Surgical Management of Retrorectal Tumors: A French Multicentric Experience of 270 Consecutives Cases.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 11 2021
01 11 2021
Historique:
pubmed:
3
8
2021
medline:
23
11
2021
entrez:
2
8
2021
Statut:
ppublish
Résumé
To report the largest multicentric experience on surgical management of retrorectal tumors (RRT). Literature data on RRT is limited. There is no consensus concerning the best surgical approach for the management of RRT. Patients operated for RRT in 18 academic French centers were retrospectively included (2000-2019). A total of 270 patients were included. Surgery was performed through abdominal (n = 72, 27%), bottom (n = 190, 70%), or combined approach (n = 8, 3%). Abdominal approach was laparoscopic in 53/72 (74%) and bottom approach was Kraske modified procedures in 169/190 (89%) patients. In laparoscopic abdominal group, tumors were more frequently symptomatic (37/53, 70% vs 88/169, 52%, P = 0.02), larger [mean diameter = 60.5 ± 24 (range, 13-107) vs 51 ± 26 (20-105) mm, P = 0.02] and located above S3 vertebra (n = 3/42, 7% vs 0%, P = 0.001) than those from Kraske modified group. Laparoscopy was associated with a higher risk of postoperative ileus (n = 4/53, 7.5% vs 0%, P = 0.002) and rectal fistula (n = 3/53, 6% vs 0%, P=0.01) but less wound abscess (n = 1/53, 2% vs 24/169, 14%, P = 0.02) than Kraske modified procedures. RRT was malignant in 8%. After a mean follow up of 27 ±39 (1-221) months, local recurrence was noted in 8% of the patients. After surgery, chronic pain was observed in 17% of the patients without significant difference between the 2 groups (15/74, 20% vs 3/30, 10%; P = 0.3). Both laparoscopic and Kraske modified approaches can be used for surgical treatment of RRT (according to their location and their size), with similar long-term results.
Sections du résumé
OBJECTIVE
To report the largest multicentric experience on surgical management of retrorectal tumors (RRT).
BACKGROUND
Literature data on RRT is limited. There is no consensus concerning the best surgical approach for the management of RRT.
METHODS
Patients operated for RRT in 18 academic French centers were retrospectively included (2000-2019).
RESULTS
A total of 270 patients were included. Surgery was performed through abdominal (n = 72, 27%), bottom (n = 190, 70%), or combined approach (n = 8, 3%). Abdominal approach was laparoscopic in 53/72 (74%) and bottom approach was Kraske modified procedures in 169/190 (89%) patients. In laparoscopic abdominal group, tumors were more frequently symptomatic (37/53, 70% vs 88/169, 52%, P = 0.02), larger [mean diameter = 60.5 ± 24 (range, 13-107) vs 51 ± 26 (20-105) mm, P = 0.02] and located above S3 vertebra (n = 3/42, 7% vs 0%, P = 0.001) than those from Kraske modified group. Laparoscopy was associated with a higher risk of postoperative ileus (n = 4/53, 7.5% vs 0%, P = 0.002) and rectal fistula (n = 3/53, 6% vs 0%, P=0.01) but less wound abscess (n = 1/53, 2% vs 24/169, 14%, P = 0.02) than Kraske modified procedures. RRT was malignant in 8%. After a mean follow up of 27 ±39 (1-221) months, local recurrence was noted in 8% of the patients. After surgery, chronic pain was observed in 17% of the patients without significant difference between the 2 groups (15/74, 20% vs 3/30, 10%; P = 0.3).
CONCLUSIONS
Both laparoscopic and Kraske modified approaches can be used for surgical treatment of RRT (according to their location and their size), with similar long-term results.
Identifiants
pubmed: 34334645
doi: 10.1097/SLA.0000000000005119
pii: 00000658-202111000-00013
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
766-772Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Jao SW, Beart RW, Spencer RJ, et al. Retrorectal tumors. Mayo Clinic experience, 1960-1979. Dis Colon Rectum 1985; 28:644–652.
Middeldorf K. Zur Kenntnis der angeborden Sacralgeschwulste. Virchow's Arch Pathol Anat 1885; 101:37–44.
Lovedaly SB, Dockerty MB. Extragenital pelvic tumors in women. Am J Obstet Gynecol 1949; 58:215–234.
Malafosse M, Gallot D, Douvin D, et al. Peri-ano-rectal cysts and tumours of vestigial origin in the adult. J Chir 1977; 113:351–360.
Barthod F, Hervé de Sigalony JP, Parc R. Les formations kystiques vestigiales rétrorectales de l’adulte. À propos de trois cas. Ann Chir 1996; 50:906–912.
Uhlig BE, Johnson RL. Presacral tumors and cysts in adults. Dis Colon Rectum 1975; 18:581–596.
Hobson KG, Ghaemmaghami V, Roe JP, et al. Tumors of the retrorectal space. Dis Colon Rectum 2005; 48:1964–1974.
Chéreau N, Lefevre JH, Meurette G, et al. Surgical resection of retrorectal tumours in adults: long-term results in 47 patients. Colorectal Dis 2013; 15:e476–e482.
Messick CA, Hull T, Rosselli G, et al. Lesions originating within the retrorectal space: a diverse group requiring individualized evaluation and surgery. J Gastrointest Surg 2013; 17:2143–2152.
Mathis KL, Dozois EJ, Grewal MS, et al. Malignant risk and surgical outcomes of presacral tailgut cysts. Br J Surg 2010; 97:575–579.
Baek SK, Hwang GS, Vinci A, et al. Retrorectal tumors: a comprehensive literature review. World J Surg 2016; 40:2001–2015.
Lev-Chelouche D, Gutman M, Goldman G, et al. Presacral tumors: a practical classification and treatment of a unique and heterogenous group of diseases. Surgery 2003; 133:473–478.
Chêne G, Voitellier M. Tératome bénin mature pré-sacré et formations kystiques vestigiales rétro-rectales chez l’adulte. J Chir 2006; 143:310–314.
Kraske P. Zur extirpation hochsitzender mastdarm-krebse. Verhandl Deutch Gellesch Chir 1885; 14:464–474.
Duclos J, Maggiori L, Zappa M, et al. Laparoscopic resection of retrorectal tumors: a feasibility study in 12 consecutive patients. Surg Endosc 2014; 28:1223–1229.
Woodfield JC, Chalmers AG, Phillips N, et al. Algorithms for the surgical management of retrorectal tumours. Br J Surg 2008; 95:214–221.
Yang B-L, Gu Y-F, Shao W-J, et al. Retrorectal tumors in adults: magnetic resonance imaging findings. World J Gastroenterol 2010; 16:5822–5829.
Dindo D, Demartines N, Clavien P-A, et al. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205–213.
von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370:1453–1457.
Sharpe LA, Van Oppen DJ. Laparoscopic removal of a benign pelvic retroperitoneal dermoid cyst. J Am Assoc Gynecol Laparosc 1995; 2:223–226.
Mullaney TG, Lightner AL, Johnston M, et al. A systematic review of minimally invasive surgery for retrorectal tumors. Tech Coloproctol 2018; 22:255–263.
Carpelan-Holmström M, Koskenvuo L, Haapamäki C, et al. Clinical management of 52 consecutive retro-rectal tumours treated at a tertiary referral centre. Colorectal Dis 2020; 22:1279–1285.
Glasgow SC, Birnbaum EH, Lowney JK, et al. Retrorectal tumors: a diagnostic and therapeutic challenge. Dis Colon Rectum 2005; 48:1581–1587.
Dozois EJ, Jacofsky DJ, Billings BJ, et al. Surgical approach and oncologic outcomes following multidisciplinary management of retrorectal sarcomas. Ann Surg Oncol 2011; 18:983–988.
Boscà A, Pous S, Artès MJ, et al. Tumours of the retrorectal space: management and outcome of a heterogeneous group of diseases. Colorectal Dis 2011; 14:1418–1423.
Macafee DAL, Sagar PM, El-Khoury T, et al. Retrorectal tumours: optimization of surgical approach and outcome. Colorectal Dis 2012; 14:1411–1417.
Sagar AJ, Koshy A, Hyland R, et al. Preoperative assessment of retrorectal tumours. Br J Surg 2014; 101:573–577.
Pastouras D, Pawa N, Osmani H, et al. Management of tailgut cysts in a tertiary referral centre: a 10-year experience. Colorectal Dis 2015; 17:724–729.
Hopper L, Eglinton TW, Wakeman C, et al. Progress in the management of retrorectal tumours. Colorectal Dis 2016; 18:410–417.
Sakr A, Kim HS, Han YD, et al. Single-center experience of 24 cases of tailgut cyst. Ann Coloproctol 2019; 35:268–274.