Li Zeyu, Lu Min
Department of Colorectal Surgery, First Affiliated Hospital of China Medical University, Shenyang, China.
Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
Front Oncol. 2021 Mar 16;11:639028. doi: 10.3389/fonc.2021.639028. eCollection 2021.
Presacral tumors are a group of rare and heterogeneous tumors that arise from the potential presacral space between the rectum and sacrum. The low occurrence and diverse origins make the diagnosis and treatment of these tumors a challenge. The aim of the study was to retrospectively review patient demographics and to identify advantages and disadvantages in the diagnosis and treatment of these tumors.
Retrospectively collected and reviewed data from patients who received treatment of presacral tumors at the First Affiliated Hospital of China Medical University between August 2009 and June 2019.
The data from forty-four patients (33 females) with a median age of 50 years who were diagnosed with a presacral/retrorectal tumor were analyzed. The majority of tumors were congenital (61.4%) and benign tumors are more common (59.1%). The median age of patients with benign tumor was significantly higher than that of malignant tumor. The most common symptoms were sacrococcygeal/perianal pain (56.8%) and mass (36.4%), and 8 out of 9 patients having lower limb symptoms diagnosed with malignant tumor. The tumor detection rate of digital rectal examination was 75% and more than 90% of all patients underwent one or more radiology imaging exams for tumor diagnosis. Every patient had a biopsy result. The most common type of tumor was presacral cyst (40.9%) with overall tumor median size of 5.6 cm. Thirty-one (70.5%) patients underwent surgery, most often the posterior route (83.9%). Posterior route surgery had significantly shorter operation time and tumors operated posterior route were significantly smaller. The survival rate after surgery was 100%. The median course of disease was 6 months and median follow-up was 25 months.
Presacral tumors have low occurrence and are more frequently observed in females in their 30s and 50s indicating a possible link between tumor occurrence and hormonal changes. Patients with lower limb symptoms were more likely to have a malignant presacral tumor. Posterior route was the most commonly utilized surgical approach. Supplementary iodine tincture treatment of cysts ruptured in operation could potentially be helpful in reducing the chance of recurrence.
骶前肿瘤是一组罕见的异质性肿瘤，起源于直肠和骶骨之间潜在的骶前间隙。其低发病率和多样的起源使得这些肿瘤的诊断和治疗成为一项挑战。本研究的目的是回顾性分析患者的人口统计学特征，并确定这些肿瘤诊断和治疗中的优缺点。
回顾性收集并分析2009年8月至2019年6月在中国医科大学附属第一医院接受骶前肿瘤治疗的患者数据。
分析了44例（33例女性）中位年龄50岁、诊断为骶前/直肠后肿瘤患者的数据。大多数肿瘤为先天性（61.4%），良性肿瘤更为常见（59.1%）。良性肿瘤患者的中位年龄显著高于恶性肿瘤患者。最常见的症状是骶尾部/肛周疼痛（56.8%）和肿块（36.4%），9例有下肢症状的患者中有8例诊断为恶性肿瘤。直肠指检的肿瘤检出率为75%，超过90%的患者接受了一项或多项影像学检查以诊断肿瘤。每位患者均有活检结果。最常见的肿瘤类型是骶前囊肿（40.9%），肿瘤总体中位大小为5.6厘米。31例（70.5%）患者接受了手术，最常采用后路（83.9%）。后路手术的手术时间明显较短，经后路手术的肿瘤明显较小。术后生存率为100%。疾病中位病程为6个月，中位随访时间为25个月。
骶前肿瘤发病率低，在30多岁和50多岁的女性中更常见，提示肿瘤发生与激素变化之间可能存在联系。有下肢症状的患者更有可能患有恶性骶前肿瘤。后路是最常用的手术方法。术中囊肿破裂后补充碘酒治疗可能有助于降低复发几率。
