Retrorectal Tumors

Abstract

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.

Retrorectal Tumors in Adults: A 10-Year Retrospective Study

“…RTs may present with nonspecific signs and symptoms and they have a great variety of manifestations. 2,6,9,17 This variability is associated with the location and diameter of the tumor, whether the sacral root has been invaded or not, and the presence or absence of infection. 12,20 Macafee et al reported that most of their patients presented with a pain or discomfort in the lower back, over the sacrum or in the perineal area.…”

“…MRI is more valuable than CT because it is useful in assessing the planes of resection and spatial relationship to surrounding structures and also in determining the most convenient management and imaging procedures for each patient. 9,10,[21][22][23][24] In our series, most of our patients had undergone CT in other clinics due to various reasons. Prior to surgery, the patients without MR contraindications were evaluated with MRI, both for diagnosis and treatment.…”

“…9 Proctoscopy may not detect the small-scale lesions, but it can visualize the extraluminal compression in large lesions. 19 In our study, sigmoidoscopy was performed in 10 patients who had large tumor with extraluminal compression.…”

“…26 Wolpert et al and Verazin et al suggested that biopsy should be preferred only when the resection of the lesion is difficult and the histodiagnosis is needed for planning additional treatments such as chemotherapy or radiation therapy. 9,27 Biopsies can cause a number of serious complications including fatal septic complications, perforation, bleeding, and fistulas. Moreover, tumor seeding is another serious risk which may arise from biopsy.…”

“…7,8 RTs generally remain asymptomatic or present with nonspecific symptoms. 9 Therefore, RTs may be overlooked unless a high index of suspicion is present, and the diagnosis is established either incidentally or during exploration for other pathologies. Moreover, RTs present difficulties in treatment although improved techniques are used in perioperative care.…”