Assistance Publique Hôpitaux de Marseille, Timone Hospital, Marseille, France.
Assistance Publique Hôpitaux de Paris, Saint-Antoine Hospital, Paris, France.
Ann Surg. 2021 Nov 1;274(5):766-772. doi: 10.1097/SLA.0000000000005119.
To report the largest multicentric experience on surgical management of retrorectal tumors (RRT).
Literature data on RRT is limited. There is no consensus concerning the best surgical approach for the management of RRT.
Patients operated for RRT in 18 academic French centers were retrospectively included (2000-2019).
A total of 270 patients were included. Surgery was performed through abdominal (n = 72, 27%), bottom (n = 190, 70%), or combined approach (n = 8, 3%). Abdominal approach was laparoscopic in 53/72 (74%) and bottom approach was Kraske modified procedures in 169/190 (89%) patients. In laparoscopic abdominal group, tumors were more frequently symptomatic (37/53, 70% vs 88/169, 52%, P = 0.02), larger [mean diameter = 60.5 ± 24 (range, 13-107) vs 51 ± 26 (20-105) mm, P = 0.02] and located above S3 vertebra (n = 3/42, 7% vs 0%, P = 0.001) than those from Kraske modified group. Laparoscopy was associated with a higher risk of postoperative ileus (n = 4/53, 7.5% vs 0%, P = 0.002) and rectal fistula (n = 3/53, 6% vs 0%, P=0.01) but less wound abscess (n = 1/53, 2% vs 24/169, 14%, P = 0.02) than Kraske modified procedures. RRT was malignant in 8%. After a mean follow up of 27 ±39 (1-221) months, local recurrence was noted in 8% of the patients. After surgery, chronic pain was observed in 17% of the patients without significant difference between the 2 groups (15/74, 20% vs 3/30, 10%; P = 0.3).
Both laparoscopic and Kraske modified approaches can be used for surgical treatment of RRT (according to their location and their size), with similar long-term results.
报告直肠后肿瘤（RRT）的最大多中心手术治疗经验。
关于 RRT 的文献数据有限。对于 RRT 的治疗，尚无最佳手术方法的共识。
回顾性纳入 18 个法国学术中心的 270 例 RRT 手术患者（2000-2019 年）。
共纳入 270 例患者。手术通过腹部（n=72，27%）、盆底（n=190，70%）或联合入路（n=8，3%）进行。腹部入路腹腔镜手术 53 例（74%），盆底入路改良 Kraske 手术 169 例（89%）。在腹腔镜腹部组中，肿瘤更常出现症状（37/53，70% vs 88/169，52%，P=0.02），且更大[平均直径=60.5±24（范围，13-107） vs 51±26（20-105）mm，P=0.02]，且位于 S3 椎体以上（n=3/42，7% vs 0%，P=0.001）的比例高于改良 Kraske 组。腹腔镜手术与术后肠梗阻（n=4/53，7.5% vs 0%，P=0.002）和直肠瘘（n=3/53，6% vs 0%，P=0.01）的风险较高，但与改良 Kraske 组相比，切口脓肿（n=1/53，2% vs 24/169，14%，P=0.02）的风险较低。RRT 恶性肿瘤占 8%。平均随访 27±39（1-221）个月后，8%的患者出现局部复发。术后慢性疼痛在 17%的患者中观察到，两组之间无显著差异（74 例中有 15 例，20% vs 30 例中有 3 例，10%；P=0.3）。
腹腔镜和改良 Kraske 入路均可用于 RRT 的手术治疗（根据其位置和大小），长期结果相似。
