Ann Surg Treat Res.  2020 Aug;99(2):110-117. 10.4174/astr.2020.99.2.110.

Retrorectal tumor: a single-center 10-years’ experience

• Yalav O
• Topal U
• Eray
• Deveci MA
• Gencel E
• Rencuzogullari A

• KMID: 2504823
• DOI: http://doi.org/10.4174/astr.2020.99.2.110

Abstract

Purpose
Retrorectal tumors (RTs) are a rare incidence and recommendations on the ideal surgical approaches are lacking. This study aimed to evaluate outcomes and follow-up results of patients undergoing excision of RTs at our institution.
Methods
A retrospective review was conducted for undergoing surgery for RT between January 2009 and January 2019. Demographic characteristics, presenting symptoms, preoperative diagnostic tests, surgical procedures, histopathological results, intraoperative and postoperative complications, postoperative hospital stay, postoperative 30-day mortality, 90-day unplanned readmission rate, and long-term outcomes were evaluated.
Results
Twenty patients with a mean age of 48.3 ± 14.2 were analyzed. The most common presenting complaint was perineal pain (35.0%). Magnetic resonance imaging and computed tomography was preferred in 18 and 2 patients, respectively. Tumor localization was below the level of the third sacral vertebrae in 14 patients for whom the posterior surgical approach was used. No postoperative mortality was recorded at the end of follow-up of 53.8 ± 40 months. Mean length of postoperative hospital stay was 8.6 ± 9.4 days. Ten percent of the patients had unplanned hospital readmission within 90 days after discharge. Recurrence developed in 1 patient, for whom pathology were reported as chordoma.
Conclusion
RT should be managed by a multidisciplinary team given the complexity and heterogeneity of these tumors despite the fact that the majority are benign. A good understanding of pelvic anatomy and characterization of lesions through detailed radiological imaging is crucial to optimize surgical planning. Complete surgical resection is key for prolonged disease-free and overall survival of patients diagnosed with RTs.

Keyword

Chordoma; General surgery; Rectum; Treatment

Figure

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  Fig. 1 (A) CT shows soft-tissue (white arrow) mass with an approximately 8.5 × 7.0-cm axial diameter destructing the sacrum, containing coarse calcifications. (B) MRI shows a mass of 9.0 cm × 8.4 cm × 8.3 cm in the posterior of the sacrum with a lobulated contoured heterogeneous chondrogenic matrix (white arrow).

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  Fig. 2 Posterior approach. (A) T1-weighted fat sat contrast-enhanced MRI is indicating the homogeneous cystic lesions at the tip of the coccyx (white arrow). (B) Incision through the midline coccyx. (C) The surgical specimen, cyst resection with coccyx.

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  Fig. 3 Anterior approach. (A) MRI shows the soft-tissue mass in the posterolateral part of the rectum, probably considered to be of mesenchymal origin in 9.0 × 7.0 × 7.0-cm dimensions partially extending to the ischial fossa. (B) Laparoscopic view of retrorectal space (white arrow) and mesenchymal mass (black arrow). (C) A view of soft-tissue mass after laparoscopic resection.

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  Fig. 4 Combined approach. (A) Anterior view of the chordoma (black arrow) in retrorectal area. (B) Posterior view after partial sacrectomy. Black arrow shows resection margin of the partial sacrectomy and white arrow shows posterior face of mesorectum. (C) Right gluteus maximus myocutaneous perforator flap was designed with 15.0 × 8.0-cm skin part and the flap was rotated 110° to the sacral defect area. (D) The donor area was closed primarily and the flap was fully adapted onto the sacral area.

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