Hopper L, Eglinton T W, Wakeman C, Dobbs B R, Dixon L, Frizelle F A
Department of Colorectal Surgery, Christchurch Public Hospital, Christchurch, New Zealand.
Colorectal Dis. 2016 Apr;18(4):410-7. doi: 10.1111/codi.13117.
Tumours in the retrorectal space are rare and pathologically heterogeneous. The roles of imaging and preoperative biopsy, nonoperative management and the indications for surgical resection are controversial. This study investigated a series of retrorectal tumours treated in a single institution with the aim of producing a modern improved management algorithm.
A retrospective analysis was conducted of the management of all retrorectal lesions identified between 1998 and 2013 from a radiology database search. Patient demographics, presenting symptoms, imaging, biopsy, management and the results were recorded. Descriptive statistics were used and Kaplan-Meier survival analysis was performed.
Sixty-nine patients with a confirmed retrorectal tumour were identified. The median age was 50 (36-67 interquartile range) and 42 (56%) were female. Twenty (29%) of the tumours were malignant: 4 of 41 cystic lesions were malignant (12.9%) vs. 16 of 28 solid (or heterogeneous) lesions (57.1%) (P < 0.0001). Imaging demonstrated a 95% sensitivity and 64% specificity for differentiating benign from malignant tumours. Magnetic resonance imaging (MRI) was significantly better at distinguishing between benign and malignant tumours than computed tomography (94% vs. 64%, P = 0.03). Percutaneous biopsy was performed in 16 patients and only 27 underwent resection. There was no evidence of local recurrence associated with biopsy. Solid lesions were associated with a nonsignificant decreased overall survival (P = 0.348).
This study demonstrated that MRI should be the investigation of choice for retrorectal lesions. Biopsy of solid lesions is safe and useful for guiding neoadjuvant and surgical therapy. Cystic lesions without suspicious radiological features can be followed by serial imaging without resection.
直肠后间隙肿瘤罕见且病理异质性强。影像学检查、术前活检、非手术治疗以及手术切除指征的作用存在争议。本研究对在单一机构治疗的一系列直肠后肿瘤进行了调查，旨在制定一种现代的、改进的管理算法。
对1998年至2013年间通过放射学数据库检索确定的所有直肠后病变的管理进行回顾性分析。记录患者的人口统计学资料、症状、影像学检查、活检、治疗及结果。采用描述性统计并进行Kaplan-Meier生存分析。
确定了69例确诊的直肠后肿瘤患者。中位年龄为50岁（四分位间距为36 - 67岁），42例（56%）为女性。20例（29%）肿瘤为恶性：41例囊性病变中有4例为恶性（12.9%），而28例实性（或异质性）病变中有16例为恶性（57.1%）（P < 0.0001）。影像学检查对鉴别良性与恶性肿瘤的敏感性为95%，特异性为64%。磁共振成像（MRI）在区分良性和恶性肿瘤方面明显优于计算机断层扫描（94%对64%，P = 0.03）。16例患者进行了经皮活检，仅27例接受了切除。没有证据表明活检会导致局部复发。实性病变与总体生存率非显著性降低相关（P = 0.348）。
本研究表明，MRI应作为直肠后病变的首选检查方法。实性病变的活检对于指导新辅助治疗和手术治疗是安全且有用的。无可疑影像学特征的囊性病变可通过连续影像学检查随访而无需切除。
