Surgical management of retro-rectal tumors in the adult

Barraqué, M.; Filippello, Alexandre; Brek, A.; Baccot, S.; Porcheron, J.; Barabino, Gabriele

doi:10.1016/j.jviscsurg.2019.03.002

Cited by 10 publications

(17 citation statements)

References 37 publications

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“…2,17,18 Although the first diagnostic modality is usually computed tomography (CT), nuclear magnetic resonance imaging (MRI) allows to better characterize solid cystic lesions, define the plane between the tumor and the presacral fascia, and evaluate invasion to adjacent structures , as for example in the commitment of spaces S1-S2 that defines iresecability. 12,19 One of the most named controversies in the literature is the preoperative biopsy of a lesion in the pre-sacral space, this due to the high risk of complications such as infection, bleeding, neuralgia, among others, however this is recommended only in unresectable or highly aggressive, such as osteogenic sarcoma, amenable to management with radiation therapy or chemotherapy; although other authors such as Bukhetan consider that this procedure as a high risk of spreading in malignant lesions. 2,12,20 Regarding treatment, most of these injuries benefit from surgical management, with an approach that will depend on the location of the tumor within the pelvis.…”

Section: Discussionmentioning

confidence: 99%

“…There are three main approaches: the posterior perineal or pre-sacral, which is preferred for lesions that are below S3, the anterior or transabdominal, and the combined recommended in tumors that extend above the S3 level. 2,17,19 In the case described in this publication, the transabdominal approach was used, in which the first thing dissected is the mesorectum of the anterior portion of the lesion, then separating it from the presacral fascia; before completely removing the tumor, it is necessary to control the arterial supply identifying and ligating the middle sacral artery, later it is necessary to reject the rectum to extract the surgical piece. 18 Among the postoperative complications described are not only infection or the appearance of hematomas, but also the rectal fistula in 3% of cases, as well as the loss of the voiding or defecation reflex due to nerve injury above the S2 level (mainly due to hypogastric plexus injury).…”

Section: Discussionmentioning

confidence: 99%

“…For its part, radiation therapy is high doses is preferred when there is incomplete excision of a chondroma or when there is local infiltration. 19 Another therapy in development is immunotherapy with tyrosine kinase inhibitors, such as Imatinib, which has shown good results, increasing survival, in the management of advanced chondromas. On the other hand, epidermal growth factor inhibitors such as Cetuximab and Gefitinib have shown a good response in patients with chondromas that present local recurrence and metastasis.…”

Section: Discussionmentioning

confidence: 99%

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Neuroendocrine tumor in the presacral region: a case report

Barbosa¹,

Padilla²,

Rojas³

et al. 2020

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The strange presentation of lesions in the pre-sacral space and the ambiguity of its clinic make it difficult to establish its diagnosis as the first possibility. Additionally, given that several germ lines converge in this space, it is possible to find a variety of lesions, one of the rarest, without incidence registered in the literature, neuroendocrine tumors. For its diagnosis there are different types of markers, among which stands out chromogranin A, and imaging studies that allow determining the characteristics of the lesions. Regarding treatment, surgical resection remains the initial management of these tumors. The following article aims to describe the case of a 27-year-old white female patient, with no significant history, who presented pain with root characteristics predominantly in the right lower limb; after which it was taken to take images showing a tumor in the pre-sacral space, so it was necessary to carry out a surgical resection of the lesion. For its part, the immunohistochemical study revealed a tumor of neuroendocrine origin grade 2, after which it was referred to the oncology clinic. The description of this case is considered relevant given its unusual presentation and the limited number of reports in the literature, mainly at the national level.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Neuroendocrine tumor in the presacral region: a case report

Barbosa¹,

Padilla²,

Rojas³

et al. 2020

MOJS

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“…Between 20%-38% of cases are reported as asymptomatic and identified incidentally [8][9][10]. Larger lesions may cause functional symptoms such as obstructive defaecation or neurological lower limb deficits or anorectal/genitourinary dysfunction secondary to nerve root compression [11,12]. Retrorectal masses are commonly categorised according to whether they are congenital, neurogenic or osseous and then further subdivided based on their malignancy status.…”

Section: Introductionmentioning

confidence: 99%

Evolution of the management of retrorectal masses: A retrospective cohort study

et al. 2021

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Aim: Retrorectal masses are abnormalities located anatomically in the retrorectal space.A significant proportion are asymptomatic with no malignant potential while others cause symptoms due to mechanical pressure or malignant infiltration. We reviewed and categorised the retrorectal masses encountered over a 30-year time period in a specialist colorectal hospital and describe our management algorithm for consideration by other multidisciplinary teams (MDT).Methods: This was a retrospective analysis of consecutive patients referred between 1984-2019. A detailed review of clinical presentation, imaging features, postoperative histology and impact on morbidity and anorectal function is reported.Results: A total of 143 patients with median age of 46 years and female preponderance (74%) were reviewed. The commonest presenting symptom was pain (46%) and all malignant cases had symptoms (n = 17). Over the last decade, more asymptomatic patients have presented with a retrorectal mass (33%, p = 0.04) and more patients are opting for surveillance rather than resection (33%, p = 0.013). Increasing age and lesion size were associated with malignancy (p < 0.05). Radiological features associated with malignancy included: solid/heterogeneous component, lobulated borders or locally invasive.Following surgery, complications included chronic pain (40%), poor wound healing (23%) and bowel dysfunction (10%). Conclusions:The management of retrorectal masses remains complex. There are features, both clinical and radiological, that can help determine the best management strategy. Management should be in a high-volume tertiary centre and preferably through a complex rectal cancer MDT. Long-term sequelae such as chronic pain must be highlighted to patients. We advocate the establishment of an international registry to further record and characterise these rare, potentially troublesome lesions.

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“…Presacral tumors are rare neoplasms with an incidence of 1/63 000 [1] and present with a wide variety of histological types. The malignancy rate, however, tends to be about 33% [2]. Surgery is usually indicated even in benign lesions, but is greatly dependent on the risk of malignancy and malignant degeneration [3].…”

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confidence: 99%