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World J Gastrointest Surg. Nov 27, 2021; 13(11): 1327-1337
Published online Nov 27, 2021. doi: 10.4240/wjgs.v13.i11.1327
Retrorectal tumors: A challenge for the surgeons
Bengi Balci, Alp Yildiz, Sezai Leventoğlu, Bulent Mentes
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
Author contributions: Balci B and Yildiz A reviewed the literature; Balci B wrote the manuscript; Yildiz A arranged the figures; Mentes B and Leventoğlu S reviewed and edited the manuscript; all authors read and agreed to the published version of the manuscript.
Conflict-of-interest statement: All authors declare having no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sezai Leventoğlu, MD, Professor, Surgeon, Department of Surgery, Gazi University Medical School, 22 Sokak 26-2 Emek, Ankara 06530, Turkey. sezaileventoglu@hotmail.com
Received: February 21, 2021
Peer-review started: February 21, 2021
First decision: July 16, 2021
Revised: July 26, 2021
Accepted: September 22, 2021
Article in press: September 22, 2021
Published online: November 27, 2021
Processing time: 278 Days and 1 Hours
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.

Keywords: Retrorectal tumors; Congenital cystic lesions; Teratomas; Perineal approach; Transabdominal approach, Combined abdominoperineal approach

Core Tip: With advances in imaging modalities and increased clinicians' awareness, the diagnosis of a retrorectal tumor has been improving over the years. This review article discusses the epidemiology, classification and suggested diagnostic methods, with current treatment options mostly focusing on surgical approaches and follow-up recommendations, for patients with retrorectal tumors.