Retrorectal Tumors Research Articles

Benign retrorectal tumours: Contribution of laparoscopic approach

Introduction: Presacral tumours are extremely rare entities as the asymptomatic retrorectal mass, although its clinical presentation includes infectious complications and signs of malignant degeneration. Magnetic resonance imaging is the most efficient imaging study for its diagnosis. The treatment of choice is complete surgical excision and traditional approaches are mainly through abdominal, posterior and perineal approach, depending on anatomical characteristics of the lesion. Laparoscopic excision of these retrorectal lesions has been reported in a few cases. Patients and methods: We report two cases of 38 and 24-year-old women who complained of anorectal symptoms and were diagnosed as retrorectal tumour by imaging studies. One of them was infected. Both cases were resected by means of laparoscopic techniques. There was no surgical complication and they were discharged on the 3rd and 4th postoperative day, respectively. Histopathologic findings revealed benign cystic teratoma in both cases. A follow-up after 36 months showed no recurrence. Our surgical endoscopic technique and a brief review of perioperative cares are presented and discussed. Discussion: Laparoscopic excision could be indicated in selected retrorectal tumours and a great surgeon’s resolve is always required. A meticulous dissection must be performed in order to identify and preserve vital structures. It’s only absolute contraindications seemed to be the suspicion of malignancy and operative inexperience. Conclusions: The complete laparoscopic removal of presacral lesions is a responsible surgical procedure which offers advantages from the sanitary and aesthetic point of view. This new endoscopic indication could be considered probably as a better technique than open approach in selected patients.

Tumours of the retrorectal space: management and outcome of a heterogeneous group of diseases

Retrorectal tumours are a rare and complex entity in adults and children. They present a varied symptomatology and their treatment is very different according to their histology. We aimed to evaluate our experience of tumours of the retrorectal space. Forty patients with retrorectal tumours were divided into two groups according to age. The variables analysed were sex, signs and symptoms, complementary examinations, surgical approaches, adjuvant therapies, pathological analyses, recurrence and survival. Symptoms across the 30 adults varied--back pain (18) was the most common. Surgical intervention was performed on 20 patients; the rest were candidates for other treatments: five metastatic disease, two lymphomas and two Ewing tumour. The most common surgical approach was posterior, with 10 cases (50%). In all, 70% of adult tumours were malignant, with chordoma (30%) and metastases (20%) being the most common lesions. The most frequent benign lesion was hamartoma (10%). The 1- and 5-year mortality rates were 23.8% and 38.1%, respectively. In the paediatric group, three patients were diagnosed in utero. The symptoms among children varied and all were operated upon. The most frequent tumour was teratoma. Overall mortality was 20%. Given their complexity, these tumours should be addressed by experts and all treatment options must be contemplated. They continue to present a challenge, above all in malignant tumours where the tumour cannot be controlled at a locoregional level.

Retrorectal tumours: optimization of surgical approach and outcome

The aim was to identify the radiological features of retrorectal tumours that influence management and to highlight technical points that facilitate safe surgical excision. A consecutive series of patients was identified from a prospective database. All cases were discussed within a multidisciplinary team. Medical records, radiology and pathology reports were also checked retrospectively. Fifty-six patients [37 women; median age 51 (20-88) years] underwent excision of retrorectal tumours between 2002 and 2010 under the care of one surgeon. Seventeen (37.5%) had a malignant tumour. The commonest symptom was pain or discomfort. Features identified after MRI that suggested malignancy included heterogenous signal intensity (15/17 malignant lesions vs 5/39 benign lesions), an irregular infiltrative margin (14/17 malignant lesions vs 4/39 benign lesions) and enhancement (14/17 malignant lesions vs 2/39 benign lesions) (all P < 0.05). An abdominal approach was used in 27 (48%) patients, a perineal/trans-sacral approach in 20 (36%) and a composite abdomino-sacral approach in nine (16%). The perineal approach was used if the tumours were below the middle of S3 without sacral, pelvic side-wall or visceral involvement. The three most common types of tumour were schwannoma (n = 11), tail gut cyst (n = 13) and chordoma (n = 9). Over a median follow-up period of 46 (6-90) months there were two local recurrences among the malignant tumours (both resected) and two deaths (both sarcomas). MR imaging, avoidance of routine preoperative biopsy and careful clinical evaluation result in a good outcome after surgical excision of retrorectal tumours.

Management eines retrorektalen Tumors unter Berücksichtigung einer seltenen Differenzialdiagnose

We present a case of a retrorectal space occupying lesion diagnosed as an adenocarcinoma of unknown primary origin by preoperative histopathology. Localization slightly above the anal sphincter would have required extirpation of the rectum. Rectal palpation, endosonography and radiological imaging, however, suggested a retrorectal tumor or a metastasis of an adenocarcinoma. Both entities would have required local resection. We applied a surgical algorithm including frozen biopsy allowing a stepwise choice of operative procedure from the spectrum in question. The operation performed was thus tailored to the entity of the tumor.

Retrorectal Teratoma: A Rare Cause of Pain in the Tailbone

Retrorectal tumors are extremely rare and heterogeneous, requiring complete surgical excision for definitive diagnosis and optimal outcome. We describe a patient presenting with chronic "tailbone pain" who was found to have a benign cystic teratoma in the presacral space. She underwent en bloc resection and recovered well. Radiographic and pathologic images from this unique case are depicted and clinical features discussed.

Surgical Treatment of Retrorectal Tumors: A Retrospective Study of a Ten-Year Experience in Three Institutions

The relative rarity and anatomical position of retrorectal tumors may lead to difficulty in diagnosis and surgical management. This was a retrospective review of 93 patients who had resection of retrorectal tumors between 2002 and 2011. All patients in this study were treated with excision of the retrorectal tumors. Surgical approach included transsacral approach (78 cases), transabdominal approach (12 cases) and combined approach (3 cases). Seventy-two benign lesions (77.4%) and 21 malignant (22.6%) were confirmed by histological examination. The 72 benign cases included dermoid cysts (26 cases), simple cysts (12 cases), teratomas (12 cases), neurofibromas (12 cases), fibrolipomas (6 cases), neurilemmomas (3 cases) and synovioma (1 case). The twenty-one malignant cases included lymphomas (6 cases), malignant teratomas (5 cases), fibrosarcomas (3 cases), interstitialomas (6 cases) and malignant mesothelioma (1 case). Complications occurred in 16.1% of patients including intra-operative bleedings (6 cases), rectal injury (6 cases) and presacral infection (3 cases). Primary retrorectal tumors are very rare. Successful treatment of these tumors requires extensive knowledge of pelvic anatomy and expertise in pelvic surgery.

Retrorectal Chordoma: Case Report and Literature Review

Objective: To present a case of retrorectal chordoma and a literature review of this condition. Introduction: Tumors of the retrorectal area are rather rare. Retrorectal lesions can be cystic or solid, benign or malignant, and can be classified as congenital, neurogenic, osseous or miscellaneous. Diagnosis is frequently delayed until the tumors reach considerable size. Wide en bloc resection should be performed once the diagnosis is made. Case report: A 63 year old male patient, who complaint of progressive and recent onset constipation, and light pain at the coccigeal area. At the digital examination of the rectum we appreciate a firm, smooth presacral mass swelling the posterior rectal wall, with intact rectal mucosa. The MRI showed a multilobulated retrorectal mass; and the patient underwent to a wide en bloc resection of the tumor. The histopathological study of the specimen corroborates the presence of chordoma. Conclusions: Retrorectal tumors are rare; their diagnosis is difficult and late. Treatment is surgical with wide resection; chordomas have poor sensitivity to radiotherapy and chemotherapy.

Posterior approach (Kraske procedure) for surgical treatment of presacral tumors

Presacral tumors are rare, but can comprise a great variety of histological types. Congenital tumors are the most common. Once the diagnosis is established, surgical resection is essential because of the potential for malignancy or infection. Previous biopsy is not necessary or may be even harmful. To decide the best surgical approach (abdominal, sacral or combined) an individual and multidisciplinary analysis must be carried out. We report three cases of cystic presacral masses in which a posterior approach (Kraske procedure) enabled complete resection, the only way to decrease local recurrence. All patients had a satisfactory recovery. A brief overview of retrorectal tumors is presented, focusing on classification, clinical presentation, diagnosis and surgical management.

An unusual case of a retrorectal neuroendocrine tumor with high- and low-grade differentiation

An unusual case of a retrorectal neuroendocrine tumor with high- and low-grade differentiation

Surgical management of retrorectal tumors: a retrospective study of a 9-year experience in a single institution

BackgroundThe relative rarity and anatomical position of retrorectal tumors may lead to difficulty in diagnosis and surgical management.MethodsThis was a retrospective review of 62 patients who had resection of retrorectal tumors between 2002 and 2010.ResultsAll patients in this study were treated by excision of the retrorectal tumors. Surgical approach included transsacral approach (52 cases), transabdominal approach (eight cases), and combined approach (two cases). A total of 48 benign lesions (77.4%) and 14 malignant lesions (22.6%) were confirmed by histological examination. The 48 benign cases included dermoid cysts (17 cases), simple cysts (eight cases), teratomas (eight cases), neurofibromas (eight cases), fibrolipomas (four cases), neurilemmomas (two cases), and synovioma (one case). The 14 malignant cases included lymphomas (four cases), malignant teratomas (three cases), fibrosarcomas (two cases), interstitialomas (four cases) and malignant mesothelioma (one case). Complications occurred in 14.5% of patients and included intraoperative bleeding (three cases), rectal injury (three cases), and presacral infection (three cases).ConclusionPrimary retrorectal tumors are very rare. Successful treatment of these tumors requires extensive knowledge of pelvic anatomy and expertise in pelvic surgery.

Retrorectal tumors.

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.

Laparoscopic Approach to Retrorectal Tumors

Retrorectal or presacral tumors are extremely rare and their histologic origin varies greatly. Surgical excision is indicated to prevent complications or to rule out malignancy. A laparoscopic approach has been infrequently reported to date. The aim of this article is to report our experience in 4 cases, and to review the current world experience on laparoscopic approach to retrorectal tumors. Between 1998 and 2009, we operated 4 cases in which a presacral tumor was diagnosed. A pure laparoscopic procedure was performed in 3 cases and a combined laparoscopic/transacral approach in a fourth. In addition, a systematic literature review and relevant reports on laparoscopic approach of these tumors were analyzed. All patients underwent laparoscopic dissection of the tumor with extraction through a Phannestiel incision except in 1 case that was performed transsacrally. Simultaneously, the literature review showed 11 articles with a total number of 18 patients approached by laparoscopy. The laparoscopic approach of retrorectal tumors is feasible. The advantages are an enhanced access and visualization of the pelvic structures and a more controlled preservation of nerve and vascular integrity. It seems to be a safe procedure and can be combined with a posterior approach if needed.

Retrorectal tumours: literature review and Vilnius university hospital "Santariskiu klinikos" experience of 14 cases

ObjectiveRetrorectal 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.Methods14 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.Results13 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.ConclusionsRetrorectal 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.

Clinicopathological features of retrorectal tumors in adults: 9 years of experience in a single institution

PurposePrimary tumors of the retrorectal space in adults are very rare. Most of them are benign masses, but malignant masses are reported on occasion. This study aimed to investigate the clinicopathological features of retrorectal tumors.MethodsThe medical records of fifteen patients who underwent surgical resection of a retrorectal tumor from March 2002 to April 2010 in our hospital were reviewed retrospectively.ResultsOut of 15 patients, thirteen were females and two males. About 1.7 patients were diagnosed with retrorectal tumor annually in our hospital. The incidence is one per 1,500 surgeries performed under general anesthesia. An anterior approach was performed in eight patients and a posterior approach with excision of the coccyx in five patients. Combined approach was performed in two patients. Four patients (three in abdominal approach and one in combined approach) underwent laparoscopic resection. The mean size of tumors was 6.2 ± 2.9 cm. Mature teratoma (four) and neurilemmoma (four) were the most common tumors. Except for one case of chondrosarcoma, fourteen tumors were confirmed to be of benign nature in histologic examination. Patients who underwent a transabdominal approach with laparoscopic surgery had no postoperative complication and had a tendency to experience earlier recovery than those with open surgery.ConclusionSurgical resection of a retrorectal tumor is recommended to relieve pressure symptoms and to confirm the diagnosis. A laparoscopic approach may offer excellent visualization of the deep structures in the retrorectal space, reduce surgical trauma, and be helpful for early postoperative recovery.

How to Treat Retrorectal Cysts or Tumors in Adult

See Article on Page 303-314 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. Lesions are classified as congenital, neurogenic, osseous, inflammatory, or miscellaneous. The diagnosis is not difficult if one uses abdomenpelvis computed tomography and magnetic resonance imaging. The cases become difficult to treat when the patient has had a previous operation such as drainage of its content under the diagnosis of an anal fistula or sinus. Although treatment depends on diagnosis and anatomic location, most retrorectal lesions require surgical resection. Most lesions are benign, but malignant neoplasms are not uncommon. Thus, we should consider the bias in the article in terms of the retrorectal cyst being benign. When removal of the retrorectal mass is to be attempted, a frozen pathologic examination is mandatory. Waldeyer's facia, which is a good landmark for surgery, divides the retrorectal space into inferior and superior compartments. There are no nerves, blood vessels or lymphatics within two leaves. The operative approach is determined on digital examination and radiologic findings. When the examiner's finger cannot palpate the upper edge of the tumor, removing the cyst by only using a posterior approach is difficult. Levator muscles should be closed with sutures in cases of posterior approaches.

Laparoscopic Management of Tailgut Cyst: Case Report and Review of Literature

Tailgut cyst, also called retrorectal hamartoma, is a rare congenital lesion that arises from the remnants of the postanal primitive gut and is usually located anterior to the sacrum and posterior to the rectum. It is usually asymptomatic or demonstrates mass effects, and preoperatively is frequently misdiagnosed as adnexal tumor. Treatment is complete surgical resection. The English-language literature contains only limited reports of the laparoendoscopic approach to retrorectal cystic tumor and tailgut cyst. Herein, we report our experience with successful laparoscopic management of a tailgut cyst, discuss the laparoscopic resection technique, and present a review of the literature.

Retrorectal cyst hamartoma: report of a pediatric case

The retrorectal hamartoma cyst or retrorectal cyst is an uncommon congenital lesion. We present the case of a 7 days-old girl with a retrorectal tumor diagnosed by ultrasound during pregnancy. The histological examination was a cyst lined by squamous and urotelial typical epithelium and a double layer of smooth muscle. The treatment of choice is the complete excision of the lesion, as local recurrences or a malignant transformation have been observed.

Laparoscopic excision of a retrorectal schwannoma

Retrorectal tumors are uncommon and are usually managed by open surgical excision. Recent advances in laparoscopic techniques have led to the use of laparoscopy for a variety of problems in colorectal surgery, including the excision of retrorectal tumours. This case report, which describes the laparoscopic excision of a benign schwannoma arising from the second sacral nerve root, highlights the benefits of accurate preoperative diagnosis with MR imaging and the advantages of a laparoscopic approach while pointing out principles that should be adhered to when using this approach. The tumour was successfully resected without neural compromise and with a prompt and full postoperative recovery.

Surgical excision of retrorectal tumour using transanal endoscopic microsurgery

Abstract Surgical excision is the best therapeutic option for tumours in the retrorectal space. Classically, surgery in this area required an abdominal or posterior approach, or a combination of the two methods. We report the use of transanal endoscopic microsurgery for the treatment of retrorectal tumours as an alternative to classical procedures.

Retrorectal tumors in adults: Magnetic resonance imaging findings

To retrospectively evaluate the magnetic resonance imaging (MRI) features of adult retrorectal tumors and compare with histopathologic findings. MRI features of 21 patients with preoperative suspicion of retrorectal tumors were analyzed based on the histopathological and clinical data. Fourteen benign cystic lesions appeared hypointense on T1-weighted images, and hyperintense on T2-weighted images with regular peripheral rim. Epidermoid or dermoid cysts were unilocular, and tailgut cysts were multilocular. Presence of intracystic intermediate signal intensity was observed in one case of tailgut cyst with a component of adenocarcinoma. Six solid tumors were malignant lesions and showed heterogeneous intensity on MRI. Mucinous adenocarcinomas showed high signal intensity on T2-weighted and mesh-like enhancing areas on fat-suppressed T2-weighted images. There was a fistula between the mass and anus with an internal opening in mucinous adenocarcinomas arising from anal fistula. Gastrointestinal stromal tumors displayed low signal intensity on T1-weighted images, and intermediate to high signal intensity on T2-weighted images. Central necrosis could be seen as a high signal on T2-weighted images. MRI is a helpful technique to define the extent of the retrorectal tumor and its relationship to the surrounding structures, and also to demonstrate possible complications so as to choose the best surgical approach.