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Presacral Neuroendocrine Neoplasms: A Multi-site Review of Surgical Outcomes

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Presacral neuroendocrine neoplasms (PNENs) are rare tumors, with limited data on management and outcomes.

Methods

A retrospective review of institutional medical records was conducted to identify all patients with PNENs between 2008 and 2022. Data collection included demographics, symptoms, imaging, surgical approaches, pathology, complications, and long-term outcomes.

Results

Twelve patients were identified; two-thirds were female, averaging 44.8 years of age, and, for the most part, presenting with back pain, constipation, and abdominal discomfort. Preoperative imaging included computed tomography scans and magnetic resonance images, with somatostatin receptor imaging and biopsies being common. Half of the patients had metastatic disease on presentation. Surgical approach varied, with anterior, posterior, and combined techniques used, often involving muscle transection and coccygectomy. Short-term complications affected one-quarter of patients. Pathologically, PNENs were mainly well-differentiated grade 2 tumors with positive synaptophysin and chromogranin A. Associated anomalies were common, with tail-gut cysts prevalent. Mean tumor diameter was 6.3 cm. Four patients received long-term adjuvant therapy. Disease progression necessitated additional interventions, including surgery and various chemotherapy regimens. Skeletal, liver, thyroid, lung, and pancreatic metastases occurred during follow-up, with no mortality reported. Kaplan–Meier analysis showed a 5-year local recurrence rate of 23.8%, disease progression rate of 14.3%, and de novo metastases rate of 30%.

Conclusion

The study underscores the complex management of PNENs and emphasizes the need for multicenter research to better understand and manage these tumors. It provides valuable insights into surgical outcomes, recurrence rates, and overall survival, guiding future treatment strategies for PNEN patients.

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Funding

This research did not receive external funding.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA

    Tommaso Violante MD, Brenda Murphy MD, Davide Ferrari MD, David W. Larson MD, MBA, Eric J. Dozois MD & William R. Perry MB, ChB, MPH

  2. School of General Surgery, Alma Mater Studiorum University of Bologna, Bologna, Italy

    Tommaso Violante MD & Davide Ferrari MD

  3. General Surgery Residency Program, University of Milan, Milan, Italy

    Davide Ferrari MD

  4. Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA

    Rondell P. Graham MBBS

  5. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Patrick Navin MB, BCh, BAO

  6. Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA

    Amit Merchea MD

  7. Department of Oncology, Mayo Clinic, Rochester, MN, USA

    Thorvardur R. Halfdanarson MD

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  1. Tommaso Violante MD
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Correspondence to William R. Perry MB, ChB, MPH.

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Disclosure

Thorvardur Halfdanarson has received research support from Thermo Fisher Scientific, Advanced Accelerator Applications (a Novartis company), Camurus, Crinetics, and ITM Isotopen Technologien Muenchen. He has also undertaken consultancy/advisory board/steering committee work for Ipsen, TerSera, Advanced Accelerator Applications (a Novartis company), Terumo, ITM Isotopen Technologien Muenchen, Crinetics, Perspective Therapeutics, and Camurus. Tommaso Violante, Brenda Murphy, Davide Ferrari, Rondell P. Graham, Patrick Navin, Amit Merchea, David W. Larson, Eric J. Dozois, and William R. Perry have no conflicts of interest to disclose in relation to this work.

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Violante, T., Murphy, B., Ferrari, D. et al. Presacral Neuroendocrine Neoplasms: A Multi-site Review of Surgical Outcomes. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15328-3

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