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Galán C, Hernández MP, Martínez MC, Sánchez A, Bollo J, Targarona EM. Surgical treatment of retrorectal tumors: a plea for a laparoscopic approach. Surg Endosc 2023; 37:9080-9088. [PMID: 37798533 PMCID: PMC10709236 DOI: 10.1007/s00464-023-10448-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/05/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Retrorectal tumors (RRTs) are rare and often surgically excised due to the risk of malignant degeneration and compressive or obstructive symptoms. The approach for excision has traditionally been based on tumor location and performed using either a transabdominal or perineal approach depending on the position of the tumor. The advent of minimally invasive surgery, however, has challenged this paradigm. Here, we determined the applicability and potential advantages of a laparoscopic transabdominal approach in a series of 23 patients with RRTs. MATERIAL AND METHODS We included 23 patients presenting with RRTs treated at the Surgical Gastrointestinal Unit at Hospital de Sant Pau that were registered prospectively since 1998. The preoperative evaluation consisted of colonoscopy, CT scan and/or MRI, mechanical bowel lavage, and antibiotic therapy. Signed consent was obtained from all patients for a laparoscopic transabdominal approach unless the tumor was easily accessible via a perineal approach. In case of recurrence, a transanal endoscopic microsurgery (TEM) approach was considered. Surgical details, immediate morbidity, and short- and long-term outcomes were recorded. RESULTS Of the 23 RRT cases evaluated, 16 patients underwent a laparoscopic transabdominal approach and 6 underwent a perineal approach. No patients required conversion to open surgery. In the laparoscopic transabdominal group, the mean operating time was 158 min, the average postoperative hospital stay was 5 days, and postoperative morbidity was 18%. Three patients had recurrent RRTs, two of the three underwent surgical reintervention. The third patient was radiologically stable and close follow-up was decided. CONCLUSION Our results show that laparoscopic transabdominal excision of RRT is a safe and effective technique, offering the potential advantages of less invasive access and reduced morbidity. This approach challenges the traditional paradigm of excision of these infrequent tumors based solely on tumor location and offers a viable alternative for the treatment of these infrequent tumors.
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Affiliation(s)
- Clara Galán
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - M Pilar Hernández
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
- Institute for Biomedical Research, Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - M Carmen Martínez
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
- Institute for Biomedical Research, Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Anna Sánchez
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
- Institute for Biomedical Research, Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Jesús Bollo
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
- Institute for Biomedical Research, Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Eduardo Mª Targarona
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
- Institute for Biomedical Research, Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain.
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Liu X, Zhao M, Fu H, Si L, Wang Q, Mao M, Zhu Y, Guo R. The surgical treatment of female primary pelvic retroperitoneal tumours: A retrospective study of 99 patients from a single centre in China. Int J Med Robot 2023:e2591. [PMID: 37904623 DOI: 10.1002/rcs.2591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/18/2023] [Accepted: 10/16/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND To summarise the application of minimally invasive surgery for female primary pelvic retroperitoneal tumours (PPRTs). METHODS The clinical data of PPRT in a hospital between January 2017 and August 2022 were retrospectively collected. Surgical outcomes for cystic and solid tumours and two minimally invasive techniques were compared. RESULTS 99 patients were included. Cystic tumours had fewer intraoperative injuries (4.0% vs. 28.0%, p < 0.001) than solid tumours. Robot-assisted laparoscopy (RALS) seemed to have fewer intraoperative complications (8.3% vs. 35.1%, p = 0.156) than conventional laparoscopy (CLS) in solid tumours. For cystic tumours, RALS included larger tumour sizes and longer operative times (p < 0.05), but intraoperative injury was comparable to CLS. RALS exhibited a higher cost than CLS in all tumours. CONCLUSIONS Minimally invasive surgery for solid PPRTs tends to be more difficult than for cystic tumours, and RALS has a slight advantage over CLS with respect to short-term PPRT outcomes.
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Affiliation(s)
- Xueyan Liu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengling Zhao
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hanlin Fu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lulu Si
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian Wang
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Mao
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Zhu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruixia Guo
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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3
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Gong J, Xu Y, Zhang Y, Qiao L, Xu H, Zhu P, Yang B. Primary malignant tumours and malignant transformation of cysts in the retrorectal space: MRI diagnosis and treatment outcomes. Gastroenterol Rep (Oxf) 2022; 10:goac048. [PMID: 36157328 PMCID: PMC9491843 DOI: 10.1093/gastro/goac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 06/11/2022] [Accepted: 07/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background There are no clear guidelines for the diagnosis and treatment of malignant retrorectal tumours. The purpose of this study was to increase preoperative diagnostic knowledge and to describe the outcomes of treatment for these patients. Methods This retrospective study was conducted on patients who underwent complete retrorectal tumour resection between May 2006 and July 2018, and had confirmed post-operative pathology reports. Demographic and clinical data (including imaging, perioperative, pathological, and prognostic data) were collected and analysed. Results Malignant lesions were identified in 15 (9 [60%], female) patients. The median age of the patients was 59 years (range, 34–72 years). Primary malignant tumours were identified in seven patients with solid tumours, in which gastrointestinal stromal tumours accounted for 71.4% (five of seven) and the remainder were chordoma or mucinous adenocarcinoma. Malignant transformation of cysts occurred in another eight patients with heterogeneous tumours, while histopathological features were present in 75% (six of eight) of patients with mucinous adenocarcinoma, and the remainder were squamous-cell carcinoma or neuroendocrine tumour (Grade 2). The malignant characteristics of the solid portions observed using magnetic resonance imaging (MRI) were as follows: the cyst wall of the tumour was irregularly thickened; the surface was convex or lobed; the solid tumour had no capsule, or the capsule was destroyed; and the surface had a gyrus-like morphology. At a median follow-up time of 52 months (range, 13–100 months), the overall recurrence-free survival rate was 40.0% and the survival rate was 46.7%. Conclusion Some MRI features can be used to distinguish malignant retrorectal tumours from benign retrorectal tumours. The survival rate of patients with malignant retrorectal tumours is poor.
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Affiliation(s)
- Jing Gong
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China.,First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Yumeng Xu
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China.,First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Yan Zhang
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China.,First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Lichao Qiao
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China.,First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Haixia Xu
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China.,First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Ping Zhu
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Bolin Yang
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
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Wang PP, Lin C, Zhou JL, Xu KW, Qiu HZ, Wu B. Risk factors for perioperative complications in laparoscopic surgeries of retrorectal cystic lesions. World J Gastrointest Surg 2021; 13:1685-1695. [PMID: 35070073 PMCID: PMC8727184 DOI: 10.4240/wjgs.v13.i12.1685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/14/2021] [Accepted: 10/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of retrorectal lesions is low, and no consensus has been reached regarding the most optimal surgical approach. Laparoscopic approach has the advantage of minimally invasive. The risk factors influencing perioperative complications of laparoscopic surgery are rarely discussed.
AIM To investigate the risk factors for perioperative complications in laparoscopic surgeries of retrorectal cystic lesions.
METHODS We retrospectively reviewed the medical records of patients who underwent laparoscopic excision of retrorectal cystic lesions between August 2012 and May 2020 at our hospital. All surgeries were performed in the general surgery department. Patients were divided into groups based on the lesion location and diameter. We analysed the risk factors like type 2 diabetes mellitus, hypertension, the history of abdominal surgery, previous treatment, clinical manifestation, operation duration, blood loss, perioperative complications, and readmission rate within 90 d retrospectively.
RESULTS Severe perioperative complications occurred in seven patients. Prophylactic transverse colostomy was performed in four patients with suspected rectal injury. Two patients underwent puncture drainage due to postoperative pelvic infection. One patient underwent debridement in the operating room due to incision infection. The massive-lesion group had a significantly longer surgery duration, higher blood loss, higher incidence of perioperative complications, and higher readmission rate within 90 d (P < 0.05). Univariate analysis, multivariate analysis, and logistic regression showed that lesion diameter was an independent risk factor for the development of perioperative complications in patients who underwent laparoscopic excision of retrorectal cystic lesions.
CONCLUSION The diameter of the lesion is an independent risk factor for perioperative complications in patients who undergo laparoscopic excision of retrorectal cystic lesions. The location of the lesion was not a determining factor of the surgical approach. Laparoscopic surgery is minimally invasive, high-resolution, and flexible, and its use in retrorectal cystic lesions is safe and feasible, also for lesions below the S3 level.
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Affiliation(s)
- Pei-Pei Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Chen Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jiao-Lin Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Kai-Wen Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hui-Zhong Qiu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Balci B, Yildiz A, Leventoğlu S, Mentes B. Retrorectal tumors: A challenge for the surgeons. World J Gastrointest Surg 2021; 13:1327-1337. [PMID: 34950423 PMCID: PMC8649566 DOI: 10.4240/wjgs.v13.i11.1327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/26/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
Retrorectal or presacral tumors are rare lesions located in the presacral area and considered as being derived from multiple embryological remnants. These tumors are classified as congenital, neurogenic, osseous, inflammatory, or miscellaneous. The most common among these are congenital benign lesions that present with non-specific symptoms, such as lower back pain and change in bowel habit. Although congenital and developmental tumors occur in younger patients, the median age of presentation is reported to be 45 years. Magnetic resonance imaging plays a crucial role in treatment management through accurate diagnosis of the lesion, the evaluation of invasion to adjacent structures, and the decision of appropriate surgical approach. The usefulness of preoperative biopsy is still debated; currently, it is only indicated for solid or heterogeneous tumors if it will alter the treatment management. Surgical resection with clear margins is considered the optimal treatment; described approaches are transabdominal, perineal, combined abdominoperineal, and minimally invasive. Benign retrorectal tumors have favorable long-term outcomes with a low incidence of recurrence, whereas malignant tumors have a potential for distant organ metastasis in addition to local recurrence.
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Affiliation(s)
- Bengi Balci
- Department of General Surgery, Ankara Oncology Training and Research Hospital, Ankara 06060, Turkey
| | - Alp Yildiz
- Department of General Surgery, Ankara Yenimahalle Training and Research Hospital, Ankara 06370, Turkey
| | - Sezai Leventoğlu
- Department of Surgery, Gazi University Medical School, Ankara 06530, Turkey
| | - Bulent Mentes
- Department of General Surgery, Memorial Ankara Hospital, Ankara 06060, Turkey
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Surgical Management of Retrorectal Tumors: A French Multicentric Experience of 270 Consecutives Cases. Ann Surg 2021; 274:766-772. [PMID: 34334645 DOI: 10.1097/sla.0000000000005119] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report the largest multicentric experience on surgical management of retrorectal tumors (RRT). SUMMARY BACKGROUND DATA 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 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 a 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.
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Li Z, Lu M. Presacral Tumor: Insights From a Decade's Experience of This Rare and Diverse Disease. Front Oncol 2021; 11:639028. [PMID: 33796466 PMCID: PMC8008122 DOI: 10.3389/fonc.2021.639028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background Presacral tumors are a group of rare and heterogeneous tumors that arise from the potential presacral space between the rectum and sacrum. The low occurrence and diverse origins make the diagnosis and treatment of these tumors a challenge. The aim of the study was to retrospectively review patient demographics and to identify advantages and disadvantages in the diagnosis and treatment of these tumors. Methods Retrospectively collected and reviewed data from patients who received treatment of presacral tumors at the First Affiliated Hospital of China Medical University between August 2009 and June 2019. Results The data from forty-four patients (33 females) with a median age of 50 years who were diagnosed with a presacral/retrorectal tumor were analyzed. The majority of tumors were congenital (61.4%) and benign tumors are more common (59.1%). The median age of patients with benign tumor was significantly higher than that of malignant tumor. The most common symptoms were sacrococcygeal/perianal pain (56.8%) and mass (36.4%), and 8 out of 9 patients having lower limb symptoms diagnosed with malignant tumor. The tumor detection rate of digital rectal examination was 75% and more than 90% of all patients underwent one or more radiology imaging exams for tumor diagnosis. Every patient had a biopsy result. The most common type of tumor was presacral cyst (40.9%) with overall tumor median size of 5.6 cm. Thirty-one (70.5%) patients underwent surgery, most often via the posterior route (83.9%). Posterior route surgery had significantly shorter operation time and tumors operated via posterior route were significantly smaller. The survival rate after surgery was 100%. The median course of disease was 6 months and median follow-up was 25 months. Conclusions Presacral tumors have low occurrence and are more frequently observed in females in their 30s and 50s indicating a possible link between tumor occurrence and hormonal changes. Patients with lower limb symptoms were more likely to have a malignant presacral tumor. Posterior route was the most commonly utilized surgical approach. Supplementary iodine tincture treatment of cysts ruptured in operation could potentially be helpful in reducing the chance of recurrence.
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Affiliation(s)
- Zeyu Li
- Department of Colorectal Surgery, First Affiliated Hospital of China Medical University, Shenyang, China.,Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Min Lu
- Department of Colorectal Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
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Baverez M, Thibaudeau E, Libois V, Kerdraon O, Senellart H, Raoul JL. Retrorectal Mucinous Adenocarcinoma Arising from a Tailgut Cyst: A Case Report. Case Rep Oncol 2021; 14:147-151. [PMID: 33776696 PMCID: PMC7983577 DOI: 10.1159/000513028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022] Open
Abstract
We report the case of a 57-year-old woman who presented with local invasion of the anal canal by mucinous adenocarcinoma, the malignant transformation of a long-term preexisting retrorectal tailgut cyst. This progression is infrequent and justifies preemptive surgical treatment of retrorectal cysts.
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Affiliation(s)
- Manon Baverez
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Emilie Thibaudeau
- Department of Surgical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Vincent Libois
- Department of Radiotherapy, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Olivier Kerdraon
- Department of Pathology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Hélène Senellart
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Jean-Luc Raoul
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
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Rompen IF, Scheiwiller A, Winiger A, Metzger J, Gass JM. Robotic-Assisted Laparoscopic Resection of Tailgut Cysts. JSLS 2021; 25:JSLS.2021.00035. [PMID: 34354334 PMCID: PMC8325480 DOI: 10.4293/jsls.2021.00035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: Tailgut cysts are rare remnants of the embryological hindgut. Resections are difficult to perform due to the narrow and delicate presacral space where they are usually located. Many different approaches have been described, but to date, no studies have been performed concerning robotic assisted surgery for this entity. Therefore, we conducted a retrospective analysis to evaluate the feasibility and outcome parameters of the robotic anterior approach for resection of tailgut cysts and to compare our results with available literature. Material and Methods: Data was retrospectively obtained from hospital records of all patients who underwent robotic assisted resection of tailgut cysts between January 1, 2017 and June 30, 2020. Outcomes include baseline characteristics, pre-operative radiological workup, operative time, intra- and postoperative complications, and histopathological results. Results: Between January 1, 2017 and June 30, 2020, five patients underwent robotic resection of tailgut cysts. All patients were female and mean age was 47.2 years (range 31.6–63.1 years). Only one patient reported to have local symptoms that could be attributed to the tailgut cyst. Median tumor size was 42 mm (range 30–64 mm). There was no conversion and median operating time was 235 minutes (range 184–331 minutes). Four patients had additional procedures. Intra- and postoperative complications included one intra-operative injury of the rectal wall, which was immediately oversewn, and one postoperative presacral hematoseroma with mild neurological symptoms. None of the specimens showed signs of malignant transformation in histopathological workup. Conclusion: This retrospective analysis shows that robotic resections of tailgut cysts are feasible and safe. Regarding the localization of tailgut cysts in the presacral space, the robotic assisted anterior approach is excellently suited, especially if the cysts are localized above the levator muscle. Longer operative times and higher material costs are outweighed by precise and safe preparation with a robotic platform in this delicate region and confined space. We recommend the robotic assisted anterior approach for the resection of tailgut cysts and retrorectal lesions in general.
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Affiliation(s)
- Ingmar F Rompen
- Department of General Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Andreas Scheiwiller
- Department of General Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Alain Winiger
- Department of Radiology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Jürg Metzger
- Department of General Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Jörn-Markus Gass
- Department of General Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
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