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Retrorectal Tumors: A Comprehensive Literature Review

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Abstract

Importance

Retrorectal tumors are rare lesions that comprise a multitude of histologic types. Reports are limited to small single-institution case series, and recommendations on the ideal surgical approaches are lacking.

Objective

The purpose of the study was to provide a comprehensive review of the epidemiology, pathologic subtypes, surgical approaches, and clinical outcomes of retrorectal tumors.

Evidence Review

We conducted a review of the literature using PubMed and searched the reference lists of published studies.

Results

A total of 341 studies comprising 1708 patients were included. Overall, 68 % of patients were female. The mean age was 44.6 ± 13.7 years. Of all patients, 1194 (70 %) had benign lesions, and 514 patients (30 %) had malignant tumors. Congenital tumors (60.5 %) were the most frequent histologic type. Other pathologic types were neurogenic tumors (14.8 %), osseous tumors (3.1 %), inflammatory tumors (2.6 %), and miscellaneous tumors (19.1 %). Biopsy was performed in 27 % of the patients. Of these patients, incorrect diagnoses occurred in 44 %. An anterior surgical approach (AA) was performed in 299 patients (35 %); a posterior approach (PA) was performed in 443 (52 %), and a combined approach (CA) was performed in 119 patients (14 %). The mean length of stay (LOS) of PA was 7 ± 5 days compared to 8 ± 7 days for AA and 11 ± 7 days for CA (p < 0.05). The overall morbidity rate was 13.2 %: 19.3 % associated with anterior approach, 7.2 % associated with posterior approach, and 24.7 % after a combined approach (p < 0.05). Overall postoperative recurrence rate was 21.6 %; 6.7 % after an anterior approach, 26.6 % after a posterior approach, and 28.6 % after a combined approach (p < 0.05). A minimally invasive approach (MIS) was employed in 83 patients. MIS provided shorter hospital stays than open surgery (4 ± 2 vs. 9 ± 7 days; p < 0.05). Differences in complication rate were 19.8 % in MIS and 12.2 % in open surgery and not statistically significant.

Conclusions and Relevance

Retrorectal tumors are most commonly benign in etiology, of a congenital nature, and have a female predominance. Complete surgical resection is the cornerstone of retrorectal tumor management. A minimal access surgery approach, when feasible, appears to be a safe option for the management of retrorectal tumors, with shorter operative time and length of stay.

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Funding for this study was provided by departmental support.

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Authors and Affiliations

  1. Keimyung University College of Medicine, Daegu, Republic of Korea

    Seong Kyu Baek

  2. Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA

    Grace Soon Hwang, Alessio Vinci, Mehraneh D. Jafari, Fariba Jafari, Zhobin Moghadamyeghaneh & Alessio Pigazzi

  3. Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Grace Soon Hwang

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  1. Seong Kyu Baek
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Correspondence to Alessio Pigazzi.

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Seong Kyu Baek and Grace Soon Hwang denotes co-first authorship.

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Baek, S.K., Hwang, G.S., Vinci, A. et al. Retrorectal Tumors: A Comprehensive Literature Review. World J Surg 40, 2001–2015 (2016). https://doi.org/10.1007/s00268-016-3501-6

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