A systematic review of minimally invasive surgery for retrorectal tumors

Abstract

Retrorectal tumors are rare tumors that require resection for symptoms, malignancy and potential malignant transformation. Traditional approaches have included laparotomy, perineal excision or a combination. Multiple minimally invasive techniques are available which have the potential to minimize morbidity and enhance recovery. We performed a systematic review of the literature to determine the feasibility and surgical outcomes of retrorectal tumors approached using minimally invasive surgical techniques. Publications in which adult patients (≥ 18 years) had a minimally invasive approach (laparoscopic or robotic) for resection of a primary retrorectal tumor were included. Data were collected on approach, preoperative investigation, size and sacral level of the tumor, operating time, length of stay, perioperative complications, margins and recurrence. Thirty-five articles which included a total of 82 patients met the inclusion criteria. The majority of patients were female (n = 65; 79.2%), with a mean age of 41.7 years (range 18-89 years). Seventy-three patients (89.0%) underwent laparoscopic or combined laparoscopic-perineal resection, and 9 (10.8%) had a robotic approach. The conversion rate was 5.5%. The overall 30-day morbidity rate was 15.7%, including 1 intraoperative rectal injury (1.2%). Ninety-five percent (n = 78) of the retrorectal tumors were benign. Median length of stay was 4 days for both laparoscopic and robotic groups, with ranges of 1-8 and 2-10 days, respectively. No tumor recurrence was noted during follow-up [median 28 months (range 5-71 months)]. A minimally invasive approach for the resection of retrorectal tumors is feasible in selected patients. Careful patient selection is necessary to avoid incomplete resection and higher morbidity than traditional approaches.

Robotic resection of a multicystic tailgut cyst

“…To our knowledge, this is the first reported case in Australia and New Zealand. Worldwide, there have been case reports of robotic resection of retrorectal tumours 5 6…”

Retrorectal Epidermal Inclusion Cyst: An Incidental Finding During Cesarean Section

“…Complete surgical removal of epidermal cysts and other retrorectal tumors is the only treatment option. Surgery is indicated when signs and symptoms are suspicious of either compression of the surrounding structures and malignant transformation or to prevent common complications such as infections and fistula formation [5,12]. Moreover, surgical resection is also recommended to establish a definitive diagnosis, as evident in our case.…”

Robot-Assisted Laparoscopic Trans-abdominal Excision of a Retro-rectal Mass: Case Report

“…[2,3] Studies have also shown there to be shorter operative and recovery times with the robotic approach. [2,[4][5][6] Decreased post-operative pain and blood loss have also been appreciated. [2,6] Finally, based on available data, the post-operative outcome is similar for robotic and laparoscopic resection.…”

“…[2,6] Finally, based on available data, the post-operative outcome is similar for robotic and laparoscopic resection. [4,5] An additional benefit of the abdominal approach is the decreased risk of perineal wound complications. Such complications include formation of rectocutaneous fistulas and wound infections, sequelae of which could be necessity for colostomy creation and administration of intravenous antibiotics, respectively.…”