Abstract
Background
Tumors occurring within the retrorectal space are rare and their low incidence has led to a paucity of literature regarding them.
Methods
Adult patients with retrorectal tumors managed at this institution from 1981–2011 were identified. A retrospective chart review was conducted to obtain relevant data.
Results
Retrorectal tumors were identified in 87 patients (67 female) with median age at diagnosis of 44 years (19–88), and median follow-up 8 months (0.1–225). Of the 25 different histologic tumors diagnosed, hamartomas were most common (32 %; n = 28) followed by epidermal cysts (11 %; n = 10), and teratomas (10 %; n = 9). Twenty-six percent (23/87) of all tumors were malignant. CT scans were obtained in 84 % (73/87) of patients, MRI in 59 % (51/87), and TRUS in 16 % (14/87). While 74 % (64/87) of tumors were at or below the S4 level, operative approach was strictly posterior in 73 % (46/63) of these tumors. Twenty-eight percent (24/87) of patients underwent diagnostic biopsy with no reported biopsy site recurrence. Thirty percent (7/23) of resected malignant (all recurrences: distant) and eleven percent (7/64) of benign tumors (all recurrences: local) recurred. Survival was 70 % (16/23) for malignant tumors and 98 % (63/64) for benign tumors.
Conclusions
Retrorectal tumors remain heterogeneous and a diagnostic challenge. Pre-operative imaging may help guide surgeons; however, malignancy portends worse outcomes. Despite preoperative biopsy site recurrence concerns, no patient in this study had biopsy site recurrence. As their natural history remains unclear, more studies are necessary to further characterize their behavior.
Similar content being viewed by others
References
Cody, H.S., 3rd, R.C. Marcove, and S.H. Quan, Malignant retrorectal tumors: 28 years’ experience at Memorial Sloan-Kettering Cancer Center. Dis Colon Rectum, 1981. 24(7): p. 501–6.
Jao, S.W., R.W. Beart, Jr., R.J. Spencer, H.M. Reiman, and D.M. Ilstrup, Retrorectal tumors. Mayo Clinic experience, 1960–1979. Dis Colon Rectum, 1985. 28(9): p. 644–52.
Bohm, B., J.W. Milsom, V.W. Fazio, I.C. Lavery, J.M. Church, and J.R. Oakley, Our approach to the management of congenital presacral tumors in adults. Int J Colorectal Dis, 1993. 8(3): p. 134–8.
Freier, D.T., J.C. Stanley, and N.W. Thompson, Retrorectal tumors in adults. Surg Gynecol Obstet, 1971. 132(4): p. 681–6.
Grahovac, G., M. Vilendecic, M. Vukelic-Markovic, I. Topic, and S. Lambasa, An unexpected obstacle: a retrorectal mass went undetected until the patient was in labor. Am J Obstet Gynecol, 2011. 205(6): p. 578 e1-2.
Killingsworth, C. and T.R. Gadacz, Tailgut cyst (retrorectal cystic hamartoma): report of a case and review of the literature. Am Surg, 2005. 71(8): p. 666–73.
McCawley, N., A. Hanly, G. Solon, C. Shilling, J. Deasy, E.W. Kay, and D.A. McNamara, Adenocarcinoma arising in a retrorectal teratoma: case report and review of the literature. Colorectal Dis, 2011. 13(9): p. e312–3.
Negro, F., M. Mercuri, V. Ricciardi, M. Massari, C. Destito, S. Mafucci, and T. Cozza, Presacral epidermoid cyst. A case report. Ann Ital Chir, 2006. 77(1): p. 75–7.
Satyadas, T., M. Davies, N. Nasir, S. Halligan, and C.A. Akle, Tailgut cyst associated with a pilonidal sinus: an unusual case and a review. Colorectal Dis, 2002. 4(3): p. 201–204.
Takahashi, R., S. Nagayama, Y. Mori, H. Isoda, A. Yoshizawa, T. Manabe, and Y. Sakai, A large cystic gastrointestinal stromal tumor of the rectum in the retrorectal space. Int J Clin Oncol, 2010. 15(6): p. 601–7.
Yang, D.M., H.C. Kim, H.L. Lee, S.H. Lee, and G.Y. Kim, Squamous cell carcinoma arising from a presacral epidermoid cyst: CT and MR findings. Abdom Imaging, 2008. 33(4): p. 498–500.
Coco, C., A. Manno, C. Mattana, A. Verbo, D. Sermoneta, G. Franceschini, A. De Gaetano, L.M. Larocca, L. Petito, G. Pedretti, G. Rizzo, C. Lodoli, and D. D’Ugo, Congenital tumors of the retrorectal space in the adult: report of two cases and review of the literature. Tumori, 2008. 94(4): p. 602–7.
Brindley, G.V., Sacral and Presacral Tumors. Ann Surg, 1945. 121(5): p. 721–34.
Du, F., K. Jin, X. Hu, X. Dong, and F. Cao, Surgical treatment of retrorectal tumors: a retrospective study of a ten-year experience in three institutions. Hepatogastroenterology, 2012. 59(117): p. 1374–7.
Hjermstad, B.M. and E.B. Helwig, Tailgut cysts. Report of 53 cases. Am J Clin Pathol, 1988. 89(2): p. 139–47.
Uhlig, B.E. and R.L. Johnson, Presacral tumors and cysts in adults. Dis Colon Rectum, 1975. 18(7): p. 581–9.
Hobson, K.G., V. Ghaemmaghami, J.P. Roe, J.E. Goodnight, and V.P. Khatri, Tumors of the retrorectal space. Dis Colon Rectum, 2005. 48(10): p. 1964–74.
Marcos, E.J.D.a.M.D.H., Presacral Tumors. 2nd ed. The ASCRS Textbook for Colon and Rectal Surgery, ed. P.L.R. David E. Beck, Theodore J. Saclarides, Anthony J. Senagore, Michael J. Stamos, Steven D. Wexner. 2011: Springer Science+Business Media, LLC. 15.
Ghosh, J., T. Eglinton, F.A. Frizelle, and A.J. Watson, Presacral tumours in adults. Surgeon, 2007. 5(1): p. 31–8.
Glasgow, S.C., E.H. Birnbaum, J.K. Lowney, J.W. Fleshman, I.J. Kodner, D.G. Mutch, S. Lewin, M.G. Mutch, and D.W. Dietz, Retrorectal tumors: a diagnostic and therapeutic challenge. Dis Colon Rectum, 2005. 48(8): p. 1581–7.
Church, J.M., P.J. Raudkivi, and G.L. Hill, The surgical anatomy of the rectum--a review with particular relevance to the hazards of rectal mobilisation. Int J Colorectal Dis, 1987. 2(3): p. 158–66.
Ludwig, K.A.a.K., M. F., Trans-Sacral Approaches for Presacral Cyst/Rectal Tumor. Operative Techniques in General Surgery, 2005: p. 126–136.
Lovelady, S.B. and M.B. Dockerty, Extragenital pelvic tumors in women. Am J Obstet Gynecol, 1949. 58(2): p. 215–36.
Buchs, N., S. Taylor, and B. Roche, The posterior approach for low retrorectal tumors in adults. Int J Colorectal Dis, 2007. 22(4): p. 381–5.
Pidala, M.J., T.E. Eisenstat, R.J. Rubin, and E.P. Salvati, Presacral cysts: transrectal excision in select patients. Am Surg, 1999. 65(2): p. 112–5.
Wolpert, A., M. Beer-Gabel, O. Lifschitz, and A.P. Zbar, The management of presacral masses in the adult. Tech Coloproctol, 2002. 6(1): p. 43–9.
Singer, M.A., J.R. Cintron, J.E. Martz, D.J. Schoetz, and H. Abcarian, Retrorectal cyst: a rare tumor frequently misdiagnosed. J Am Coll Surg, 2003. 196(6): p. 880–6.
Zoller, S., A. Joos, D. Dinter, W. Back, K. Horisberger, S. Post, and P. Palma, Retrorectal tumors: excision by transanal endoscopic microsurgery. Rev Esp Enferm Dig, 2007. 99(9): p. 547–50.
Glasgow, S.C. and D.W. Dietz, Retrorectal tumors. Clin Colon Rectal Surg, 2006. 19(2): p. 61–8.
Guillem, P., O. Ernst, M. Herjean, and J.P. Triboulet, [Retrorectal tumors: an assessment of the abdominal approach]. Ann Chir, 2001. 126(2): p. 138–42.
Mathis, K.L., E.J. Dozois, M.S. Grewal, P. Metzger, D.W. Larson, and R.M. Devine, Malignant risk and surgical outcomes of presacral tailgut cysts. Br J Surg, 2010. 97(4): p. 575–9.
Izant, R.J., Jr. and H.C. Filston, Sacrococcygeal teratomas. Analysis of forty-three cases. Am J Surg, 1975. 130(5): p. 617-21.
Miles, R.M. and G.S. Stewart, Jr., Sacrococcygeal teratomas in adult. Ann Surg, 1974. 179(5): p. 676–83.
Lev-Chelouche, D., M. Gutman, G. Goldman, E. Even-Sapir, I. Meller, J. Issakov, J.M. Klausner, and M. Rabau, Presacral tumors: a practical classification and treatment of a unique and heterogeneous group of diseases. Surgery, 2003. 133(5): p. 473–8.
Localio, S.A., K. Eng, and J.H. Ranson, Abdominosacral approach for retrorectal tumors. Ann Surg, 1980. 191(5): p. 555–60.
Rapport, R.L., 2nd and G.S. Ferguson, Dorsal approach to presacral biopsy: technical case report. Neurosurgery, 1997. 40(5): p. 1087-8.
Dozois, E.J.a.H.M., M.D., Presacral Tumors., in The ASCRS Textbook of Colon and Rectal Surgery, D.E. Beck, Roberts, P.L., Saclarides, T.J., Senagore, A.J., Stamos, M.J., Wexner, S.D., Editor. 2011, Springer: New York. p. 359-374.
Dozois, E.J., J.C. Wall, R.J. Spinner, D.J. Jacofsky, M.J. Yaszemski, F.H. Sim, S.L. Moran, R.R. Cima, D.R. Larson, M.G. Haddock, S.H. Okuno, and D.W. Larson, Neurogenic tumors of the pelvis: clinicopathologic features and surgical outcomes using a multidisciplinary team. Ann Surg Oncol, 2009. 16(4): p. 1010–6.
Syed, R., J.A. Bishop, and S.Z. Ali, Sacral and presacral lesions: cytopathologic analysis and clinical correlates. Diagn Cytopathol, 2012. 40(1): p. 7–13.
Pappalardo, G., F.M. Frattaroli, E. Casciani, N. Moles, D. Mascagni, D. Spoletini, G. Fanello, and G. Gualdi, Retrorectal tumors: the choice of surgical approach based on a new classification. Am Surg, 2009. 75(3): p. 240–8.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Messick, C.A., Hull, T., Rosselli, G. et al. Lesions Originating Within the Retrorectal Space: A Diverse Group Requiring Individualized Evaluation and Surgery. J Gastrointest Surg 17, 2143–2152 (2013). https://doi.org/10.1007/s11605-013-2350-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-013-2350-y