Posterior approach (Kraske procedure) for surgical treatment of presacral tumors

Abstract

Presacral tumors are rare, but can comprise a great variety of histological types. Congenital tumors are the most common. Once the diagnosis is established, surgical resection is essential because of the potential for malignancy or infection. Previous biopsy is not necessary or may be even harmful. To decide the best surgical approach (abdominal, sacral or combined) an individual and multidisciplinary analysis must be carried out. We report three cases of cystic presacral masses in which a posterior approach (Kraske procedure) enabled complete resection, the only way to decrease local recurrence. All patients had a satisfactory recovery. A brief overview of retrorectal tumors is presented, focusing on classification, clinical presentation, diagnosis and surgical management.

Tumours of Retrorectal Space: A Rare Entity Scarcely Known by General Surgeons

“…The lesion must be separated from mesorectum and presacral fascia to the level of elevators ani muscle. In case of malignat tumours with involvement of surrounding structures a resection in bloc is mandatory (low anterior rectum resection), and in some cases this will include sacrum and nerve roots [13,14]. S3 root is required for urinary and fecal continence, so if S3 is excised, colostomy is necessary.…”

A Rare Clinical Case Causing Dystocia and Lumbago: Retrorectal Dermoid Cyst

“…Retrorectal mass is rarely seen, with incidence of 1/40,000. [1,2] Mass lesion of this region is generally benign, though may at times demonstrate malignant characteristics.…”

Robotic resection of retrorectal tumor: an alternative to the Kraske procedure

“…The Kraske procedure (originally developed by Paul Kraske in 1884 for carcinoma of the rectum) allows access to the rectum via the presacral space in instances where the lesion cannot be addressed transanally [1] . The most common presacral masses are developmental cysts [2][3][4] , which histologically can be classified as epidermoid, dermoid, and enteric cysts.…”

“…The most common presacral masses are developmental cysts [2][3][4] , which histologically can be classified as epidermoid, dermoid, and enteric cysts. The latter can be subdivided into mucus-secreting and duplication cysts [3,5] .…”