Abstract
Background
Presacral tumors are a rare entity typically treated with an open surgical approach. A limited number of minimally invasive resections have been described. The aim of the study is to evaluate the safety and efficacy of roboticresection of presacral tumors.
Methods
This is a retrospective single system analysis, conducted at a quaternary referral academic healthcare system, and included all patients who underwent a robotic excision of a presacral tumor between 2015 and 2023. Outcomes of interest were operative time, estimated blood loss, complications, length of stay, margin status, and recurrence rates.
Results
Sixteen patients (11 females and 5 males) were included. The median age of the cohort was 51 years (range 25–69 years). The median operative time was 197 min (range 98–802 min). The median estimated blood loss was 40 ml, ranging from 0 to 1800 ml, with one patient experiencing conversion to open surgery after uncontrolled hemorrhage. Urinary retention was the only postoperative complication that occurred in three patients (19%) and was solved within 30 days in all cases. The median length of stay was one day (range 1–6 days). The median follow-up was 6.7 months (range 1–110 months). All tumors were excised with appropriate margins, but one benign and one malignant tumor recurred (12.5%). Ten tumors were classified as congenital (one was malignant), two were mesenchymal (both malignant), and five were miscellaneous (one malignant).
Conclusions
Robotic resection of select presacral pathology is feasible and safe. Further studies must be conducted to determine complication rates, outcomes, and long-term safety profiles.
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Data availability
To facilitate transparency and research, the corresponding author will share anonymized data upon reasonable request, ensuring participant privacy.
References
Hobson KG, Ghaemmaghami V, Roe JP, Goodnight JE, Khatri VP (2005) Tumors of the retrorectal space. Dis Colon Rectum 48(10):1964–1974
Neale JA (2011) Retrorectal tumors. Clin Colon Rectal Surg 24(3):149–160
Kelley SR, Dozois EJ (2022) Presacral tumors. The ASCRS textbook of colon and rectal surgery. Springer, pp 375–396
Uhlig BE, Johnson RL (1975) Presacral tumors and cysts in adults. Dis Colon Rectum 18(7):581–589
Woodfield JC, Chalmers AG, Phillips N, Sagar PM (2008) Algorithms for the surgical management of retrorectal tumours. Br J Surg 95(2):214–221
Chéreau N, Lefevre JH, Meurette G et al (2013) Surgical resection of retrorectal tumours in adults: long-term results in 47 patients. Colorectal Dis 15(8):e476-482
Mullaney TG, Lightner AL, Johnston M, Kelley SR, Larson DW, Dozois EJ (2018) A systematic review of minimally invasive surgery for retrorectal tumors. Tech Coloproctol 22(4):255–263
Kim CW, Lee S-H (2019) Laparoscopic resection of presacral tumor: a new approach in the era of the minimally invasive surgery. J Minim Invasive Surg 22(3):131–133
Roy SP, Khalessi A, Phan-Thien KC (2019) Robotic resection of a multicystic tailgut cyst. BMJ Case Rep 12(9):e231286
Solís-Peña A, Ngu LWS, Kraft Carré M et al (2022) Robotic abdominal resection of tailgut cysts—a technical note with step-by-step description. Colorectal Dis 24(6):793–796
Marano A, Giuffrida MC, Peluso C, Testa V, Bosio P, Borghi F (2020) Robotic approach to large tailgut cyst with malignant transformation: a case report. Int J Surg Case Rep 77(Suppl):S57-s60
Rompen IF, Scheiwiller A, Winiger A, Metzger J, Gass JM (2021) Robotic-assisted laparoscopic resection of tailgut cysts. JSLS. https://doi.org/10.4293/JSLS.2021.00035
Murad MH, Sultan S, Haffar S, Bazerbachi F (2018) Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 23(2):60–63
Elm EV, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 335(7624):806–808
KDIGO Clinical Practice Guideline for Acute Kidney Injury (2012) Kidney Int Suppl. 2(Suppl 1):8
Macafee DA, Sagar PM, El-Khoury T, Hyland R (2012) Retrorectal tumours: optimization of surgical approach and outcome. Colorectal Dis 14(11):1411–1417
Sagar AJ, Tan WS, Codd R, Fong SS, Sagar PM (2014) Surgical strategies in the management of recurrent retrorectal tumours. Tech Coloproctol 18(11):1023–1027
Dozois EJ, Jacofsky DJ, Billings BJ et al (2011) Surgical approach and oncologic outcomes following multidisciplinary management of retrorectal sarcomas. Ann Surg Oncol 18(4):983–988
Sagar AJ, Koshy A, Hyland R, Rotimi O, Sagar PM (2014) Preoperative assessment of retrorectal tumours. Br J Surg 101(5):573–577
Baek SK, Hwang GS, Vinci A et al (2016) Retrorectal tumors: a comprehensive literature review. World J Surg 40(8):2001–2015
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Davide Ferrari, MD Acquisition, analysis, and interpretation of data. Drafting the manuscript and critical revision of the article for important intellectual content.Final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Tommaso Violante, MD Acquisition, analysis, and interpretation of data. Drafting the manuscript and critical revision of the article for important intellectual content. Final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Poppy Addison, MD Acquisition, analysis, and interpretation of data. Drafting the manuscript and critical revision of the article for important intellectual content. Final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Amit Merchea, MD Analysis, and interpretation of data. Critical revision of the article for important intellectual content. Final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. William R. G. Perry, MB, BCh, MPH Analysis and interpretation of data, Critical revision of the article for important intellectual content. Final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Scott R. Kelley, MD Analysis, and interpretation of data. Critical revision of the article for important intellectual content. Final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Kellie L. Mathis, MD, MS Analysis, and interpretation of data. Critical revision of the article for important intellectual content. Final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Eric J. Dozois, MD Analysis, and interpretation of data. Critical revision of the article for important intellectual content. Final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. David W. Larson, MD, MBA Conceptualization and design of the project. Acquisition, analysis, and interpretation of data. Drafting the manuscript and critical revision of the article for important intellectual content. Final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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This retrospective study involving human participants has been granted institutional review board approval (ID 23-003829) prior to commencing.
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Ferrari, D., Violante, T., Addison, P. et al. Robotic resection of presacral tumors. Tech Coloproctol 28, 49 (2024). https://doi.org/10.1007/s10151-024-02922-6
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DOI: https://doi.org/10.1007/s10151-024-02922-6