Advertisement

Techniques in Coloproctology

, Volume 22, Issue 4, pp 255–263 | Cite as

A systematic review of minimally invasive surgery for retrorectal tumors

  • T. G. Mullaney
  • A. L. Lightner
  • M. Johnston
  • S. R. Kelley
  • D. W. Larson
  • E. J. Dozois
Review

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.

Keywords

Colorectal/anal neoplasia Minimally invasive surgery Retrorectal tumors Robotic Laparoscopic 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

No informed consent was required as this is a systematic review of previously published literature.

References

  1. 1.
    Lovelady SB, Dockerty MB (1949) Extragenital pelvic tumors in women. Am J Obstet Gynecol 58(2):215–236CrossRefPubMedGoogle Scholar
  2. 2.
    Hobson KG, Ghaemmaghami V, Roe JP, Goodnight JE, Khatri VP (2005) Tumors of the retrorectal space. Dis Colon Rectum 48(10):1964–1974.  https://doi.org/10.1007/s10350-005-0122-9 CrossRefPubMedGoogle Scholar
  3. 3.
    Whittaker LD, Pemberton JD (1938) Tumors ventral to the sacrum. Ann Surg 107(1):96–106CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Woodfield JC, Chalmers AG, Phillips N, Sagar PM (2008) Algorithms for the surgical management of retrorectal tumours. Br J Surg 95(2):214–221.  https://doi.org/10.1002/bjs.5931 CrossRefPubMedGoogle Scholar
  5. 5.
    Chereau 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–e482.  https://doi.org/10.1111/codi.12255 CrossRefPubMedGoogle Scholar
  6. 6.
    Duclos J, Maggiori L, Zappa M, Ferron M, Panis Y (2014) Laparoscopic resection of retrorectal tumors: a feasibility study in 12 consecutive patients. Surg Endosc 28(4):1223–1229.  https://doi.org/10.1007/s00464-013-3312-x CrossRefPubMedGoogle Scholar
  7. 7.
    La Rosa S, Boni L, Finzi G et al (2010) Ghrelin-producing well-differentiated neuroendocrine tumor (carcinoid) of tailgut cyst. Morphological, immunohistochemical, ultrastructural, and RT-PCR study of a case and review of the literature. Endocr Pathol 21(3):190–198.  https://doi.org/10.1007/s12022-010-9127-6 CrossRefPubMedGoogle Scholar
  8. 8.
    Carchman E, Gorgun E (2015) Robotic-assisted resection of presacral sclerosing epithelioid fibrosarcoma. Tech Coloproctol 19(3):177–180.  https://doi.org/10.1007/s10151-015-1274-9 CrossRefPubMedGoogle Scholar
  9. 9.
    Fong SS, Codd R, Sagar PM (2014) Laparoscopic excision of retrorectal tumours. Colorectal Dis 16(11):O400–O403.  https://doi.org/10.1111/codi.12774 CrossRefPubMedGoogle Scholar
  10. 10.
    Nedelcu M, Andreica A, Skalli M et al (2013) Laparoscopic approach for retrorectal tumors. Surg Endosc 27(11):4177–4183.  https://doi.org/10.1007/s00464-013-3017-1 CrossRefPubMedGoogle Scholar
  11. 11.
    Zhou JL, Wu B, Xiao Y et al (2014) A laparoscopic approach to benign retrorectal tumors. Tech Coloproctol 18(9):825–833.  https://doi.org/10.1007/s10151-014-1146-8 CrossRefPubMedGoogle Scholar
  12. 12.
    Oh JK, Yang MS, Yoon DH et al (2014) Robotic resection of huge presacral tumors: case series and comparison with an open resection. J Spinal Disord Tech 27(4):E151–E154.  https://doi.org/10.1097/BSD.0b013e318299c5fd CrossRefPubMedGoogle Scholar
  13. 13.
    Glasgow SC, Birnbaum EH, Lowney JK et al (2005) Retrorectal tumors: a diagnostic and therapeutic challenge. Dis Colon Rectum 48(8):1581–1587.  https://doi.org/10.1007/s10350-005-0048-2 CrossRefPubMedGoogle Scholar
  14. 14.
    Hopper L, Eglinton TW, Wakeman C, Dobbs BR, Dixon L, Frizelle FA (2016) Progress in the management of retrorectal tumours. Colorectal Dis 18(4):410–417.  https://doi.org/10.1111/codi.13117 CrossRefPubMedGoogle Scholar
  15. 15.
    Sagar AJ, Koshy A, Hyland R, Rotimi O, Sagar PM (2014) Preoperative assessment of retrorectal tumours. Br J Surg 101(5):573–577.  https://doi.org/10.1002/bjs.9413 CrossRefPubMedGoogle Scholar
  16. 16.
    Verazin G, Rosen L, Khubchandani IT, Sheets JA, Stasik JJ, Riether R (1986) Retrorectal tumor: is biopsy risky? South Med J 79(11):1437–1439CrossRefPubMedGoogle Scholar
  17. 17.
    Baek SK, Hwang GS, Vinci A et al (2016) Retrorectal tumors: a comprehensive literature review. World J Surg 40(8):2001–2015.  https://doi.org/10.1007/s00268-016-3501-6 CrossRefPubMedGoogle Scholar
  18. 18.
    Jao SW, Beart RW Jr, Spencer RJ, Reiman HM, Ilstrup DM (1985) Retrorectal tumors. Mayo Clinic experience, 1960–1979. Dis Colon Rectum 28(9):644–652CrossRefPubMedGoogle Scholar
  19. 19.
    Simpson PJ, Wise KB, Merchea A et al (2014) Surgical outcomes in adults with benign and malignant sacrococcygeal teratoma: a single-institution experience of 26 cases. Dis Colon Rectum 57(7):851–857.  https://doi.org/10.1097/DCR.0000000000000117 CrossRefPubMedGoogle Scholar
  20. 20.
    Kye BH, Kim HJ, Cho HM, Chin HM, Kim JG (2011) Clinicopathological features of retrorectal tumors in adults: 9 years of experience in a single institution. J Korean Surg Soc 81(2):122–127.  https://doi.org/10.4174/jkss.2011.81.2.122 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Marinello FG, Targarona EM, Luppi CR, Boguna I, Molet J, Trias M (2011) Laparoscopic approach to retrorectal tumors: review of the literature and report of 4 cases. Surg Laparosc Endosc Percutan Tech 21(1):10–13.  https://doi.org/10.1097/SLE.0b013e3182020e69 CrossRefPubMedGoogle Scholar
  22. 22.
    Konstantinidis K, Theodoropoulos GE, Sambalis G et al (2005) Laparoscopic resection of presacral schwannomas. Surg Laparosc Endosc Percutan Tech 15(5):302–304CrossRefPubMedGoogle Scholar
  23. 23.
    Gunkova P, Martinek L, Dostalik J, Gunka I, Vavra P, Mazur M (2008) Laparoscopic approach to retrorectal cyst. World J Gastroenterol 14(42):6581–6583CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Imboden S, Al-Fana A, Kuhn A, Mueller MD (2014) Pandora’s box and retrorectal tumors in laparoscopy: a case report and review of the literature. Int J Surg Case Rep 5(10):706–709.  https://doi.org/10.1016/j.ijscr.2014.08.012 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Sukhadiya MV, Das U (2015) Laparoscopic approach to type IV sacrococcygeal teratoma in an adult. Indian J Surg 77(Suppl 1):62–63.  https://doi.org/10.1007/s12262-014-1130-6 CrossRefPubMedGoogle Scholar
  26. 26.
    Jatal S, Pai VD, Rakhi B, Saklani AP (2016) Presacral schwannoma: laparoscopic resection, a viable option. Ann Transl Med 4(9):176.  https://doi.org/10.21037/atm.2016.04.07 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Palanivelu C, Rangarajan M, Senthilkumar R, Madankumar MV, Annapoorni S (2008) Laparoscopic and perineal excision of an infected “dumb-bell” shaped retrorectal epidermoid cyst. J Laparoendosc Adv Surg Tech A 18(1):88–92.  https://doi.org/10.1089/lap.2007.0010 CrossRefPubMedGoogle Scholar
  28. 28.
    Lu NH, Tseng MJ (2010) Laparoscopic management of tailgut cyst: case report and review of literature. J Minim Invasive Gynecol 17(6):802–804.  https://doi.org/10.1016/j.jmig.2010.07.011 CrossRefPubMedGoogle Scholar
  29. 29.
    Mueller F, Wunschel A, Ulrich U (2011) Laparoscopic treatment of a tailgut cyst. Eur J Obstet Gynecol Reprod Biol 159(1):233–234.  https://doi.org/10.1016/j.ejogrb.2011.06.017 CrossRefPubMedGoogle Scholar
  30. 30.
    Lim SW, Huh JW, Kim YJ, Kim HR (2011) Laparoscopy-assisted resection of tailgut cysts: report of a case. Case Rep Gastroenterol 5(1):22–27.  https://doi.org/10.1159/000322912 CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Salameh JR, Votanopoulos KI, Hilal RE et al (2002) Rectal duplication cyst in an adult: the laparoscopic approach. J Laparoendosc Adv Surg Tech A 12(6):453–456.  https://doi.org/10.1089/109264202762252758 CrossRefPubMedGoogle Scholar
  32. 32.
    Rao M, Sagar P, Duff S, Hulme-Moir M, Brayshaw I (2010) Laparoscopic excision of a retrorectal schwannoma. Tech Coloproctol 14(4):353–355.  https://doi.org/10.1007/s10151-010-0586-z CrossRefPubMedGoogle Scholar
  33. 33.
    Szyllo K, Lesnik N (2013) Sacrococcygeal teratoma—case report and review of the literature. Am J Case Rep 14:1–5.  https://doi.org/10.12659/AJCR.883727 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Gascon Hove M, Pueyo Rabanal A, Cea Soriano M, Galindo Jara P, Garijo Alvarez JA (2014) Single-port access surgery resection of a presacral schwannoma. Tech Coloproctol 18(4):407–408.  https://doi.org/10.1007/s10151-012-0968-5 CrossRefPubMedGoogle Scholar
  35. 35.
    Kumar S, Pragatheeswarane M, Sharma AP et al (2017) Expanding the horizon of robotic surgery to large pelvic paraganglioma. J Robot Surg 11(2):247–250.  https://doi.org/10.1007/s11701-016-0648-y CrossRefPubMedGoogle Scholar
  36. 36.
    Jones M, Khosa J (2013) Presacral tumours: a rare case of a dermoid cyst in a paediatric patient. BMJ Case Rep.  https://doi.org/10.1136/bcr-2013-008783 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Sharpe LA, Van Oppen DJ (1995) Laparoscopic removal of a benign pelvic retroperitoneal dermoid cyst. J Am Assoc Gynecol Laparosc 2(2):223–226CrossRefPubMedGoogle Scholar
  38. 38.
    Holz S, Keyzer C, Van Stadt J, Willemart S, Chasse E (2013) Presacral ganglioneuroma with abnormal FDG uptake: a case report. Acta Chir Belg 113(4):298–300CrossRefPubMedGoogle Scholar
  39. 39.
    Palep JH, Mistry S, Kumar A, Munshi M, Puranik M, Pednekar A (2015) Robotic excision of a pre-coccygeal nerve root tumor. J Minim Access Surg 11(1):103–105.  https://doi.org/10.4103/0972-9941.147722 CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Melvin WS (1996) Laparoscopic resection of a pelvic schwannoma. Surg Laparosc Endosc 6(6):489–491CrossRefPubMedGoogle Scholar
  41. 41.
    Chopra S, Dharmaraja A, Satkunasivam R, Gill IS (2017) Robot-assisted laparoscopic resection of a pelvic schwannoma. Urol Case Rep 11:63–65.  https://doi.org/10.1016/j.eucr.2016.11.027 CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Tsutsui A, Nakamura T, Mitomi H et al (2011) Successful laparoscopic resection of a sacrococcygeal teratoma in an adult: report of a case. Surg Today 41(4):572–575.  https://doi.org/10.1007/s00595-010-4274-4 CrossRefPubMedGoogle Scholar
  43. 43.
    Paul PG, Pravinkumar T, Sheetal B (2012) Sacrococcygeal neurofibroma: rare cause for chronic pelvic pain. J Minim Invasive Gynecol 19(4):517–520.  https://doi.org/10.1016/j.jmig.2012.03.006 CrossRefPubMedGoogle Scholar
  44. 44.
    Al-Khattabi M, Chouillard E, Louboutin A, Fauconnier A, Bader G (2010) Giant pararectal epidermoid tumor mimicking ovarian cyst: combined laparoscopic and perineal surgical approach. J Minim Invasive Gynecol 17(1):113–115.  https://doi.org/10.1016/j.jmig.2009.10.003 CrossRefPubMedGoogle Scholar
  45. 45.
    Champney MS, Ehteshami M, Scales FL (2010) Laparoscopic resection of a presacral ganglioneuroma. Am Surg 76(4):E1–E2PubMedGoogle Scholar
  46. 46.
    Kassir R, Kaczmarek D (2014) A late-recognized Currarino syndrome in an adult revealed by an anal fistula. Int J Surg Case Rep 5(5):240–242.  https://doi.org/10.1016/j.ijscr.2014.02.011 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Colorectal SurgerySt Vincent’s HospitalMelbourneAustralia
  2. 2.Department of Colon and Rectal SurgeryMayo ClinicRochesterUSA
  3. 3.RochesterUSA

Personalised recommendations