Risk of malignancy and outcomes of surgically resected presacral tailgut cysts: A current review of the Mayo Clinic experience

Abstract

Aim:The aim of this study was to describe the surgical management, outcomes and risk of malignancy of presacral tailgut cysts. Method:A retrospective analysis of all patients who underwent resection of tailgut cyst at Mayo Clinic in Arizona, Florida and Minnesota between 2008 and 2020 was performed.Demographics, presentation, evaluation, surgical approach, postoperative complications, pathology and recurrence rates were reviewed.Results: Seventy-three patients were identified (81% female) with a mean age of 45 years. Thirty-nine patients (53%) were symptomatic, most commonly with pelvic pain (26 patients). Digital rectal examination identified a palpable mass in 68%. Mean tumour size was 6 cm. Resection was primarily performed through a posterior approach (77%, n = 56), followed by a transabdominal approach (18%, n = 13) and a combined approach (5%, n = 4). Six patients underwent a minimally invasive resection (laparoscopic/robotic).Coccygectomy or distal sacrectomy was performed in 41 patients (56%). Complete resection was achieved in 94% of patients. Thirty-day morbidity occurred in 18% and was most commonly wound related; there was no mortality. Malignancy was identified in six patients (8%). For the 30 patients with follow-up greater than 1 year, the median follow-up was 39 months (range 1.0-11.1 years). Local recurrence was identified in three patients and distant metastatic disease in one patient. Conclusion:The rate of malignancy in presacral tailgut cysts based on this current review was 8%. Overall recurrence was 5% at a median of 24 months.

Mucinous adenocarcinoma arising from a tailgut cyst: A case report

“…According to their embryonic origin, cysts are classified into epidermal, dermal, neural, teratoma, enteric, rectal duplication, mucous-secreting, enterogenous, simplex, gland anal, rectal, hamartoma, and TCs[ 5 , 8 ]. TCs are found in the presacral space and are typically thin-walled cysts that may be single or multiloculated, branched, and may contain green opalescent colloid fluid[ 2 ].…”

“…Hjermstad and Helwig reported the largest case series of TCs, which included 53 patients with an age range of 4 days to 73 years and average age of 36 years[ 10 ]. Based on the current literature, TCs may be asymptomatic or present with non-specific symptoms owing to the large size of the pelvic mass[ 2 , 5 , 8 ]. They can also lead to several complications including a neurogenic bladder, haemorrhage, faecal incontinence, faecal fistula, intestinal obstruction, infections, or malignant transformation as observed in the present case[ 11 , 12 ].…”

“…Retrorectal hamartomas or tailgut cysts (TCs) are very rare, with an incidence rate of approximately 1/40000[ 1 ]. TCs are believed to be embryologically derived from a remnant of the posterior intestine[ 2 ]. Alternative terminologies such as ‘cyst of postanal intestine’, ‘retrorectal cystic hamartoma’, ‘tailgut vestiges’, ‘myoepithelial hamartoma of the rectum’, and ‘rectal cyst’ have been used in the literature to describe these lesions[ 3 ].…”

“…Forty percent of TCs occurring in children and new-borns are teratomas. Moreover, 10% of teratomas coexist with developmental disorders of the midline such as encephalocele[ 2 , 5 ]. In this age group, tumours could be benign, whereas malignant tumours are more common in older children[ 5 ].…”

Cystic lesions of the retrorectal space

“…The literature comprises single case reports or small series of tailgut cysts, with only three published large series of 24, 53 and 73 cases 12–15 . There is a wide age range at presentation, with a peak in middle age and a marked female predominance 11,12,14–16 .…”