Surgical resection of retrorectal tumors resulted in a 5-year recurrence-free survival rate of 98% and a local recurrence rate of 3% in a 25-year retrospective cohort study conducted at a tertiary referral center.
Retrorectal tumors arise in the presacral space and represent a rare and heterogeneous group of lesions that pose diagnostic and surgical challenges. Researchers evaluated long-term surgical outcomes and the clinical implications of preoperative biopsy among patients who underwent treatment between 2000 and 2025.
The study included 61 patients, with descriptive and comparative analyses performed on 58 patients with complete follow-up. The mean age was 47 years, and 81% were female. Most tumors were detected incidentally during imaging performed for unrelated conditions, accounting for 93% of diagnoses. Among symptomatic patients, the most common presentations were nonspecific abdominal pain and abdominal fullness. The mean tumor diameter measured on imaging was 6 cm.
All patients underwent cross-sectional imaging with computed tomography or magnetic resonance imaging. Preoperative biopsy was performed in 12% of patients. Researchers observed no statistically significant differences in postoperative complications between patients who underwent biopsy and those who did not; however, complications occurred in 29% of patients who underwent biopsy compared with 4% of patients without biopsy.
Patients with shorter symptom duration were more likely to undergo biopsy. Researchers noted that imaging findings and surgical anatomy may often provide sufficient information for surgical planning without tissue sampling.
The surgical approach was determined by the tumor’s relationship to the third sacral vertebra. Tumors located below this level were typically managed with a posterior approach, whereas lesions located above the vertebra were treated using an anterior abdominal approach. In the cohort, 91% of patients underwent posterior resection, 3% anterior resection, and 5% a combined anterior–posterior approach. Complete resection was achieved in all patients.
Postoperative complications occurred in 7% of patients and consisted of surgical site infections or small fluid collections managed with antibiotic therapy. No patient required reoperation, and no postoperative mortality was reported. The mean hospital stay was approximately 10 days.
Histopathological findings showed that 95% of tumors were benign and about 5% were malignant, with a small subset classified as borderline lesions. Tailgut cysts were the most common diagnosis, accounting for 47% of cases, followed by epidermoid cysts at 22% and mature cystic teratomas at 7%. Less common tumors included gastrointestinal stromal tumors and schwannomas. Malignant tumors included neuroendocrine tumor, ependymoma, and chordoma.
During follow-up lasting up to 190 months, two patients experienced recurrence. One patient underwent repeat surgery, while the other declined additional surgery and was managed with surveillance.
Researchers also reported a rare case in which a previously resected tailgut cyst later recurred as a high-grade neuroendocrine tumor, highlighting the potential for malignant transformation in congenital retrorectal lesions.
The researchers noted several limitations, including the single-center design and the small number of recurrence and complication events, which prevented multivariate analysis.
“Preoperative biopsy should not be routinely performed and must be considered selectively, given its potential complication risk and limited diagnostic yield in some cases,” wrote lead researcher Fadime Kutluk, MD, of Florence Nightingale Hospital in Istanbul, and colleagues.
Disclosures: The researchers reported no conflicts of interest.
Source: Medicine
