Controversies in presacral tumors management

Abstract

Presacral tumors are rare lesions of the retrorectal space that can present diagnostic and therapeutic difficulty because of their anatomic location and the different tissue types and etiology. Although the diagnosis and management of these tumors has evolved in recent years, several points still to be addressed in order to improve perioperative diagnosis and treatment. In the upcoming we will try to highlight some controversial points; the pre-operative biopsies, neoadjuvant therapy, the necessity of surgery and the role of minimally invasive surgeries of presacral tumors.

Case report: Laparoscopic approach in the treatment of presacral lipoma

“…The accurate etiology of lipomas is generally unknown. Presacral lipomas, as well as other benign retrorectal tumours, are often completely asymtomatic, therefore they may frequently be clinically unrecognised and diagnosed tardy [ 4 , 6 , 9 , 10 ]. They are usually found incidentally when performing a pelvic or rectal examination [ 4 , 9 ].…”

“…Patients may have a wide spectrum of complaints, such as rectal fullness, change in bowel habit, painful defecation, dysuria, faecal or urinary incontinence, sexual dysfunction, neurological symptoms in the lower back and perineum, pain. Rarely, retrorectal tumors may lead to obstructive labor and predispose the patient to life-threatening dystocia [ 4 , 6 , 7 , 10 ].…”

“…The access and approach of the tumour depends on its size, location, structure, involvement of adjacent structures. Generally, tumours above the level of S3 or with invasion of adjacent structures will require an anterior or combined approach and en bloc resection; and lesions below the level of S3 will be resectable via the perineal posterior approach [ 4 , 6 , 10 , 14 ]. Surgery can be undertaken either by open or laparoscopic approach [ 14 ].…”

“…All retrorectal tumours, including lipomas, should be resected [ 3 , 6 , 7 ]. In the presenting case laparoscopic surgery was indicated due to exclude malignant process, because it is difficult to differentiate lipoma from low-grade liposarcoma on magnetic resonance imaging [ 10 ]. There are several common approaches for resection of the retrorectal tumours: anterior approach, posterior approach and combined approach.…”

“…In the presenting case laparoscopic surgery was indicated due to exclude malignant process, because it is difficult to differentiate lipoma from low-grade liposarcoma on magnetic resonance imaging [ 10 ].…”