The John Golligher Colorectal Surgery Unit, St. James's University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK.
Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James's University Hospital, Leeds, UK.
BJS Open. 2022 Mar 8;6(2). doi: 10.1093/bjsopen/zrac044.
Tumours of the retrorectal space are uncommon, pathologically heterogeneous, and difficult to diagnose, with ongoing controversy over their surgical management. The aim of this study was to evaluate the surgical management of a consecutive series of patients who had undergone excision of primary retrorectal tumours (PRRTs) at a tertiary referral centre.
Patients were identified from a prospectively maintained database between 1 March 2001 and 1 August 2021. Electronic patient records were reviewed for demographics, preoperative imaging, operative details, histology, and follow-up. A chi-squared test was used to assess the statistical significance of findings.
A total of 144 patients were included in the study. Of these, 103 patients were female (71.5 per cent), 46 patients (31.9 per cent) presented incidentally, and 99 of the patients had tumours located below S3 (68.7 per cent). Overall, 76 patients underwent a transperineal approach (52.7 per cent) with the most common findings of a benign tailgut cyst occurring in 59 (40.9 per cent) of cases. Preoperative MRI predicted urovascular and pelvic sidewall involvement assessed intraoperatively with a sensitivity of 83.3 and 90 per cent and a specificity of 98.1 and 98 per cent respectively. Risk of malignancy in solid tumours was 31.4 versus 8.8 per cent in cystic tumours (relative risk 3.5, 95 per cent c.i. 1.6 to 7.6, P < 0.001). Major complications (Clavien-Dindo grade III and above) occurred in eight patients (5.6 per cent) and all-cause long-term mortality was 4.8 per cent (seven patients).
PRRTs can be safely excised with minimal complications in specialized centres by surgical teams with the relevant expertise. This study questions the conservative management of cystic tumours and given the risk of solid tumour malignancy, supports surgical management.
直肠后间隙肿瘤较为少见，其病理表现多样，诊断困难，手术治疗一直存在争议。本研究旨在评估在一家三级转诊中心接受原发性直肠后肿瘤（PRRT）切除术的连续患者系列的手术治疗方法。
本研究通过前瞻性维护的数据库，于 2001 年 3 月 1 日至 2021 年 8 月 1 日期间，识别出符合条件的患者。电子病历记录中评估了患者的人口统计学、术前影像学、手术细节、组织学和随访信息。使用卡方检验评估发现的统计学意义。
本研究共纳入 144 例患者。其中 103 例（71.5%）为女性，46 例（31.9%）为偶然发现，99 例（68.7%）肿瘤位于 S3 以下。总体而言，76 例患者采用经会阴入路（52.7%），最常见的发现是良性尾肠囊肿，59 例（40.9%）为尾肠囊肿。术前 MRI 预测了术中发现的尿生殖血管和骨盆侧壁受累，其敏感性分别为 83.3%和 90%，特异性分别为 98.1%和 98%。实性肿瘤的恶性风险为 31.4%，囊性肿瘤为 8.8%（相对风险 3.5，95%可信区间 1.6 至 7.6，P<0.001）。8 例（5.6%）患者发生严重并发症（Clavien-Dindo 分级 III 级及以上），全因长期死亡率为 4.8%（7 例）。
在有相关专业知识的外科医生的专业中心，PRRT 可以安全切除，并发症很少。本研究对囊性肿瘤的保守治疗提出质疑，并支持对所有实体肿瘤恶性肿瘤风险进行手术治疗。
