden
- Department of Surgery, Fukui Prefectural Hospital, 2‑8‑1, Yotsui, Fukui, Fukui, 910‑8526, Japan
| | - Yasuo Hashidume
- Department of Surgery, Fukui Prefectural Hospital, 2‑8‑1, Yotsui, Fukui, Fukui, 910‑8526, Japan
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Abstract
Due to the rarity and large diversity of the primary retrorectal tumors (RTs), the diagnoses are often difficult and they can be misdiagnosed. We present our experience in light of scarce information available on the clinical manifestations of RTs. The retrospective study included 17 patients diagnosed as RTs between January 2004 and January 2014. Demographic characteristics, length of symptoms, clinical findings, diagnostic methods, evaluations on the treatment procedures and postoperative periods, pathology, complications, and length of hospital stay were recorded. A mean of 1.7 of patients were diagnosed with RTs annually in our hospital. Patients comprised 12 females and 5 males. Pain and discomfort were the most common symptoms at presentation. All the lesions were evaluated by using magnetic resonance imaging (MRI) and computed tomography (CT), and all the patients were treated operatively. Based on the preoperative MRI or CT findings, an anterior approach was performed in 7 patients, a posterior approach in 6 patients, and combined approach in 4 patients. Mean size of tumors was 9.2 ± 4.3 cm. Epidermoid cyst (n = 8) was the most common tumor. Except for 1 case of liposarcoma, 16 tumors were confirmed to be of benign nature in histologic examination. Mean length of hospital stay 12.4 ± 6.8 days. Retrorectal tumors are heterogeneous and lead to diagnostic difficulties. A high index of clinical suspicion is needed for diagnosis. Preoperative imaging may be helpful in determining the course of treatment. Total excision of a retrorectal tumor may alleviate pressure symptoms and confirm the diagnosis.
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Dziki Ł, Włodarczyk M, Sobolewska-Włodarczyk A, Saliński A, Salińska M, Tchórzewski M, Mik M, Trzciński R, Dziki A. Presacral tumors: diagnosis and treatment - a challenge for a surgeon. Arch Med Sci 2019; 15:722-729. [PMID: 31110540 PMCID: PMC6524179 DOI: 10.5114/aoms.2016.61441] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/27/2016] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Presacral tumors are a rare group of heterogeneous lesions located in a potential space referred to as the retrorectal or presacral space. Lack of characteristic symptomatology and difficult anatomical localization make the diagnosis and management challenging for a surgeon. The aim of this study was to analyze cases of presacral tumors that underwent surgical treatment with regard to diagnostics, methods and outcomes. MATERIAL AND METHODS The study enrolled patients who underwent surgical treatment at the Department of General and Colorectal Surgery, Medical University of Lodz. The data was analyzed for age, gender, clinical symptoms, type of diagnostic procedures conducted, histopathology results, type of treatment implemented, intra- and perioperative complications as well as early and long-term treatment outcomes. RESULTS The study enrolled 29 patients who underwent surgical treatment for presacral tumors. Malignant tumors accounted for 34% of all cases (n = 10), and 80% of them occurred in men. Benign cases accounted for 66% of cases (n = 19), and they occurred predominantly in women (58%). Malignant lesions were more common in men (p < 0.05). The average age of patients with benign tumors was lower than that of patients with malignant tumors (p < 0.05). The transsacral approach was used in 51% of patients, abdominal laparotomy in 41% and a combined approach in 7%. Cure was achieved in 72% of patients, including 67% who were cured after their initial surgery. CONCLUSIONS Presacral tumors are more common in men and more commonly are malignant tumors in this group. The success rate of surgical treatment is 72%, and selection of the surgical approach does not affect the final treatment outcome.
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Affiliation(s)
- Łukasz Dziki
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Marcin Włodarczyk
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | | | - Aleksander Saliński
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Magdalena Salińska
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Marcin Tchórzewski
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Michał Mik
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Radzisław Trzciński
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Adam Dziki
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
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Coco C, Manno A, Mattana C, Verbo A, Sermoneta D, Franceschini G, De Gaetano A, Larocca LM, Petito L, Pedretti G, Rizzo G, Lodoli C, D'Ugo D. Congenital Tumors of the Retrorectal Space in the Adult: Report of Two Cases and Review of the Literature. TUMORI JOURNAL 2018; 94:602-7. [DOI: 10.1177/030089160809400428] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background To describe and discuss, on the basis of the authors’ experience and a review of the literature, the main aspects regarding the etiology, diagnosis, treatment and prognosis of congenital tumors of the retrorectal space. Methods We present 2 cases of congenital retrorectal tumors, a sacrococcygeal teratoma and a dermoid cyst, which represent, from the pathogenetic point of view, the most frequent presentation of the rare tumors of the retrorectal space. Results The reported cases are typical. The teratoma presented as an encapsulated, mixed mass located in the pelvic cavity behind the rectum and the vaginal canal, without signs of sacral involvement. The dermoid cyst appeared as a unilocular lesion filled with sebum and hair, which extended laterally to the iliopubic branch, medially to the urethra and anal canal, and posteriorly to the adipose tissue of the right buttock. Pelvic MRI produced a precise picture of the extension of the lesion and of the relationship between the mass and the pelvic organs and surrounding bony structures. Both lesions were completely removed via the perineal approach without coccygectomy. No recurrences were observed at 2 years of follow-up. Conclusions Congenital retrorectal tumors are rare. MRI is crucial for diagnosis and preoperative planning. Complete surgical removal is the treatment of choice. Resection of the coccyx is necessary only in case of its involvement by the neoplastic mass or suspected malignant transformation.
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Affiliation(s)
- Claudio Coco
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Manno
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Mattana
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Verbo
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniel Sermoneta
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | - Luigi Petito
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Pedretti
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianluca Rizzo
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Lodoli
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico D'Ugo
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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Emoto S, Kaneko M, Murono K, Sasaki K, Otani K, Nishikawa T, Tanaka T, Hata K, Kawai K, Imai H, Saito N, Kobayashi H, Tanaka S, Ikemura M, Ushiku T, Nozawa H. Surgical management for a huge presacral teratoma and a meningocele in an adult with Currarino triad: a case report. Surg Case Rep 2018; 4:9. [PMID: 29352751 PMCID: PMC5775187 DOI: 10.1186/s40792-018-0419-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Currarino triad is a rare hereditary syndrome comprising anorectal malformation, sacral bony defect, and presacral mass. Most of the patients are diagnosed during infancy. CASE PRESENTATION A 44-year-old man was diagnosed with Currarino triad, with a huge presacral teratoma and meningocele. One-stage surgery via posterior approach was successful. CONCLUSIONS Treatment of the presacral mass in the Currarino triad, diagnosed in adulthood, is challenging. Multidisciplinary management and detailed planning before surgery are important for a satisfactory outcome.
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Affiliation(s)
- Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Manabu Kaneko
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kensuke Otani
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takeshi Nishikawa
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keisuke Hata
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hideaki Imai
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Kobayashi
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan
| | - Masako Ikemura
- Department of Pathology, The University of Tokyo, Tokyo, Japan
| | - Tetsuo Ushiku
- Department of Pathology, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Baek SK, Hwang GS, Vinci A, Jafari MD, Jafari F, Moghadamyeghaneh Z, Pigazzi A. Retrorectal Tumors: A Comprehensive Literature Review. World J Surg 2017; 40:2001-15. [PMID: 27083451 DOI: 10.1007/s00268-016-3501-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
IMPORTANCE Retrorectal tumors are rare lesions that comprise a multitude of histologic types. Reports are limited to small single-institution case series, and recommendations on the ideal surgical approaches are lacking. OBJECTIVE The purpose of the study was to provide a comprehensive review of the epidemiology, pathologic subtypes, surgical approaches, and clinical outcomes of retrorectal tumors. EVIDENCE REVIEW We conducted a review of the literature using PubMed and searched the reference lists of published studies. RESULTS A total of 341 studies comprising 1708 patients were included. Overall, 68 % of patients were female. The mean age was 44.6 ± 13.7 years. Of all patients, 1194 (70 %) had benign lesions, and 514 patients (30 %) had malignant tumors. Congenital tumors (60.5 %) were the most frequent histologic type. Other pathologic types were neurogenic tumors (14.8 %), osseous tumors (3.1 %), inflammatory tumors (2.6 %), and miscellaneous tumors (19.1 %). Biopsy was performed in 27 % of the patients. Of these patients, incorrect diagnoses occurred in 44 %. An anterior surgical approach (AA) was performed in 299 patients (35 %); a posterior approach (PA) was performed in 443 (52 %), and a combined approach (CA) was performed in 119 patients (14 %). The mean length of stay (LOS) of PA was 7 ± 5 days compared to 8 ± 7 days for AA and 11 ± 7 days for CA (p < 0.05). The overall morbidity rate was 13.2 %: 19.3 % associated with anterior approach, 7.2 % associated with posterior approach, and 24.7 % after a combined approach (p < 0.05). Overall postoperative recurrence rate was 21.6 %; 6.7 % after an anterior approach, 26.6 % after a posterior approach, and 28.6 % after a combined approach (p < 0.05). A minimally invasive approach (MIS) was employed in 83 patients. MIS provided shorter hospital stays than open surgery (4 ± 2 vs. 9 ± 7 days; p < 0.05). Differences in complication rate were 19.8 % in MIS and 12.2 % in open surgery and not statistically significant. CONCLUSIONS AND RELEVANCE Retrorectal tumors are most commonly benign in etiology, of a congenital nature, and have a female predominance. Complete surgical resection is the cornerstone of retrorectal tumor management. A minimal access surgery approach, when feasible, appears to be a safe option for the management of retrorectal tumors, with shorter operative time and length of stay.
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Affiliation(s)
- Seong Kyu Baek
- Keimyung University College of Medicine, Daegu, Republic of Korea
| | - Grace Soon Hwang
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA.,Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alessio Vinci
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA
| | - Mehraneh D Jafari
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA
| | - Fariba Jafari
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA
| | - Zhobin Moghadamyeghaneh
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA
| | - Alessio Pigazzi
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA.
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11
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Kaushal D, Yap R, Moses D, Muhlmann M. Tail gut cyst: an unusual case. ANZ J Surg 2017; 89:264-265. [PMID: 28512765 DOI: 10.1111/ans.14030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/15/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Devesh Kaushal
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Raymond Yap
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Daniel Moses
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Mark Muhlmann
- Prince of Wales Hospital, Sydney, New South Wales, Australia
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12
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Yu G, Cao F, Gong H, Liu P, Sun G, Zhang W. Embolization of blood-supply artery followed by surgery for treatment of mesorectal Castleman's disease: case report and literature review. Gastroenterol Rep (Oxf) 2017; 7:141-145. [PMID: 28057712 PMCID: PMC6454847 DOI: 10.1093/gastro/gow040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/17/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022] Open
Abstract
A 23-year-old male patient was diagnosed as having a hypervascular pelvic mass by ultrasonography and magnetic resonance examination. A pathology puncture showed vitreous vascular Castleman’s disease. Because of concerns about tumor blood supply, embolization under digital subtraction angiography (DSA) was performed on the artery of the pelvic tumor before resection of the mass and surrounding rectum. Castleman’s disease of pelvic lymph node (mixed type, mainly hyaline vascular type) was confirmed pathologically from postoperative biopsy. Embolization of the blood-supply artery of a hypervascular mass should be considered before surgery is performed.
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Affiliation(s)
- Guanyu Yu
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Fuao Cao
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Haifeng Gong
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Peng Liu
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Ge Sun
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Wei Zhang
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
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13
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14
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Uçar AD, Erkan N, Yıldırım M. Surgical treatment of retrorectal (presacral) tumors. World J Surg Proced 2015; 5:127-136. [DOI: 10.5412/wjsp.v5.i1.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 12/05/2014] [Accepted: 12/19/2014] [Indexed: 02/07/2023] Open
Abstract
Retrorectal (also known as presacral) tumor (RT) is a rare disease of retrorectal space. They can be classified as congenital, inflammatory, neurogenic, osseous, or miscellaneous. The most common presentation is an asymptomatic mass discovered on routine rectal examination, but certain nonspecific symptoms can be elicited by careful history and physical examination. The primary and only satisfactory treatment is surgery for RTs. Three approaches commonly used for resection are abdominal, transsacral, or a combined abdominosacral approach. Prognosis is directly related primary local control, which is often difficult to achieve for malignant lesions.
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15
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Sagar AJ, Koshy A, Hyland R, Rotimi O, Sagar PM. Preoperative assessment of retrorectal tumours. Br J Surg 2014; 101:573-7. [DOI: 10.1002/bjs.9413] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2013] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Retrorectal tumours present diagnostic and surgical challenges. This study aimed to identify whether preoperative imaging and/or biopsy provide diagnostic accuracy.
Methods
A consecutive series of patients who had undergone excision of a retrorectal tumour were identified from a database (2002–2013). Details of patient demographics, preoperative presentation, imaging, biopsy, surgical procedure, and gross and microscopic pathology were reviewed. Preoperative imaging and/or biopsies were compared with eventual pathology findings.
Results
In total, 76 patients were identified, all of whom had undergone preoperative cross-sectional imaging whereas only 22 had preoperative biopsy. Imaging correctly discriminated benign from malignant tumours in 72 of the 76 patients (specificity 97 per cent, sensitivity 88 per cent, positive predictive value 88 per cent and negative predictive value 97 per cent). The corresponding values for preoperative biopsy (benign versus malignant) were 100, 83, 100 and 93 per cent. None of the four patients who were assessed incorrectly as having benign or malignant disease on imaging would have undergone an alternative procedure had this been known before surgery. Preoperative biopsy did not significantly influence patient management, and the absence of preoperative biopsy had no detrimental effect; a definitive preoperative histological diagnosis would not have influenced subsequent management.
Conclusion
Preoperative imaging was accurate in the assessment of retrorectal tumours, whereas biopsy did not add to the surgical strategy.
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Affiliation(s)
- A J Sagar
- The John Goligher Department of Colorectal Surgery, St James's University Hospital, Leeds, UK
| | - A Koshy
- The John Goligher Department of Colorectal Surgery, St James's University Hospital, Leeds, UK
| | - R Hyland
- Department of Radiology, St James's University Hospital, Leeds, UK
| | - O Rotimi
- Department of Histopathology, St James's University Hospital, Leeds, UK
| | - P M Sagar
- The John Goligher Department of Colorectal Surgery, St James's University Hospital, Leeds, UK
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16
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Verma VK. Retrorectal epidermoid presenting as difficulty in bowel evacuation. Indian J Surg 2014; 75:69-70. [PMID: 24426517 DOI: 10.1007/s12262-011-0296-4] [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: 05/04/2010] [Accepted: 01/05/2011] [Indexed: 11/26/2022] Open
Abstract
A rare case of retrorectal epidermoid is presented which was diagnosed by digital rectal examination and sonography. The tumor was removed through perinial approach. Literature of this rare tumor is briefly described.
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Affiliation(s)
- Vineet K Verma
- Department of Surgery, Hardoi Nursing Home, Hardoi, UP India
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17
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Neurological outcome following resection of benign presacral neurogenic tumors using a nerve-sparing technique. Dis Colon Rectum 2013; 56:1185-93. [PMID: 24022536 DOI: 10.1097/dcr.0b013e31829e4e4f] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Benign presacral nerve sheath tumors represent up to 10% of all presacral tumors. Limited data exist regarding the impact of the surgical technique on neurological outcomes following resection. OBJECTIVE The aim of this study was to test our hypothesis that a nerve-sparing resection technique results in the improvement of preoperative neurological dysfunction and minimal postoperative neurological morbidity. DESIGN This study is a case series of all patients with benign neurogenic presacral tumors operated on by the same 2 surgeons between 2004 and 2010 at our institution. SETTINGS This study was performed at a tertiary care center. PATIENTS Adult patients with benign presacral neurogenic tumors who underwent a nerve-sparing resection were included. MAIN OUTCOME MEASURES Postoperative urogenital, anorectal, and lower-extremity neurological functions were analyzed. RESULTS Seventeen patients were identified with a mean age of 40 years; 14 were women. Preoperatively, 13 patients had symptoms from neurological dysfunction or presumed mass effect of the tumor. The mean tumor size was 7.4 cm. The pathology was a schwannoma in 12 patients and neurofibroma in 5 patients. Mortality was nil, and 30-day morbidity was noted in 3 patients (hemorrhage, ileus, acute respiratory distress syndrome, deep vein thrombosis, and transient foot drop). Mean follow-up was 36 months. Of the 13 symptomatic patients, 7 achieved complete resolution of symptoms and 5 had improved, but persistent symptoms. None of the 4 asymptomatic patients developed postoperative neurological dysfunction. LIMITATIONS Small sample size was a limitation of this study. CONCLUSIONS With the use of a nerve-sparing technique, function-preserving resection can be safely completed with an overall improvement in symptoms.
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Jones M, Khosa J. Presacral tumours: a rare case of a dermoid cyst in a paediatric patient. BMJ Case Rep 2013; 2013:bcr2013008783. [PMID: 23682084 PMCID: PMC3669780 DOI: 10.1136/bcr-2013-008783] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Presacral tumours are considered very rare tumours with their incidence being around 1:40 000. Presacral dermoid tumours, part of the family of presacral tumours, usually present in the female adult population. They are benign tumours arising from all the three germ cell layers. Presentation in a paediatric population, defined as an individual under the age of 18 years, is extremely rare. A 15-year-old girl presented with abdominal pain present for 5 years diagnosed as a somatisation disorder. Upon further investigation with abdominal CT and MRI a diagnosis of a presacral mass was made. A laparoscopic-assisted transabdominal excision of the mass was performed and histopathology confirmed the radiological suspicion of a presacral dermoid cyst. As there are no reports of a presacral dermoid cysts being excised and reported in the paediatric surgical literature, we hope to highlight this pathology as a potential cause of abdominal pain in the paediatric population.
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Affiliation(s)
- Matthew Jones
- Department of General Surgery, Fremantle Hospital, Perth, Western Australia, Australia.
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19
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Baek SW, Kang HJ, Yoon JY, Whang DY, Park DH, Yoon SG, Kim HS, Lee JK, Lee JD, Kim KY. Clinical Study and Review of Articles (Korean) about Retrorectal Developmental Cysts in Adults. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2011; 27:303-14. [PMID: 22259746 PMCID: PMC3259427 DOI: 10.3393/jksc.2011.27.6.303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 09/08/2011] [Indexed: 12/11/2022]
Abstract
Purpose A retrorectal developmental cyst (tailgut cyst, epidermoid cyst, dermoid cyst, teratoma, and duplication) is very rare disease, and the symptoms are not characteristic so that sometimes this disease is still misdiagnosed as a supralevator abscess or a complex anal fistula. We would like to present a clinical approach to this disease. Methods We retrospectively examined the charts of 15 patients who were treated for retrorectal cysts from January 2001 to November 2009. Results All 15 patients were female. The average age was 41 years (range, 21 to 60 years). Fourteen patients (93.3%) were symptomatic, and the most common symptom was anal pain or discomfort. Nine patients (60%) had more than one previous operation (range, 1 to 9 times) for a supralevator abscess, an anal fistula, etc. In 12 patients (80%), the diagnosis could be made by using the medical history and physical examination. Thirteen cysts (80%) were excised completely through the posterior approach. The average diameter of the cysts was 4.8 cm (range, 2 to 10 cm). Pathologic diagnoses were 8 tailgut cysts (53.3%), 5 epidermoid cysts (33.3%) and 2 dermoid cysts (13.3%). The average follow-up period was 18.3 months (range, 1 to 64 months). Conclusion In our experience, high suspicion and physical examination are the most important diagnostic methods. If a female patient has a history of multiple perianal operations, a retrorectal bulging soft mass, a posterior anal dimple, and no conventional creamy foul odorous pus in drainage, the possibility of a retrorectal developmental cyst must be considered.
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Affiliation(s)
- Sung Wook Baek
- Department of Surgery, Seoul Song Do Colorectal Hospital, Seoul, Korea
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20
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Abstract
Tumors that arise in the retrorectal (presacral) space are uncommon lesions that present with nonspecific signs and symptoms, which lead to difficult diagnoses. For complete evaluation of the lesion, cross-sectional imaging is required to determine the extent of resection and the appropriate surgical approach. Surgical removal leads to favorable outcomes for patients with benign purely cystic retrorectal tumors. Preoperative tissue diagnosis with transperineal and transsacral biopsies of solid or heterogeneous cystic lesions, are essential to determine the necessity of neoadjuvant therapy, which may decrease local recurrence after surgery and avoid an unnecessary delay in systemic therapy.
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Affiliation(s)
- Jeffrey A. Neale
- Department of Colon and Rectal Surgery, Henry Ford Hospital, Detroit, Michigan
- The Colorectal Institute, Fort Myers, Florida
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21
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Strupas K, Poskus E, Ambrazevicius M. Retrorectal tumours: literature review and vilnius university hospital "santariskiu klinikos" experience of 14 cases. Eur J Med Res 2011; 16:231-6. [PMID: 21719397 PMCID: PMC3352196 DOI: 10.1186/2047-783x-16-5-231] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective Retrorectal tumours are rare lesions in adults. The diagnosis of retrorectal lesion is often difficult and misdiagnosis is common. We present significant number of cases in view of scarce information available on this matter. Methods 14 patients were treated at Vilnius university hospital "Santariskiu klinikos" Centre of abdominal surgery from 1997 to 2010. The case notes of patients who underwent surgery for a retrorectal tumour were reviewed retrospectively. Surgical histories, operations, histological tumour type, surgical time, weight of the specimen, blood loss, length of stay were analysed. Results 13 patients underwent laparotomy, 1 patient had combined perineal approach and laparotomy. The most common types of the tumour were fibroma (3 cases), leiomyosarcoma (2 cases). 5 tumours (35,7%) were found to be malignant. 57% of the patients had undergone at least one operation prior to definitive treatment. 5 female patients were initially admitted under gynaecologists. Hospital stay varied from 14 days to 22 days (mean 16,2 days). A report of a representative case is presented. Conclusions Retrorectal lesions in female patients can mimic gynaecological pathology. Patients with this rare pathology are to be treated in a major tertiary hospital by surgeons, who are able to operate safely in the retrorectal space.
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Affiliation(s)
- Kestutis Strupas
- Vilnius University Hospital, Santariskiu Klinikos, Centre of Abdominal Surgery, Vilnius, Lithuania.
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22
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Abstract
This study reviews a case of a large cystic anorectal teratoma successfully treated with a combined laparoscopic abdomino-paracoccygeal resection. Sacrococcygeal teratoma rarely presents in adulthood (reported incidence of 1:87 000). It is more common in females. Adult anorectal teratoma is a rare variant of sacrococcygeal teratoma. The majority of tumors spare the sacrococcygeal bone. The size and location of the tumor within the pelvis dictates whether it is approached surgically through a transabdominal, posterior, or a combined approach. We present in this article the case of a young woman with a large cystic anorectal teratoma treated successfully with a combined laparoscopic abdomino-paracoccygeal resection.
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Affiliation(s)
- Jared Murdock
- Center for Minimally Invasive Surgery, Department of Surgery, Kaiser Permanente, Los Angeles, California 90027, USA
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23
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Castleman's disease of the mesorectum: report of a case. Surg Today 2011; 41:271-5. [PMID: 21264768 DOI: 10.1007/s00595-009-4206-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 08/20/2009] [Indexed: 12/28/2022]
Abstract
Castleman's disease is a benign lymphoid proliferative disorder, which most commonly presents as a solitary mass in the mediastinum, although extrathoracic sites have been reported in the neck, axilla, pelvis, mesentery, pancreas, and retroperitoneum. We report a case of asymptomatic, isolated Castleman's disease in the mesorectum, which is extremely rare. The patient was a 34-year-old woman who underwent investigations for vaginal spotting. A presacral mass was located on the left side of the rectum, 10 cm from the anal verge. Contrast-enhanced computed tomography showed a large, well-demarcated, strongly enhancing mass with internal radiating septa in the mesorectum. The mass was well circumscribed and isointense to muscle on T1-weighted magnetic resonance imaging, appearing as a slightly hyperintense mass on T2-weighted imaging. We performed laparoscopic mesorectal mass excision, and histological examination revealed features typical of the hyaline-vascular type of Castleman's disease. Thus, when a mesorectal mass is being investigated, Castleman's disease should be considered in the differential diagnosis.
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24
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Habib T, Hamdi JT, Hussain W, Almiamini W, Hamdi K, Wani AM, Al Zeyani NR. Presacral schwannoma treated as irritable bowel syndrome. BMJ Case Rep 2010; 2010:bcr.05.2010.2972. [PMID: 22791578 DOI: 10.1136/bcr.05.2010.2972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Presacral tumours represent a heterogeneous group of predominantly benign and occasionally malignant neoplasms. These tumours, though rare, frequently present either incidentally or with vague symptoms. Schwannomas of the presacral region are one variant described as benign tumours of neurogenic origin. The case of a large presacral schwannoma in a 26-year-old man, who was treated for irritable bowel syndrome for 4 years, is presented. The patient presented with intermittent constipation, a feeling of incomplete evacuation of the bowel and vague abdominal discomfort relieved by defecation. The symptomatology worsened and constipation became frequent, and the patient experienced increased urinary frequency. Baseline investigations were normal and ultrasonography of the abdomen revealed a pelvic mass, which on CT scanning was revealed to be a large retrorectal mass. The tumour was resected and histology revealed it to be a schwannoma. This unique case is presented to emphasise that irritable bowel syndrome must be a diagnosis of exclusion, especially if atypical symptoms are present.
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Affiliation(s)
- Triq Habib
- Department of Surgery, Hera General Hospital, Makkah, Saudi Arabia
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25
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Abstract
Sacral and presacral schwannomas are often found incidentally, because they present with vague symptoms or symptomless. Schwannoma occurring in this area occasionally presents with enormous dimensions, known as a giant schwannoma. The tumor removal is a surgical challenge due to the difficult approach and abundant vascularity. The aim of this study is to review cases of giant sacral schwannomas focusing the surgical management and outcome. Six patients with sacral and presacral schwannoma were treated surgically. The patients included two males and four females, and the mean age was 47.8 years. All patients experienced pain at the time of presentation. The tumors were classified as intraosseous type in one case, dumb-bell type in four cases, and retroperitoneal type in one case. The tumors were removed with a piecemeal subtotal excision in three patients, a partial excision in two patients, and enucleation in one patient. The surgeries were performed by the combination of an anterior and posterior approach in three patients, a posterior approach in two patients, and an anterior approach in one patient. The mean surgical time was 7.8 hrs, and the mean blood loss was 2572 g. The tumor recurred in one patient after the partial excision and was removed completely in a second surgery. No patient, including the patient who underwent the second surgery, presented with pain and obvious neurological deficit at the final follow-up. The surgical treatment of the giant sacral schwannoma with a piecemeal subtotal excision can achieve a good outcome, avoiding unnecessary neurological deficit.
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Affiliation(s)
| | - Hiroshi Ozawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, SendaiJapan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, SendaiJapan
| | - Takashi Kusakabe
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, SendaiJapan
| | - Takeshi Nakamura
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, SendaiJapan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, SendaiJapan
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26
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Abstract
Retrorectal or presacral tumors are rare and can be challenging to diagnose and treat. Because the retrorectal space contains multiple embryologic remnants derived from various tissues, the tumors that develop in this space are heterogeneous. Most lesions are benign, but malignant neoplasms are not uncommon. Lesions are classified as congenital, neurogenic, osseous, inflammatory, or miscellaneous. Although treatment depends on diagnosis and anatomic location, most retrorectal lesions will require surgical resection.
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Affiliation(s)
- Kelli Bullard Dunn
- Department of Surgical Oncology, Roswell Park Cancer Institute and the University at Buffalo, State University of New York, Elm and Carlton Streets, Buffalo, NY 14263, USA.
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27
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Affiliation(s)
- T O Idama
- Department of Obstetrics and Gynaecology, York District Hospital, UK
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28
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Pappalardo G, Frattaroli FM, Casciani E, Moles N, Mascagni D, Spoletini D, Fanello G, Gualdi G. Retrorectal Tumors: The Choice of Surgical Approach Based on a New Classification. Am Surg 2009. [DOI: 10.1177/000313480907500311] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Because retrorectal-presacral tumors differ in histologic origin, symptoms, and prognosis, and often involve various neighboring structures, successful treatment of this heterogeneous group of tumors depends on the surgical approach chosen and the specialist surgeons involved. We investigated whether a new classification of retrorectal tumors based on findings from CT and MRI would simplify presurgical planning. The clinical records of a series of 34 patients who underwent surgery for retrorectal tumors from 1989 to 2003 were reviewed. Two radiologists, who were blind to the patients’ records, separately reviewed the preoperative CT and MRI findings and classified tumors according to whether they arose from the presacral area (Group 1), sacrum or spinal cord growing anteriorly (Group 2), or rectum growing posteriorly (Group 3). The preoperative CT and MRI findings for the retrorectal tumors yielded the information required to allow surgery to be properly planned (surgical approach and need to involve various specialist surgeons) in nearly all cases: 17 of the 18 patients (94.5%) with tumors arising from the retrorectal space, all 12 of those with tumors arising from the sacrum or spinal cord, and all four of those with rectal tumors. With the findings yielded by currently available CT and MRI techniques, retrorectal tumors can be anatomically and topographically classified preoperatively so as to allow surgery to be adequately planned in advance and thus optimize the surgical resection.
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Affiliation(s)
- Giuseppe Pappalardo
- Department of Surgery “P. Stefanini,” the, University of Rome “La Sapienza,” Rome, Italy
| | - Fabrizio M. Frattaroli
- Department of Surgery “P. Stefanini,” the, University of Rome “La Sapienza,” Rome, Italy
| | - Emanuele Casciani
- Department of Radiology, and the, University of Rome “La Sapienza,” Rome, Italy
| | - Nicola Moles
- Department of Surgical Sciences, University of Rome “La Sapienza,” Rome, Italy
| | - Domenico Mascagni
- Department of Surgical Sciences, University of Rome “La Sapienza,” Rome, Italy
| | - Domenico Spoletini
- Department of Surgery “P. Stefanini,” the, University of Rome “La Sapienza,” Rome, Italy
| | - Gianfranco Fanello
- Department of Surgical Sciences, University of Rome “La Sapienza,” Rome, Italy
| | - Gianfranco Gualdi
- Department of Radiology, and the, University of Rome “La Sapienza,” Rome, Italy
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Aslan E. Transvaginal excision of a retrorectal tumor presenting as rectocele. Int Urogynecol J 2008; 19:1715-7. [PMID: 18504515 DOI: 10.1007/s00192-008-0648-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 04/22/2008] [Indexed: 12/18/2022]
Abstract
Tumors occupying the retrorectal (presacral) space are uncommon and heterogeneous. It is estimated that an average of two patients with retrorectal tumors will be diagnosed per year in a standard metropolitan area. They are usually asymptomatic and diagnosed during routine physical examination incidentally. Our case was admitted with complaints of a swelling in her vagina, constipation, and difficulty in emptying her bowels. The diagnosis and treatment utilizing transvaginal approach in this case is discussed in comparison with the literature. Up to our knowledge, this is the first case presenting as rectocele and second case of retrorectal tumor surgically treated using transvaginal approach.
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Affiliation(s)
- Erdogan Aslan
- Obstetrics and Gynecology Department, Ozel Iskenderun Gelisim Hastanesi, Urgen Pasa Mah 75. Yil Blv. Ceren Ap., No:6/19, Antakya, Hatay, Turkey.
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30
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Buchs N, Taylor S, Roche B. The posterior approach for low retrorectal tumors in adults. Int J Colorectal Dis 2007; 22:381-5. [PMID: 16909248 DOI: 10.1007/s00384-006-0183-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Retrorectal tumors are uncommon in adults and arise in different tissues in the presacral space. The aim of this study is to evaluate early complete surgical resection by a perineal approach as the therapy-of-choice for tumors under the sacral promontory. PATIENTS AND METHODS We evaluated the posterior approach, especially intersphincteric and parasacrococcygeal excisions, in terms of resectability, morbidity, risk of recurrence, and anal function. The records of all patients who underwent a posterior surgical procedure in our institution for low-lying retrorectal tumors between 1994 and 2003 were reviewed. RESULTS Sixteen patients (13 women and three men) were included in this study. The age range was 21 to 57 years (median of 37 years). Pathological findings included ten tailgut cysts, three teratomas, one leiomyoma, one dermoid cyst, and one schwannoma. Complete tumor resection was obtained in 15 patients. There was one case with a microscopic residual tumor. No postoperative mortality was seen, and a minor complication occurred in one patient. There was no anal dysfunction. The postoperative course was uneventful, with only one tumor recurrence at 5 months. The median follow up was 60 months (ranging from 18 to 132 months). CONCLUSION In this study, the posterior approach allows complete resection of low retrorectal tumors, with low morbidity, no incontinence, nearly no recurrence, and no mortality.
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Affiliation(s)
- Nicolas Buchs
- Unit of Proctology, Department of Surgery, University Hospital of Geneva, 24, rue Micheli-du-Crest, 1205 Geneva, Switzerland
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31
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Chêne G, Voitellier M. Tératome bénin mature pré-sacré et formations kystiques vestigiales rétro-rectales chez l’adulte. ACTA ACUST UNITED AC 2006; 143:310-4. [PMID: 17185960 DOI: 10.1016/s0021-7697(06)73699-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Benign mature presacral teratomas or dermoid cysts occur rarely in the adult; the incidence is estimated at less than 1/40,000. They are considered to be retrorectal vestigial growths from embryonal rests; they are usually asymptomatic and discovered by chance. However, since they have a 20-30% risk of secondary infection and a 1-12.5% risk of malignant degeneration, they should undergo complete surgical resection. We present a case of presacral dermoid cyst in a young male and summarize the diagnostic and therapeutic management.
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Affiliation(s)
- G Chêne
- Département de Chirurgie Digestive et Viscérale, Centre Hospitalier de Vichy, Bd Denière, Vichy.
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32
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Abstract
PURPOSE Retrorectal tumors are a diverse group of masses derived from a variety of embryologic origins. Because of this, some confusion is associated with their diagnosis and management. Although rare, a basic understanding of the etiology, presentation, work-up, and treatment of retrorectal masses is essential. METHODS The incidence, classification, diagnosis, treatment, and prognosis of these masses are presented. A comprehensive review of the literature is included in our analysis. RESULTS Retrorectal lesions can be classified as congenital, inflammatory, neurogenic, osseous, or miscellaneous. Benign and malignant lesions behave similarly. The most common presentation is an asymptomatic mass discovered on routine rectal examination, but certain nonspecific symptoms can be elicited by careful history. Biopsy of these lesions should be avoided to prevent tumor seeding, fecal fistula, meningitis, and abscess formation. Complete surgical resection, usually after appropriate specialized imaging, remains the cornerstone of their treatment. Three approaches commonly used for resection are abdominal, transsacral, or a combined abdominosacral approach. Prognosis is directly related primarily to local control, which often is difficult to achieve for malignant lesions. CONCLUSIONS Retrorectal masses present a challenging surgical problem from diagnosis to treatment. A high index of suspicion and resultant early diagnosis, followed by thorough preoperative planning, is required for optimal management and outcome.
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Affiliation(s)
- Kristina G Hobson
- Department of Surgery, University of California Davis Medical Center, Sacramento, California 95817, USA
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34
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Glasgow SC, Birnbaum EH, Lowney JK, Fleshman JW, Kodner IJ, Mutch DG, Lewin S, Mutch MG, Dietz DW. Retrorectal tumors: a diagnostic and therapeutic challenge. Dis Colon Rectum 2005; 48:1581-7. [PMID: 15937630 DOI: 10.1007/s10350-005-0048-2] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE Tumors occurring in the retrorectal space are heterogeneous and uncommon. The utility of newer imaging techniques has not been extensively described, and operative approach is variable. This study examined the diagnosis, treatment, and outcome of retrorectal tumors at a tertiary referral center. METHODS Patients with primary, extramucosal neoplasms occurring in the retrorectal space were identified using a prospectively maintained, procedural database of all adult colorectal surgical patients (1981-2003). Patients also were incorporated from the gynecologic oncology service. Exclusion criteria included inflammatory processes, locally advanced colorectal cancer, and metastatic malignancy. Medical records, radiology, and pathology reports were reviewed retrospectively. RESULTS Thirty-four patients with retrorectal tumors were treated. Malignant tumors comprised 21 percent. Older age, male gender, and pain were predictive of malignancy (P < 0.05). Sensitivity of proctoscopy was 53 percent; this increased to 100 percent with the use of transrectal ultrasound. Accuracy of magnetic resonance vs. computed tomographic imaging for specific histologic tumor type was 28 vs. 18 percent, respectively. Surgical approach was anterior (n = 14), posterior (n = 11), and combined abdominoperineal (n = 9). Eleven patients required en bloc proctectomy. Patients undergoing posterior resection had lower blood loss and required fewer transfusions (P < 0.05). All benign tumors were resected with normal histologic margins and none recurred (median follow-up, 22 months). All patients with malignancy had recurrence/recrudescence of their disease. For these patients, median disease-free and overall survivals were 38 and 61 months, respectively. CONCLUSIONS Retrorectal tumors remain a diagnostic and therapeutic challenge. Pain, male gender, and advanced age increase the likelihood of malignancy. Various imaging modalities are useful for planning resection but cannot establish a definitive diagnosis. Whereas benign retrorectal tumors can be completely resected, curative resection of malignant retrorectal tumors remains difficult.
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Affiliation(s)
- Sean C Glasgow
- Department of Surgery, Section of Colon and Rectal Surgery, Siteman Cancer Center, Washington University, St. Louis, Missouri 63110, USA
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Abstract
OBJECT The authors endeavor to define the clinical and surgery-related profile of spinal nerve sheath tumors located in the extradural space outside both the dural sac and, apparently, the nerve roots' sleeve. METHODS A series of 24 extradural schwannomas was retrospectively selected after reviewing the notes of spinal nerve sheath tumors surgically treated at La Sapienza University of Rome. Clinical data, tumor-related characteristics, and outcome were analyzed. Women predominantly harbored these tumors. On admission sensory nerve root dysfunction was infrequently reported, whereas pyramidal tract deficits were often present. The tumor, generally large, was most frequently located in the intermediate thoracic segments and high cervical region; only one was reported in the lumbosacral region. Considerable erosion of vertebral bodies was reported in almost one third of the cases. In four patients eloquent nerve roots, that of C-5 in three and that of S-1 in one, were involved with the tumor. Radical tumor resection, with preservation of the nerve roots, was possible in several cases, whereas in two patients manipulation and resection of the C-5 root produced transient and permanent, respectively, root palsy. At follow-up examination patients for whom walking was impossible before surgery were now able to walk. CONCLUSIONS Extradural schwannomas can be distinguished from other nerve sheath tumors growing inside the spinal canal by their clinicoradiological features and unlikely nerve root origin. After surgery, recovery from pyramidal tract deficits, even severe, is noteworthy; in the authors' experience, however, resection of an involved appendicular root is more likely to result in a permanent and significant radicular deficit.
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Affiliation(s)
- Paolo Celli
- St Andrea Hospital, Department of Neurological Sciences, Rome, Italy.
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Falcone RA, Knott AW, Rafferty JF, Warner BW. Sacrococcygeal teratoma and teratocarcinoma. SEMINARS IN COLON AND RECTAL SURGERY 2004. [DOI: 10.1053/j.scrs.2004.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Klimo P, Rao G, Schmidt RH, Schmidt MH. Nerve sheath tumors involving the sacrum. Case report and classification scheme. Neurosurg Focus 2003; 15:E12. [PMID: 15350043 DOI: 10.3171/foc.2003.15.2.12] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nerve sheath tumors that involve the sacrum are rare. Delayed presentation is common because of their slow-growing nature, the permissive surrounding anatomical environment, and nonspecific symptoms. Consequently, these tumors are usually of considerable size at the time of diagnosis. The authors discuss a case of a sacral nerve sheath tumor. They also propose a classification scheme for these tumors based on their location with respect to the sacrum into three types (Types I-III). Type I tumors are confined to the sacrum; Type II originate within the sacrum but then locally metastasize through the anterior and posterior sacral walls into the presacral and subcutaneous spaces, respectively; and Type III are located primarily in the presacral/retroperitoneal area. The overwhelming majority of sacral nerve sheath tumors are schwannomas. Neurofibromas and malignant nerve sheath tumors are exceedingly rare. Regardless of their histological features, the goal of treatment is complete excision. Adjuvant radiotherapy may be used in patients in whom resection was subtotal. Approaches to the sacrum can generally be classified as anterior or posterior. Type I tumors may be resected via a posterior approach alone, Type III may require an anterior approach, and Type II tumors usually require combined anterior-posterior surgery.
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Affiliation(s)
- Paul Klimo
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84132-2303, USA
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Lev-Chelouche D, Gutman M, Goldman G, Even-Sapir E, Meller I, Issakov J, Klausner JM, Rabau M. Presacral tumors: a practical classification and treatment of a unique and heterogeneous group of diseases. Surgery 2003; 133:473-8. [PMID: 12773974 DOI: 10.1067/msy.2003.118] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Presacral tumors are a rare and diverse group of diseases that originate from the different tissues that comprise the potential presacral space. Because of their relative rarity, confusion exists regarding their clinical presentation, natural history, and treatment. The aim of this study is to describe a single institution's experience with the management of presacral tumors and to suggest a practical method of classification. METHODS Records of all patients who underwent operation for presacral tumors from the years 1991 to 2001 were reviewed. Clinical, pathologic, treatment, and outcome variables were evaluated. RESULTS Forty-two patients were included in the study and were divided into 4 groups according to lesion pathology: benign congenital (n = 12), malignant congenital (n = 9), benign acquired (n = 9), and malignant acquired (n = 12). Symptoms were nonspecific, and 26% of the cases were completely asymptomatic. Diagnosis was made with rectal examination and confirmed with pelvic computerized tomographic scan. Surgical approach varied among the different groups, with the posterior approach used mainly for congenital tumors and the anterior approach for acquired. Complete surgical resection of the tumor was obtained in all cases of benign tumors and in 76% of malignant tumors. No postoperative mortality was seen, and complications occurred in 36% (15/42); most were reversible. None of the patients with benign tumors had recurrences, and all are alive at this time. The survival rate of patients with malignant tumors was significantly improved when complete resection was possible. CONCLUSION Classification of presacral tumors into congenital versus acquired and benign versus malignant is simple and efficient. Treatment is complete surgical resection, which can be performed safely with low morbidity and no mortality.
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Affiliation(s)
- Dina Lev-Chelouche
- Department of Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Guillem P, Ernst O, Herjean M, Triboulet JP. [Retrorectal tumors: an assessment of the abdominal approach]. ANNALES DE CHIRURGIE 2001; 126:138-42. [PMID: 11284104 DOI: 10.1016/s0003-3944(00)00477-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
UNLABELLED Retrorectal tumors are frequently resected by a posterior trans- or parasacral approach, while the anterior abdominal approach is generally reserved for small tumors situated above the sacral promontory. STUDY AIM The aim of this retrospective study was to assess the use of the abdominal approach for the treatment of large tumor masses situated in the presacral space, and to evaluate the results in terms of resectability, morbidity, and risk of recurrence. PATIENTS AND METHODS Between 1986 and 1998, six female patients (age range: 25 to 79 years) with a retrorectal tumor (mean diameter: 7.5 cm) were operated on by abdominal approach. Clinical findings, morphological and histological data, the surgical resection procedure, and post-operative morbidity were studied. RESULTS Pathological findings showed that all the tumors were benign: neurofibroma (n = 2), dermoid cyst (n = 1), rectal duplication (n = 1), myelolipoma (n = 1), and epithelioid hemangioma (n = 1). Complete tumor resection was obtained macroscopically and microscopically in all cases. The postoperative course was uneventful, with no tumor recurrence detected at a mean follow-up of 31 months. CONCLUSION The anterior abdominal approach allows the complete resection of a retrorectal large tumor mass, and provides an interesting alternative to the posterior approach, with low morbidity and an absence of functional impairment.
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Affiliation(s)
- P Guillem
- Service de chirurgie digestive et générale, CAEB, hôpital Huriez, CHU de Lille, 1, place de Verdun, 59037 Lille, France
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Pidala MJ, Eisenstat TE, Rubin RJ, Salvati EP. Presacral Cysts: Transrectal Excision in Select Patients. Am Surg 1999. [DOI: 10.1177/000313489906500203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Fourteen patients presenting with presacral cystic lesions were managed over a 20-year period. Retrospective review identified 12 females and 2 males. Fifty-seven per cent were symptomatic at diagnosis. Forty-three per cent presented with pain; half of these patients had infected cysts. All lesions were palpable on digital rectal exam. Computed tomography identified the cyst in all seven patients in which it was performed. The transrectal approach was used for cyst excision in ten patients. One patient had transrectal drainage and wall biopsy only. Three patients underwent posterior parasacral excision. Pathologic review demonstrated four dermoid cysts, four epidermoid cysts, four cyst hamartomas, and two benign teratomas. One cyst hamartoma had a focus of invasive adenocarcinoma. Two complications occurred. There were no deaths. Follow-up averaged 39 months, at which time there were no recurrences. Developmental cysts are the most common presacral tumors. Excision is recommended, and the transrectal approach may be used in select patients with low morbidity and minimal recurrence.
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Affiliation(s)
- Mark J. Pidala
- Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Theodore E. Eisenstat
- Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Robert J. Rubin
- Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Eugene P. Salvati
- Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
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Domínguez J, Lobato RD, Ramos A, Rivas JJ, Gómez PA, Castro S. Giant intrasacral schwannomas: report of six cases. Acta Neurochir (Wien) 1997; 139:954-9; discussion 959-60. [PMID: 9401656 DOI: 10.1007/bf01411305] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Only 4 of the 30 previously reported cases of giant sacral schwannomas have been studied with Magnetic Resonance Imaging (MRI). We are reporting 6 more cases, 5 of which had MRI studies. There were 5 women and 1 man (average age 45 years) with long lasting symptoms consisting of lumbosacral and radicular pain accompanied by urinary disturbances and dysaesthetic sensations in the lower limbs. CT clearly defined sacral bone involvement but poorly demonstrated intraspinal tumour extension which was more evident in MRI studies. MRI also clearly showed the intrapelvic extension of the tumour, its relationship with the neighbouring structures and the dumbbell growth pattern due to tumour extension through sacral foramina which are important data for making a pro-operative diagnosis and surgical planning. Surgical treatment consisted of piecemeal tumour resection through a posterior approach in four cases. Two patients underwent operation through an abdominal transperitoneal approach followed by a sacral laminectomy. Total intracapsular resection was apparently achieved in 5 cases. Through an average follow-up period of 9.2 years and despite a rather conservative approach, the recurrence rate has been very low in our series and only one patient had to be re-operated on for tumour recurrence.
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Affiliation(s)
- J Domínguez
- Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain
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Blatter G, Halter Ward EG, Ruflin G, Jeanneret B. The problem of stabilization after sacrectomy. Arch Orthop Trauma Surg 1994; 114:40-2. [PMID: 7696048 DOI: 10.1007/bf00454735] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
After sacrectomy, mobilization of the patient is only possible if a stable connection between the spine and pelvis can be obtained. We have developed an instrumentation to fix the pelvis to the spine. Two DHS screws connected to each other were implanted in the pelvis (one DHS screw into each ilium). An internal spine fixator, anchored in L3 and L4 through transpedicular Schanz screws, was attached to these DHS screws. Two patients were stabilized with this implant after sacrectomy. One patient was able to walk with crutches; the other patient was able to walk even without crutches.
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Affiliation(s)
- G Blatter
- Klinik für Orthopädische Chirurgie, Kantonsspital St Gallen, Switzerland
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Gupta S, Sikora SS, Gupta R, Singh MK, Chattopadhyay TK. Presacral neurilemoma (schwannoma)--report of a rare case. THE JAPANESE JOURNAL OF SURGERY 1989; 19:229-31. [PMID: 2724722 DOI: 10.1007/bf02471591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A rare case of presacral neurilemoma is reported herein. Despite the large size of the tumor and the extensive destruction of the sacrum, the patient was almost asymptomatic. Accurate diagnosis depends on careful rectal examination and computerized axial tomography is the most useful single investigation. Surgery is the only treatment and for large lesions, the abdominal approach is usually preferred. Recurrence is rare and patients live a long, symptom free life even after partial resection.
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Affiliation(s)
- S Gupta
- Department of Surgery, All India Institute of Medical Sciences, New Delhi
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Simpson BA, Glass RE, Mann CV. Anterior sacral meningocoele: magnetic resonance imaging and surgical management. Br J Surg 1987; 74:1185. [PMID: 3427376 DOI: 10.1002/bjs.1800741237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- B A Simpson
- Department of Neurosurgery, London Hospital, Whitechapel, UK
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