Retrorectal tumors over 25 years: Surgical strategies and long-term outcomes from a high-volume tertiary center

Retrorectal tumors are rare and heterogeneous lesions that present significant diagnostic and surgical challenges. Owing to their low incidence, consensus on optimal management strategies is lacking, and large-scale outcome data remain limited. This study aimed to present a large, long-term, single-center experience with retrorectal tumors, focusing on surgical strategies, recurrence outcomes, and the clinical relevance of preoperative biopsy decisions. This retrospective cohort study included 58 patients who underwent surgical treatment for retrorectal tumors between 2000 and 2025. A total of 61 patients were initially enrolled; 3 were censored at their last known contact in the Kaplan-Meier survival analysis. Accordingly, descriptive and comparative analyses were performed on the remaining 58 patients with complete follow-up. Clinical data, including demographics, imaging modalities, surgical approach, histopathological diagnosis, and follow-up outcomes, were collected and analyzed. The surgical approach was determined according to the tumor's relationship to the third sacral vertebra. Statistical analyses included Kaplan-Meier survival estimation and appropriate comparative tests to evaluate postoperative outcomes. The cohort had a mean age of 46.8 ± 14.7 years, with a marked female predominance (81%). All patients underwent preoperative cross-sectional imaging, and preoperative biopsy was performed in 12% of cases. A posterior surgical approach was employed in 91% of patients. Tailgut cysts were the most frequent histopathological subtype (46.6%). No statistically significant association was observed between preoperative biopsy and postoperative complications (P > .05). During long-term follow-up, local recurrence occurred in 2 patients (3.4%). Although not statistically significant, a trend toward increased postoperative complications was observed in patients who underwent preoperative biopsy (P = .067). Although rare, retrorectal tumors can be managed effectively with accurate diagnosis, individualized surgical planning, and vigilant long-term surveillance. Preoperative biopsy should not be performed routinely and should be considered on a case-by-case basis, given its potential complication risk and limited diagnostic yield. This 25-year, single-center experience provides valuable insights into the multidisciplinary management of retrorectal tumors and supports evidence-based clinical decision-making in this anatomically complex region.