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A systematic review of minimally invasive surgery for retrorectal tumors

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Abstract

Retrorectal tumors are rare tumors that require resection for symptoms, malignancy and potential malignant transformation. Traditional approaches have included laparotomy, perineal excision or a combination. Multiple minimally invasive techniques are available which have the potential to minimize morbidity and enhance recovery. We performed a systematic review of the literature to determine the feasibility and surgical outcomes of retrorectal tumors approached using minimally invasive surgical techniques. Publications in which adult patients (≥ 18 years) had a minimally invasive approach (laparoscopic or robotic) for resection of a primary retrorectal tumor were included. Data were collected on approach, preoperative investigation, size and sacral level of the tumor, operating time, length of stay, perioperative complications, margins and recurrence. Thirty-five articles which included a total of 82 patients met the inclusion criteria. The majority of patients were female (n = 65; 79.2%), with a mean age of 41.7 years (range 18–89 years). Seventy-three patients (89.0%) underwent laparoscopic or combined laparoscopic–perineal resection, and 9 (10.8%) had a robotic approach. The conversion rate was 5.5%. The overall 30-day morbidity rate was 15.7%, including 1 intraoperative rectal injury (1.2%). Ninety-five percent (n = 78) of the retrorectal tumors were benign. Median length of stay was 4 days for both laparoscopic and robotic groups, with ranges of 1–8 and 2–10 days, respectively. No tumor recurrence was noted during follow-up [median 28 months (range 5–71 months)]. A minimally invasive approach for the resection of retrorectal tumors is feasible in selected patients. Careful patient selection is necessary to avoid incomplete resection and higher morbidity than traditional approaches.

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Authors and Affiliations

  1. Department of Colorectal Surgery, St Vincent’s Hospital, Melbourne, Australia

    T. G. Mullaney & M. Johnston

  2. Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA

    A. L. Lightner, S. R. Kelley, D. W. Larson & E. J. Dozois

  3. 201 W Center St, Rochester, MN, 55902, USA

    T. G. Mullaney

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  1. T. G. Mullaney
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Correspondence to T. G. Mullaney.

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Mullaney, T.G., Lightner, A.L., Johnston, M. et al. A systematic review of minimally invasive surgery for retrorectal tumors. Tech Coloproctol 22, 255–263 (2018). https://doi.org/10.1007/s10151-018-1781-6

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