The posterior approach for low retrorectal tumors in adults

Abstract

In this study, the posterior approach allows complete resection of low retrorectal tumors, with low morbidity, no incontinence, nearly no recurrence, and no mortality.

Sacrococcygeal sinus angle: as a new anatomic landmark for the posterior approach of presacral lesions

“…transsacral) of these two approaches [8,10,11,15]. The main factors that determine the type of surgical approach include malignancy because of invasion, size of the tumor and location of the tumor with reference to the sacrum [1,13]. Basically, anterior or combined approaches are preferred for masses above the level of the third sacral vertebra (S3) and for large and malignant masses, whereas the posterior approach is used for relatively smaller and benign masses located at the inferior sacral region (below the level of S3).…”

“…The presacral region is bounded by the rectum anteriorly, sacrum posteriorly, promontorium of the sacrum and peritoneum superiorly and iliac vessels laterally [1,10]. A wide range of pathological conditions can be seen in the presacral region [2].…”

“…A wide range of pathological conditions can be seen in the presacral region [2]. Congenital masses such as teratomas, chordomas, dermoid or epidermoid tumors; tumors arising from neural elements such as schwannomas, neurofibromas and neuroblastomas; and mass lesions showing distinct features such as infiltrative rectum tumors, metastases, rhabdomyosarcomas and lymphangiomas can be seen in the presacral region [1,3,9,10,13]. Since the presacral region involves several different anatomical structures and related pathologies, it is a common point of interest of different disciplines and generally requires a multidisciplinary approach [2].…”

“…Therefore, the selection of the most suitable surgical approach for the maximum extent of safe resection is of great importance. Three main surgical approaches are used; anterior approach, posterior approach and a combination of these two approaches [1,2,13]. There are remarkable advances in robotic surgery [6].…”

“…Also, laparoscopic procedures are used as a minimally invasive method for the lesions in the presacral region [4,14]. In the light of overall surgical experiences and technological advances, particularly two parameters play an important role in choosing the surgical approach: the size and location of the tumor [1,2,13]. The sacrum, which is the main anatomic landmark that forms a compact barrier for both parameters, is the basic anatomical point for the definition of each of the three surgical approaches.…”