[Chinese clinical practice guidelines for standardized diagnosis and treatment of presacral cysts (2026 edition)]

Presacral cysts are rare cystic or cystic-solid masses located between the sacrococcygeal bone and the rectum, and complete surgical resection is the only curative treatment. Due to the complex anatomy of the presacral region, which is adjacent to the rectum, sacrum, and important vessels and nerves, surgical procedures are technically demanding and carry high-risk. Inappropriate surgical approaches and management often lead to complications such as residual cyst wall, recurrence, massive hemorrhage, and pelvic floor dysfunction. To further enhance the clinical understanding of presacral cysts in China, standardize their diagnosis and treatment, and promote standardized management, the Integrated Pelvic Tumor Committee of China Anti-Cancer Association, based om the 2021 and 2024 editions of the "Chinese expert consensus on standardized diagnosis and treatment of presacral cysts", organized multidisciplinary experts from general surgery, gastrointestinal surgery, colorectal and anal surgery, gynecologic oncology, orthopedic soft tissue surgery, neurosurgery, pathology, medical imaging, radiation oncology, epidemiology, and public health. Combining the latest evidence-based research and domestic multicenter clinical experience, and after multiple guideline conferences, they formulated the "Chinese clinical practice guidelines for standardized diagnosis and treatment of presacral cysts (2026 edition)". The guideline aims to provide a Chinese solution for the standardized diagnosis and treatment of presacral cysts. It systematically elaborates on the etiology and pathological types, clinical manifestations and auxiliary examinations, radiological and multidimensional anatomical classification, surgical principles, selection principles for different surgical approaches, perioperative complications and their managements, multidisciplinary treatment strategies, follow-up, and subsequent treatments, and summarizes a total of 20 recommendations. Compared with previous consensus documents, the 2026 guideline proposes a refined and multidimensional anatomical classification based on the position of the sagittal midline, the inferior margin of the S4 vertebra, the number of cyst cavities, and the distance between the cyst and sacrum. It further refines the indications for transperineal, transsacrococcygeal, transabdominal, and combined approaches under the guidance of anatomical classification, enabling individualized surgical plans. It also clarifies reconstructive strategies using gluteus maximus muscle flaps and skin flaps, and provides standardized recommendations for the clinical management of cases complicated with enterocutaneous fistula, anal fistula, sacral variation requiring neuroprotection, recurrent lesions, and suspected malignancy.