Presacral tumors in the female: clinical presentation, surgical management, and results.

A relatively infrequent and heterogeneous group of tumors with similar clinical presentation may arise in the presacral space. From 1965-1980, 70 female patients with primary presacral tumors underwent surgical management at the Mayo Clinic. Twenty-three percent had no symptoms, and their tumors were found on routine pelvic examination. Most of the symptoms resulted from compression or obstruction of adjacent organs or from pressure on pelvic nerves or bone. A palpable tumor was found in 65 (93%) of the patients. Computed tomography scan has proved valuable in determining the extent and degree of tumor invasion. The abdominal approach was selected in 39 (56%), transsacral in 20 (28%), abdominal/perineal in six (9%), and transperineal in five (7%). Complications occurred in 22 patients (31%). However, there were no operative deaths. Seventy percent of the tumors were benign, and 30% were malignant. The prognosis for patients with benign tumors was excellent and their symptoms were relieved. All 21 patients with malignant tumors died between three months and four years after surgery. Survival was not prolonged by the use of radiation or chemotherapy.