Problems in Diagnosis and Treatment of Retrorectal Tumors: Our Experience in 50 Patients

  • Ghodratollah Maddah Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Abbas Abdollahi Mail Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Hamid Etemadrezaie Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Babak Ganjeifar Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Behnaz Gohari Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Mohsen Abdollahi Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Masoumeh Hassanpour Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Keywords:
Presacral tumor, Pectorectal mass, Rectorectal cyst

Abstract

Retrorectal tumors are rare lesions in adults, which remains a difficult diagnostic and management problem. The purpose of this study was to evaluate the results of surgical management of retrorectal tumors in our institution. In a retrospective study, a consecutive series of patients who underwent surgical excision of a retrorectal tumor were identified from a database. Medical records, radiology, pathology reports and surgical approach were checked retrospectively. The data was analyzed using SPSS statistical software (version 18). From 50 patients, 24 were male, and 26 were female with the mean age of 41.7 years. The origin of mass was congenital in 46% (23 cases) and neurogenic in 14% (7 patients), bone origin in 12% (6 cases) and miscellaneous in 24% (12 cases). In total, 56.7% (21 cases) were malignant. Surgical approaches included laparotomy in 11 cases, the sacral approach in 17 cases, the anterior-posterior approach in 14 cases and one case through abdomino-sacral approach. The mean follow-up was 56.7 (10-277) month. Ten patients died due to extensive metastases with a mean survival of 46.6 (1-158) months. Primary urethrorectal tumors are very rare. Successful treatment of these tumors requires careful clinical evaluation and expertise in pelvic surgery.

References

Heidenreich A, Decoud J, Lembrande RO, Rapela RO.Retrorectal Tumors and Tumor-Like Lesions: Diagnosis and Treatment. Dig Surg 1990;7:201-6.

Dozois RR. Retrorectal Tumors. In: Mazier WP, Levien DH, Luchtefeld MA, Senagore AY, eds. Surgery of the Colon, rectum and anus. 1st ed. Philadelphia, Pennsylvania: W. B. Saunders, 1995:354-366.

Post KD, Mccormick PC. Surgical management of pelvic tumors with intraspinal extension. In: Schmidek HH, editor. Schmidek and sweet operative neurosurgical techniques, indication, methods and result. 4th ed. Philadelphia: W.B. Saunders, 2000:2303-21.

Stewart RJ, Humphreys WG, Parks TG. The presentation and management of presacral tumors. Br J Surg

;73:153-5.

Freier DT, Stanley JC, Thompson NW. Retrorectal tumors in adults. Surg Gynecol Obstet 1971;132:681-6.

Feldenzer JA, Gavely JL, Gillicuddy JE. Sacral and presacral tumors: problems in diagnosis and management. Neurosurgery 1989;25:884-91.

Rosenthal DI, Scott JA, Mankin HY, Wismer GL, Brady TJ. Sacrococcygeal chordoma: Magnetic resonance imaging and computed tomograghy. AJR Am J Roentgenol 1985;145:143-7.

Bullard KM, Rothenberger DA. Colon, rectum, and anus.

In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthew JB, et al, editors. Schwartz's Principles of Surgery. 8th ed. New York: McGraw Hill Medical, 2005:1095.

Kovalcik PJ, Burke JB. Anterior sacral meningocele and the scimitar sign. Report of a case. Dis Colon Rectum

;31:806-7.

York JE, Kaczaraj A, Abisaid D, Fuller GN, Skibber JM, Janjan NA, et al. Sacral chordoma: 40 year experience at a major cancer center. Neurosurgery 1999;44:74-9.

Huth JF, Dawson EG, Eliber FR. Abdominosacral resection for a malignant tumor of the sacrum. Am J Surg.

;148:157-61.

Kaiser TE, Pritchard DJ, Unni KK. Clinicopathologic study of sacrococcygeal chordoma. Cancer 1984;53:2574-

Karakousis CP. Sacral resection with preservation of continence. Surg Gynecol Obstet 1986;163:270-3.

Yonemoto T, Tatezaki S, Takenouchi T, Ishii T, Satoh T, Moriya H. The surgical management of sacrococcygeal chordoma. Cancer 1999;85:878-83.

Stener B, Gunterberg B. Technique of high sacral amputation. In: Schmidex HH, eds. Schmidex and Sweet Operative neurosurgical techniques (indication, methods and result). 4th ed. Philadelphia: W.B. Saunders Company, 2000:2322-7.

McGuire EJ. The innervation and function of the lower urinary tract. J Neurosurg 1986;65:278-85.

Gunterberg B,Kewenter J, Petersén19. Gokaslan ZL, Romsdahl MM, Kroll SS, Walsh GL, Gillis TA, Wildrick DM, et al. Total sacrectomy and Galveston L-rod reconstruction for malignant neoplasms. Technical note. J Neurosurg 1997;87:781-7.

Simpson AH, Porter A, Davis A, Griffin A, McLeod RS, Bell RS. Cephalad sacral resection with a combined extended ilioinguinal and posterior approach. J Bone Joint Surg Am 1995;77:405-11.

Waisman M, Kligman M, Roffman M. Posterior approach for radical excision of sacral chordoma. Int Orthop

;21:181-4.

Published
2016-11-19
How to Cite
1.
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. 54(10):644-650.
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Articles