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Presacral cysts: transrectal excision in select patients

M J Pidala1, T E Eisenstat, R J Rubin

  • 1Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson School of Medicine, New Brunswick, USA.

The American Surgeon
|February 2, 1999
PubMed
Summary

Presacral cystic lesions, often developmental, are best treated with surgical excision. The transrectal approach offers a low-morbidity option for select patients, with no recurrences observed in this study.

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Pathology

Background:

  • Presacral cystic lesions are rare and can present with various symptoms.
  • Developmental cysts are the most common type of presacral tumors.

Purpose of the Study:

  • To review the management and outcomes of patients with presacral cystic lesions.
  • To evaluate the efficacy and safety of the transrectal approach for cyst excision.

Main Methods:

  • Retrospective review of 14 patients managed over 20 years.
  • Analysis of clinical presentation, diagnostic methods (including CT), surgical approaches, and pathological findings.
  • Assessment of complications, recurrence rates, and follow-up duration.

Main Results:

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  • 12 females and 2 males were identified, with 57% symptomatic at diagnosis.
  • Pain was the most common symptom (43%), with half of these cases involving infected cysts.
  • Pathology revealed dermoid cysts, epidermoid cysts, cyst hamartomas, and benign teratomas; one cyst hamartoma had adenocarcinoma.
  • Transrectal excision was performed in 10 patients, with low morbidity and no recurrences at an average 39-month follow-up.

Conclusions:

  • Developmental cysts are the predominant presacral tumors.
  • Surgical excision is recommended for presacral cystic lesions.
  • The transrectal approach is a viable option for select patients, associated with minimal recurrence and low morbidity.