Skip to main content
SpringerLink
Log in

Presacral Tumors

  • Chapter
  • First Online:
The ASCRS Textbook of Colon and Rectal Surgery

Abstract

Presacral tumors represent a rare group of both benign and malignant lesions. Most benign lesions have malignant potential and must be followed carefully if nonoperative treatment is chosen. Magnetic resonance imaging (MRI) is the best imaging study to assist in diagnosis and operative planning. When performed, biopsy may assist in management of solid and heterogeneous cystic lesions. Observation of simple cystic lesions is acceptable when a dedicated surveillance protocol is in place. Given the broad differential and significant implications of mismanagement, presacral tumors should be evaluated and treated by surgeons at centers that have a large experience in managing these complex tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Spencer RJ, Jackman RJ. Surgical management of precoccygeal cysts. Surg Gynecol Obstet. 1962;115:449–52.

    CAS  PubMed  Google Scholar 

  2. Jao SW, Beart RW Jr, Spencer RJ, Reiman HM, Ilstrup DM. Retrorectal tumors. Mayo Clinic experience, 1960–1979. Dis Colon Rectum. 1985;28(9):644–52.

    CAS  PubMed  Google Scholar 

  3. Hobson KG, Ghaemmaghami V, Roe JP, Goodnight JE, Khatri VP. Tumors of the retrorectal space. Dis Colon Rectum. 2005;48(10):1964–74.

    PubMed  Google Scholar 

  4. Messick CA, Hull T, Rosselli G, Kiran RP. Lesions originating within the retrorectal space: a diverse group requiring individualized evaluation and surgery. J Gastrointest Surg. 2013;17(12):2143–52.

    PubMed  Google Scholar 

  5. Todd LT Jr, Yaszemski MJ, Currier BL, Fuchs B, Kim CW, Sim FH. Bowel and bladder function after major sacral resection. Clin Orthop Relat Res. 2002;397:36–9.

    Google Scholar 

  6. Zoccali C, Skoch J, Patel AS, Walter CM, Maykowski P, Baaj AA. Residual neurological function after sacral root resection during en-bloc sacrectomy: a systematic review. Eur Spine J. 2016;25(12):3925–31.

    PubMed  Google Scholar 

  7. Wei R, Guo W, Ji T, Zhang Y, Liang H. One-step reconstruction with a 3D-printed, custom-made prosthesis after total en bloc sacrectomy: a technical note. Eur Spine J. 2017;26(7):1902–9.

    PubMed  Google Scholar 

  8. Glasgow SC, Birnbaum EH, Lowney JK, Fleshman JW, Kodner IJ, Mutch DG, Lewin S, Mutch MG, Dietz DW. Retrorectal tumors: a diagnostic and therapeutic challenge. Dis Colon Rectum. 2005;48(8):1581–7.

    PubMed  Google Scholar 

  9. Singer MA, Cintron JR, Martz JE, Schoetz DJ, Abcarian H. Retrorectal cyst: a rare tumor frequently misdiagnosed. J Am Coll Surg. 2003;196(6):880–6.

    PubMed  Google Scholar 

  10. Macafee DA, Sagar PM, El-Khoury T, Hyland R. Retrorectal tumours: optimization of surgical approach and outcome. Color Dis. 2012;14(11):1411–7.

    CAS  Google Scholar 

  11. Hosseini-Nik H, Hosseinzadeh K, Bhayana R, Jhaveri KS. MR imaging of the retrorectal-presacral tumors: an algorithmic approach. Abdom Imaging. 2015;40(7):2630–44.

    PubMed  Google Scholar 

  12. Lee KS, Gower DJ, McWhorter JM, Albertson DA. The role of MR imaging in the diagnosis and treatment of anterior sacral meningocele. Report of two cases. J Neurosurg. 1988;69(4):628–31.

    CAS  PubMed  Google Scholar 

  13. Sung MS, Lee GK, Kang HS, Kwon ST, Park JG, Suh JS, Cho GH, Lee SM, Chung MH, Resnick D. Sacrococcygeal chordoma: MR imaging in 30 patients. Skelet Radiol. 2005;34(2):87–94.

    Google Scholar 

  14. Chereau N, Lefevre JH, Meurette G, Mourra N, Shields C, Parc Y, Tiret E. Surgical resection of retrorectal tumours in adults: long-term results in 47 patients. Color Dis. 2013;15(8):e476–82.

    CAS  Google Scholar 

  15. Sagar AJ, Koshy A, Hyland R, Rotimi O, Sagar PM. Preoperative assessment of retrorectal tumours. Br J Surg. 2014;101(5):573–7.

    CAS  PubMed  Google Scholar 

  16. Toh JW, Morgan M. Management approach and surgical strategies for retrorectal tumours: a systematic review. Color Dis. 2016;18(4):337–50.

    CAS  Google Scholar 

  17. Wang JY, Hsu CH, Changchien CR, Chen JS, Hsu KC, You YT, Tang R, Chiang JM. Presacral tumor: a review of forty-five cases. Am Surg. 1995;61(4):310–5.

    CAS  PubMed  Google Scholar 

  18. Lev-Chelouche D, Gutman M, Goldman G, Even-Sapir E, Meller I, Issakov J, Klausner JM, Rabau M. Presacral tumors: a practical classification and treatment of a unique and heterogeneous group of diseases. Surgery. 2003;133(5):473–8.

    PubMed  Google Scholar 

  19. Merchea A, Larson DW, Hubner M, Wenger DE, Rose PS, Dozois EJ. The value of preoperative biopsy in the management of solid presacral tumors. Dis Colon Rectum. 2013;56(6):756–60.

    PubMed  Google Scholar 

  20. Simpson PJ, Wise KB, Merchea A, Cheville JC, Moir C, Larson DW, Dozois EJ. Surgical outcomes in adults with benign and malignant sacrococcygeal teratoma: a single-institution experience of 26 cases. Dis Colon Rectum. 2014;57(7):851–7.

    PubMed  Google Scholar 

  21. Sagar AJ, Tan WS, Codd R, Fong SS, Sagar PM. Surgical strategies in the management of recurrent retrorectal tumours. Tech Coloproctol. 2014;18(11):1023–7.

    CAS  PubMed  Google Scholar 

  22. Bai HM, Yang JX, Huang HF, Cao DY, Chen J, Yang N, Lang JH, Shen K. Individualized managing strategies of aggressive angiomyxoma of female genital tract and pelvis. Eur J Surg Oncol. 2013;39(10):1101–8.

    CAS  PubMed  Google Scholar 

  23. Kelley SR. Robotic extralevator excision of a retrorectal giant aggressive angiomyxoma. Obstet Gynecol Sci. 2018;61(6):693–7.

    PubMed  PubMed Central  Google Scholar 

  24. Frezza AM, Botta L, Trama A, Dei Tos AP, Stacchiotti S. Chordoma: update on disease, epidemiology, biology and medical therapies. Curr Opin Oncol. 2019;31(2):114–20.

    PubMed  Google Scholar 

  25. Springall RG, Griffiths JD. Malignant change in rectal duplication. J R Soc Med. 1990;83(3):185–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Dozois EJ, Wall JC, Spinner RJ, Jacofsky DJ, Yaszemski MJ, Sim FH, Moran SL, Cima RR, Larson DR, Haddock MG, Okuno SH, Larson DW. Neurogenic tumors of the pelvis: clinicopathologic features and surgical outcomes using a multidisciplinary team. Ann Surg Oncol. 2009;16(4):1010–6.

    PubMed  Google Scholar 

  27. Mathis KL, Dozois EJ, Grewal MS, Metzger P, Larson DW, Devine RM. Malignant risk and surgical outcomes of presacral tailgut cysts. Br J Surg. 2010;97(4):575–9.

    CAS  PubMed  Google Scholar 

  28. Hopper L, Eglinton TW, Wakeman C, Dobbs BR, Dixon L, Frizelle FA. Progress in the management of retrorectal tumours. Color Dis. 2016;18(4):410–7.

    CAS  Google Scholar 

  29. Uhlig BE, Johnson RL. Presacral tumors and cysts in adults. Dis Colon Rectum. 1975;18(7):581–9.

    CAS  PubMed  Google Scholar 

  30. Dunn KB. Retrorectal tumors. Surg Clin North Am. 2010;90(1):163–71.

    Google Scholar 

  31. Wolpert A, Beer-Gabel M, Lifschitz O, Zbar AP. The management of presacral masses in the adult. Tech Coloproctol. 2002;6(1):43–9.

    CAS  PubMed  Google Scholar 

  32. Yang DM, Park CH, Jin W, Chang SK, Kim JE, Choi SJ, Jung DH. Tailgut cyst: MRI evaluation. Am J Roentgenol. 2005;184(5):1519–23.

    Google Scholar 

  33. Caropreso PR, Wengert PA Jr, Milford HE. Tailgut cyst – a rare retrorectal tuor. Report of a case and review. Dis Colon Rectum. 1975;18(7):597–600.

    CAS  PubMed  Google Scholar 

  34. Hjermstad BM, Helwig EB. Tailgut cysts. Report of 53 cases. Am J Clin Pathol. 1988;89(2):139–47.

    CAS  PubMed  Google Scholar 

  35. Prasad AR, Amin MB, Randolph TL, Lee CS, Ma CK. Retrorectal cystic hamartoma: report of 5 cases with malignancy arising in 2. Arch Pathol Lab Med. 2000;124(5):725–9.

    CAS  PubMed  Google Scholar 

  36. Michael D, Cohen CR, Northover JM. Adenocarcinoma within a rectal duplication cyst: case report and literature review. Ann R Coll Surg Engl. 1999;81(3):205–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Pantoja E, Rodriguez-Ibanez I. Sacrococcygeal dermoids and teratomas: historical review. Am J Surg. 1976;132(3):377–83.

    CAS  PubMed  Google Scholar 

  38. Izant RJ Jr, Filston HC. Sacrococcygeal teratomas. Analysis of forty-three cases. Am J Surg. 1975;130(5):617–21.

    PubMed  Google Scholar 

  39. Dirix M, van Becelaere T, Berkenbosch L, van Baren R, Wijnen RM, Wijnen MH, van der Zee DC, Heij HA, Derikx JP, van Heurn LW. Malignant transformation in sacrococcygeal teratoma and in presacral teratoma associated with Currarino syndrome: a comparative study. J Pediatr Surg. 2015;50(3):462–4.

    PubMed  Google Scholar 

  40. Altman RP, Randolph JG, Lilly JR. Sacrococcygeal teratoma: American Academy of Pediatrics Surgical Section Survey-1973. J Pediatr Surg. 1974;9(3):389–98.

    CAS  PubMed  Google Scholar 

  41. Waldhausen JA, Kolman JW, Vellios F, Battersby JS. Sacrococcygeal teratoma. Surgery. 1963;54:933–49.

    CAS  PubMed  Google Scholar 

  42. Miles RM, Stewart GS Jr. Sacrococcygeal teratomas in adults. Ann Surg. 1974;179(5):676–83.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Hickey RC, Martin RG. Sacrococcygeal teratomas. Ann N Y Acad Sci. 1964;114:951–7.

    PubMed  Google Scholar 

  44. Gray SW, Singhabhandhu B, Smith RA, Skandalakis JE. Sacrococcygeal chordoma: report of a case and review of the literature. Surgery. 1975;78(5):573–82.

    CAS  PubMed  Google Scholar 

  45. Dahlin DC. Bone tumors. General aspects and data on 6,221 cases. 3rd ed. Springfield: Charles C. Thomas; 1978. p. 329. ISBN: 0398036926.

    Google Scholar 

  46. Pan Y, Lu L, Chen J, Zhong Y, Dai Z. Analysis of prognostic factors for survival in patients with primary spinal chordoma using the SEER Registry from 1973 to 2014. J Orthop Surg Res. 2018;13(1):76.

    PubMed  PubMed Central  Google Scholar 

  47. Kerekes D, Goodwin CR, Ahmed AK, Verlaan JJ, Bettegowda C, Abu-Bonsrah N, Sciubba DM. Local and distant recurrence in resected sacral chordomas: a systematic review and pooled cohort analysis. Global Spine J. 2019;9(2):191–201.

    PubMed  Google Scholar 

  48. Stewart RJ, Humphreys WG, Parks TG. The presentation and management of presacral tumours. Br J Surg. 1986;73(2):153–5.

    CAS  PubMed  Google Scholar 

  49. McMaster ML, Goldstein AM, Bromley CM, Ishibe N, Parry DM. Chordoma: incidence and survival patterns in the United States, 1973-1995. Cancer Causes Control. 2001;12(1):1–11.

    CAS  PubMed  Google Scholar 

  50. Fuchs B, Dickey ID, Yaszemski MJ, Inwards CY, Sim FH. Operative management of sacral chordoma. J Bone Joint Surg Am. 2005;87(10):2211–6.

    PubMed  Google Scholar 

  51. Manson F, Comalli-Dillon K, Moriaux A. Anterior sacral meningocele: management in gynecological practice. Ultrasound Obstet Gynecol. 2007;30(6):893–6.

    CAS  PubMed  Google Scholar 

  52. Berstock JR, Bunni J, Thorpe PL. Caution: laparoscopic biopsy of a large pelvic mass may result in disaster. J Minim Invasive Gynecol. 2012;19(5):651–3.

    PubMed  Google Scholar 

  53. Cheng C, Tao B, Bai S, Gao G, Li S, Shang A. Anterior sacral meningocele: a new classification and treatment using the dorsal transsacral approach. Spine. 2020;45(7):444–51.

    PubMed  Google Scholar 

  54. Hébert-Blouin MN, Sullivan PS, Merchea A, Léonard D, Spinner RJ, Dozois EJ. Neurological outcome following resection of benign presacral neurogenic tumors using a nerve-sparing technique. Dis Colon Rectum. 2013;56(10):1185–93.

    PubMed  Google Scholar 

  55. Alderete J, Novais EN, Dozois EJ, Rose PS, Sim FF. Morbidity and functional status of patients with pelvic neurogenic tumors after wide excision. Clin Orthop Relat Res. 2010;468(11):2948–53.

    PubMed  PubMed Central  Google Scholar 

  56. Freier DT, Stanley JC, Thompson NW. Retrorectal tumors in adults. Surg Gynecol Obstet. 1971;132(4):681–6.

    CAS  PubMed  Google Scholar 

  57. Randall RL. Giant cell tumor of the sacrum. Neurosurg Focus. 2003;15(2):E13. Review.

    PubMed  Google Scholar 

  58. Baek SK, Hwang GS, Vinci A, Jafari MD, Jafari F, Moghadamyeghaneh Z, Pigazzi A. Retrorectal tumors: a comprehensive literature review. World J Surg. 2016;40(8):2001–15.

    PubMed  Google Scholar 

  59. Currarino G, Coln D, Votteler T. Triad of anorectal, sacral, and presacral anomalies. AJR Am J Roentgenol. 1981;137(2):395–8.

    CAS  PubMed  Google Scholar 

  60. AbouZeid AA, Mohammad SA, Abolfotoh M, Radwan AB, Ismail MME, Hassan TA. The Currarino triad: what pediatric surgeons need to know. J Pediatr Surg. 2017;52(8):1260–8.

    PubMed  Google Scholar 

  61. Crétolle C, Pelet A, Sanlaville D, Zérah M, Amiel J, Jaubert F, Révillon Y, Baala L, Munnich A, Nihoul-Fékété C, Lyonnet S. Spectrum of HLXB9 gene mutations in Currarino syndrome and genotype-phenotype correlation. Hum Mutat. 2008;29(7):903–10.

    PubMed  Google Scholar 

  62. Leonard D, Pendlimari R, Larson DW, Dozois EJ. Currarino syndrome: typical images of a rare condition. Tech Coloproctol. 2010;14(3):289–90.

    CAS  PubMed  Google Scholar 

  63. Pendlimari R, Leonard D, Dozois EJ. Rare malignant neuroendocrine transformation of a presacral teratoma in patient with Currarino syndrome. Int J Color Dis. 2010;25(11):1383–4.

    Google Scholar 

  64. MacCarty CS, Waugh JM, Coventry MB, Cope WF Jr. Surgical treatment of sacral and presacral tumors other than sacrococcygeal chordoma. J Neurosurg. 1965;22(5):458–64.

    CAS  PubMed  Google Scholar 

  65. Dozois EJ, Jacofsky DJ, Billings BJ, Privitera A, Cima RR, Rose PS, Sim FH, Okuno SH, Haddock MG, Harmsen WS, Inwards CY, Larson DW. Surgical approach and oncologic outcomes following multidisciplinary management of retrorectal sarcomas. Ann Surg Oncol. 2011;18(4):983–8.

    PubMed  Google Scholar 

  66. Yang JC, Chang AE, Baker AR, Sindelar WF, Danforth DN, Topalian SL, DeLaney T, Glatstein E, Steinberg SM, Merino MJ, Rosenberg SA. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16(1):197–203.

    CAS  PubMed  Google Scholar 

  67. Feng M, Murphy J, Griffith KA, Baker LH, Sondak VK, Lucas DR, McGinn CJ, Ray ME. Long-term outcomes after radiotherapy for retroperitoneal and deep truncal sarcoma. Int J Radiat Oncol Biol Phys. 2007;69(1):103–10.

    PubMed  Google Scholar 

  68. Rosenberg SA, Tepper J, Glatstein E, Costa J, Baker A, Brennan M, DeMoss EV, Seipp C, Sindelar WF, Sugarbaker P, Wesley R. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982;196(3):305–15.

    CAS  PubMed  PubMed Central  Google Scholar 

  69. Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data. Sarcoma Meta-analysis Collaboration. Lancet. 1997;350(9092):1647–54.

    Google Scholar 

  70. Raut CP, Pisters PW. Retroperitoneal sarcomas: combined-modality treatment approaches. J Surg Oncol. 2006;94(1):81–7.

    PubMed  Google Scholar 

  71. Dozois EJ, Malireddy KK, Bower TC, Stanson AW, Sim FH. Management of a retrorectal lipomatous hemangiopericytoma by preoperative vascular embolization and a multidisciplinary surgical team: report of a case. Dis Colon Rectum. 2009;52(5):1017–20.

    PubMed  Google Scholar 

  72. Witherspoon P, Armitage J, Gatt M, Sagar PM. Laparoscopic excision of retrorectal schwannoma. Dis Colon Rectum. 2010;53(1):101–3.

    CAS  PubMed  Google Scholar 

  73. Duclos J, Maggiori L, Zappa M, Ferron M, Panis Y. Laparoscopic resection of retrorectal tumors: a feasibility study in 12 consecutive patients. Surg Endosc. 2014;28(4):1223–9.

    PubMed  Google Scholar 

  74. Fong SS, Codd R, Sagar PM. Laparoscopic excision of retrorectal tumours. Color Dis. 2014;16(11):O400–3.

    CAS  Google Scholar 

  75. Zhou JL, Wu B, Xiao Y, Lin GL, Wang WZ, Zhang GN, Qiu HZ. A laparoscopic approach to benign retrorectal tumors. Tech Coloproctol. 2014;18(9):825–33.

    CAS  PubMed  Google Scholar 

  76. Manabe T, Koba R, Nagayoshi K, Sadakari Y, Fujita H, Nagai S, Ueki T, Nagai E, Nakamura M. Laparoscopic excision of neurogenic retrorectal tumors. Asian J Endosc Surg. 2017;10(2):223–6.

    PubMed  Google Scholar 

  77. Cataneo J, Cataldo T, Poylin V. Robotic excision of retrorectal mass. J Gastrointest Surg. 2018;22(10):1811–3.

    PubMed  Google Scholar 

  78. Hove MG, Gil JM, Rodríguez TS, Lomas ÁF, Casajús JP, López-Farré A, Guijarro JJ. Laparoscopic approach to tailgut cyst (retrorectal cystic hamartoma). J Minim Access Surg. 2019;15(3):262–4.

    PubMed  PubMed Central  Google Scholar 

  79. Mullaney TG, Lightner AL, Johnston M, Kelley SR, Larson DW, Dozois EJ. A systematic review of minimally invasive surgery for retrorectal tumors. Tech Coloproctol. 2018;22(4):255–63.

    CAS  PubMed  Google Scholar 

  80. Bohm B, Milsom JW, Fazio VW, Lavery IC, Church JM, Oakley JR. Our approach to the management of congenital presacral tumors in adults. Int J Color Dis. 1993;8(3):134–8.

    CAS  Google Scholar 

  81. Cody HS 3rd, Marcove RC, Quan SH. Malignant retrorectal tumors: 28 years’ experience at Memorial Sloan-Kettering Cancer Center. Dis Colon Rectum. 1981;24(7):501–6.

    PubMed  Google Scholar 

  82. Maddah G, Abdollahi A, Etemadrezaie H, Ganjeifar B, Gohari B, Abdollahi M, Hassanpour M. Problems in diagnosis and treatment of retrorectal tumors: our experience in 50 patients. Acta Med Iran. 2016;54(10):644–50.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

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

    Scott R. Kelley & Eric J. Dozois

Authors
  1. Scott R. Kelley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric J. Dozois
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Scott R. Kelley .

Editor information

Editors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA

    Scott R. Steele

  2. Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA

    Tracy L. Hull

  3. University of Chicago Medical Center, Chicago, IL, USA

    Neil Hyman

  4. Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA

    Justin A. Maykel

  5. Division of Gastrointestinal Surgery, University of Florida, Gainesville, FL, USA

    Thomas E. Read

  6. Department of Colon and Rectal Surgery, Ochsner Clinic, New Orleans, LA, USA

    Charles B. Whitlow

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kelley, S.R., Dozois, E.J. (2022). Presacral Tumors. In: Steele, S.R., Hull, T.L., Hyman, N., Maykel, J.A., Read, T.E., Whitlow, C.B. (eds) The ASCRS Textbook of Colon and Rectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-66049-9_21

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-66049-9_21

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-66048-2

  • Online ISBN: 978-3-030-66049-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation