Retrorectal Tumors: A Comprehensive Literature Review.

Abstract

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. The purpose of the study was to provide a comprehensive review of the epidemiology, pathologic subtypes, surgical approaches, and clinical outcomes of retrorectal tumors. We conducted a review of the literature using PubMed and searched the reference lists of published studies. A total of 341 studies comprising 1708 patients were included. Overall, 68% of patients were female. The mean age was 44.6±13.7years. 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±5days compared to 8±7days for AA and 11±7days 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±7days; p<0.05). Differences in complication rate were 19.8% in MIS and 12.2% in open surgery and not statistically significant. 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.