Related Experiment Video
Updated: Jun 24, 2025
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Minimally invasive approach for retrorectal tumors above and below S3: a multicentric tertiary center retrospective
T Bardol1, R Souche2, C Druet3
1Digestive and Minimally Invasive Surgery Unit, Montpellier University Hospital, University of Montpellier-Nîmes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France. t-bardol@chu-montpellier.fr.
Background:
Retrorectal tumors are uncommon lesions developed in the retrorectal space. Data on their minimally invasive resection are scarce and the optimal surgical approach for tumors below S3 remains debated.
Methods:
We performed a retrospective review of consecutive patients who underwent minimally invasive resection of retrorectal tumors between 2005 and 2022 at two tertiary university hospital centers, by comparing the results obtained for lesions located above or below S3.
Results:
Of over 41 patients identified with retrorectal tumors, surgical approach was minimally invasive for 23 patients, with laparoscopy alone in 19, with transanal excision in 2, and with combined approach in 2. Retrorectal tumor was above S3 in 11 patients (> S3 group) and below S3 in 12 patients (< S3 group). Patient characteristics and median tumor size were not significantly different between the two groups (60 vs 67 mm; p = 0.975). Overall median operative time was 131.5 min and conversion rate was 13% without significant difference between the two groups (126 vs 197 min and 18% vs 8%, respectively; p > 0.05). Final pathology was tailgut cyst (48%), schwannoma (22%), neural origin tumor (17%), gastrointestinal stromal tumor (4%), and other (19%). The 90-day complication rates were 27% and 58% in the > S3 and < S3 groups, respectively, without severe morbidity or mortality. After a median follow-up of 3.3 years, no recurrence was observed in both groups. Three patients presented chronic pain, three anal dysfunction, and three urinary dysfunction. All were successfully managed without reintervention.
Conclusions:
Minimally invasive surgery for retrorectal tumors can be performed safely and effectively with low morbidity and no mortality. Laparoscopic and transanal techniques alone or in combination may be recommended as the treatment of choice of benign retrorectal tumors, even for lesions below S3, in centers experienced with minimally invasive surgery.
Insights
Minimally invasive surgery is safe and effective for retrorectal tumors, even those below S3. Experienced centers can use laparoscopic and transanal techniques for these uncommon lesions.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Retrorectal tumors are rare lesions in the retrorectal space.
- Data on minimally invasive resection of these tumors is limited.
- The optimal surgical approach for tumors below the S3 level remains debated.
Purpose of the Study:
- To evaluate the safety and efficacy of minimally invasive resection for retrorectal tumors.
- To compare outcomes for tumors located above versus below the S3 vertebral level.
Main Methods:
- Retrospective review of 23 patients undergoing minimally invasive resection of retrorectal tumors (2005-2022).
- Comparison of outcomes between tumors located above S3 (n=11) and below S3 (n=12).
- Surgical approaches included laparoscopy, transanal excision, and combined techniques.
Main Results:
- No significant difference in patient characteristics or tumor size between groups.
- Similar operative times and conversion rates for both groups.
- Common pathologies included tailgut cysts (48%) and schwannomas (22%).
- 90-day complication rates were 27% (>S3) and 58% (
- No recurrence observed at a median follow-up of 3.3 years.
Conclusions:
- Minimally invasive surgery is a safe and effective treatment for retrorectal tumors.
- Laparoscopic and transanal techniques are suitable for benign retrorectal tumors, including those below S3.
- Experienced centers should consider these approaches as the treatment of choice.
