Chinese expert consensus on standardized treatment of presacral cyst(2024 edition)

Abstract

Surgical excision is the only radical treatment for presacral cysts, which are difficult and risky because of the complex anatomical structure around them, involving important blood vessels and nerves. Improper surgical procedures will lead to recurrence of presacral cysts after surgery, causing great pain to patients. With the deepening of clinical research on presacral cysts, some new problems have been found to be overcome. On the basis of the Chinese Expert Consensus on Standardized Treatment of Presacral Cysts (2021 edition), the Pelvic Tumor Integration Professional Committee of the Chinese Anti-Cancer Association organized authoritative experts in relevant professional fields including general surgery, gastrointestinal surgery, colorectal and anal surgery, gynecological oncology, bone and soft tissue surgery, neurosurgery, pathology, imaging and other departments, to formulate the Chinese Expert Consensus on the Standardized Diagnosis and Treatment of Presacral Cysts (2024 edition) after a consensus meeting. The 2024 consensus provides a comprehensive introduction to the following seven aspects, including the origin and pathology of presacral cysts, related anatomy and classification of surgery, diagnosis and differential diagnosis, surgical philosophy, surgical methods for excision, perioperative complications and management, follow-up, and subsequent treatment, and has reached a consensus after repeated discussions and revisions. Compared with the 2021 consensus, the main updates in the 2024 consensus include the following aspects: in the anatomy and classification section, the anatomical classification of high and low, single and multiple cysts of the presacral space has been added; in the surgical concept section, it is emphasized to protect the sacral nerves for presacral cysts with sacral variations; in the surgical approach section for excision, the surgical approach for different anatomical types of presacral cysts has been further clarified. For patients with preoperative enterocutaneous fistula, the use of gluteus maximus muscle flap to repair the fistula reduces the probability of preventive stoma. For suspected malignant presacral cysts, multidisciplinary consultation is required, and if radical resection is not possible, further biopsy is performed to clarify the pathology and develop a comprehensive treatment plan.