Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
Institute for Biomedical Research, Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain.
Surg Endosc. 2023 Dec;37(12):9080-9088. doi: 10.1007/s00464-023-10448-5. Epub 2023 Oct 5.
Retrorectal tumors (RRTs) are rare and often surgically excised due to the risk of malignant degeneration and compressive or obstructive symptoms. The approach for excision has traditionally been based on tumor location and performed using either a transabdominal or perineal approach depending on the position of the tumor. The advent of minimally invasive surgery, however, has challenged this paradigm. Here, we determined the applicability and potential advantages of a laparoscopic transabdominal approach in a series of 23 patients with RRTs.
We included 23 patients presenting with RRTs treated at the Surgical Gastrointestinal Unit at Hospital de Sant Pau that were registered prospectively since 1998. The preoperative evaluation consisted of colonoscopy, CT scan and/or MRI, mechanical bowel lavage, and antibiotic therapy. Signed consent was obtained from all patients for a laparoscopic transabdominal approach unless the tumor was easily accessible via a perineal approach. In case of recurrence, a transanal endoscopic microsurgery (TEM) approach was considered. Surgical details, immediate morbidity, and short- and long-term outcomes were recorded.
Of the 23 RRT cases evaluated, 16 patients underwent a laparoscopic transabdominal approach and 6 underwent a perineal approach. No patients required conversion to open surgery. In the laparoscopic transabdominal group, the mean operating time was 158 min, the average postoperative hospital stay was 5 days, and postoperative morbidity was 18%. Three patients had recurrent RRTs, two of the three underwent surgical reintervention. The third patient was radiologically stable and close follow-up was decided.
Our results show that laparoscopic transabdominal excision of RRT is a safe and effective technique, offering the potential advantages of less invasive access and reduced morbidity. This approach challenges the traditional paradigm of excision of these infrequent tumors based solely on tumor location and offers a viable alternative for the treatment of these infrequent tumors.
直肠后肿瘤（RRT）罕见，由于恶性转化和压迫或阻塞症状的风险，通常通过手术切除。切除的方法传统上基于肿瘤的位置，根据肿瘤的位置通过经腹或经会阴途径进行。然而，微创外科的出现挑战了这一模式。在这里，我们确定了在一系列 23 例 RRT 患者中使用腹腔镜经腹入路的适用性和潜在优势。
我们纳入了自 1998 年以来在 Sant Pau 医院外科胃肠科就诊的 23 例 RRT 患者，这些患者均进行了前瞻性登记。术前评估包括结肠镜检查、CT 扫描和/或 MRI、机械肠道灌洗和抗生素治疗。所有患者均获得了使用腹腔镜经腹入路的书面同意，除非肿瘤可通过会阴入路轻松触及。在复发的情况下，考虑使用经肛门内镜微创手术（TEM）方法。记录手术细节、即时发病率以及短期和长期结果。
在评估的 23 例 RRT 病例中，16 例患者接受了腹腔镜经腹入路，6 例患者接受了会阴入路。没有患者需要转为开放性手术。在腹腔镜经腹组中，平均手术时间为 158 分钟，平均术后住院时间为 5 天，术后发病率为 18%。3 例患者出现 RRT 复发，其中 2 例再次接受了手术干预。第 3 例患者影像学稳定，决定密切随访。
我们的结果表明，腹腔镜经腹切除 RRT 是一种安全有效的技术，具有微创入路和降低发病率的潜在优势。这种方法挑战了基于肿瘤位置单纯切除这些罕见肿瘤的传统模式，为这些罕见肿瘤的治疗提供了可行的替代方案。
