Algorithms for the surgical management of retrorectal tumours

Abstract

BACKGROUND: Retrorectal tumours are uncommon and may present a surgical challenge. The aim of this study was to identify a surgical strategy based on information gained from the multidisciplinary management of retrorectal tumours. METHODS: This was a retrospective review of 27 patients who had resection of retrorectal tumours between 1998 and 2006. RESULTS: The tumours included ten cystic lesions, two mature teratomas, four chordomas, seven neurogenic tumours, two sarcomas, one angiomyxoma and one gastrointestinal stromal tumour. The diagnosis was suggested initially by non-specific clinical presentation and palpation of a retrorectal mass on examination (16 patients), pelvic imaging (six), obstructed labour (one), recurrent pilonidal sinus (one), recurrent perianal sepsis (one) and return of symptoms after resection (two). Magnetic resonance imaging (MRI) confirmed the diagnosis and enabled surgical planning. The operative approach was perineal (12 patients), abdominal (11) or combined (four). Factors that influenced the operative approach were tumour position, its neoplastic nature, involvement of the pelvic sidewall or pelvic viscera, and size. The retrorectal tumour recurred in three patients. CONCLUSION: A successful multidisciplinary surgical strategy, based on preoperative localization by MRI, has been developed for the treatment of retrorectal tumours.