Single-center Experience of 24 Cases of Tailgut Cyst

PURPOSE: Tailgut cysts are rare congenital or developmental lesions that arise from vestiges of the embryological hindgut. They are usually present in the presacral space. We report our single-center experience with managing tailgut cysts. METHODS: We conducted a retrospective analysis of 24 patients with tailgut cyst treated surgically at the Colorectal Surgery Department of Severance Hospital, Yonsei University, Seoul, South Korea, between 2007–2018. RESULTS: This study included 24 patients (18 females) with a median age of 51.5 years (range, 21–68 years). Ten cases were symptomatic and 14 were asymptomatic. Cysts were retrorectal in 21 patients. Cysts were below the coccyx level in 16 patients, opposite the coccyx in 6, and above the coccyx in 2. Cysts were supralevator in 5 patients, had a supra- and infralevator extension in 18 patients, and were infralevator in 1. Ten patients were managed using an anterior laparoscopic approach, 11 using a posterior approach, and 3 using a combined approach. Mean cyst size was 5.5 ± 2.7 cm. Postoperative complications were Clavien-Dindo (CD) classification grade II in 9 patients (37.5%) and CD grade III in 1 (4.2%). The posterior approach group showed the highest rate of complications (P = 0.021). Patients managed using a combined approach showed a larger cyst size (P < 0.001), longer operation times (P < 0.001), and a greater likelihood of tumor level above the coccyx (P = 0.002) compared to other approaches. The tumors of 2 male patients were malignant: 1 was a neuroendocrine tumor treated with radiotherapy, while the other was a closely followed adenocarcinoma. Median follow-up was 12 months (range, 1–66 months) with no recurrence. CONCLUSION: Tailgut cysts are uncommon but can cause perineal or pelvic pain. Complete surgical excision via an appropriate approach according to tumor size, location, and correlation with adjacent pelvic floor muscles is the key treatment.

Diagnosis and surgical treatment for primary presacral tumors / 中华普通外科杂志

Objective To investigate the clinical characteristics and surgical treatment for primary presacral tumors.Methods The clinical data of 42 patients of primary presacral tumors from January 2013 to May 2015 were analysed retrospectively.Results Of the 42 patients,16 cases were asymptomatic while 26 patients had discomfort at the sacral or abdominal region,or difficulty in urinating or defecation.90％ of the cases were digital rectum examination (DRE) positive.Among the 42 patients 36 cases underwent surgical treatment,1 case underwent radiotherapy,5 cases refused surgical treatment.Among those receiving surgical resection,28 cases had trans-abdominal surgery and 4 cases had trans-sacral surgery,while 3 cases had trans-abdominal & trans-sacral surgery,1 case had trans-abdominal and perineal surgery.Tumors were completely resected in 31 cases,and palliatively resected in 5 cases.3 cases suffered from intra-operative presacral hemorrhage.1 case with delayed hemorrhage required surgical intervention.2 cases from incision infection recovered after wound disinfection and dressing.3 cases had postoperative hip or leg numbness;1 case with high fever was cured by intensive antibiotics treatment.Conclusion The low incidence of presacral tumors makes early detection difficult.A diagnosis can be obtained by a positive DRE combined with CT or MRI results.Resection is a therapy of choice after biopsies.