Tumors of the retrorectal space.
OBJECTIVE
Retrorectal tumors are a diverse group of masses derived from a variety of embryologic origins. Because of this, some confusion is associated with their diagnosis and management. Although rare, a basic understanding of the etiology, presentation, work-up, and treatment of retrorectal masses is essential.


METHODS
The incidence, classification, diagnosis, treatment, and prognosis of these masses are presented. A comprehensive review of the literature is included in our analysis.


RESULTS
Retrorectal lesions can be classified as congenital, inflammatory, neurogenic, osseous, or miscellaneous. Benign and malignant lesions behave similarly. The most common presentation is an asymptomatic mass discovered on routine rectal examination, but certain nonspecific symptoms can be elicited by careful history. Biopsy of these lesions should be avoided to prevent tumor seeding, fecal fistula, meningitis, and abscess formation. Complete surgical resection, usually after appropriate specialized imaging, remains the cornerstone of their treatment. Three approaches commonly used for resection are abdominal, transsacral, or a combined abdominosacral approach. Prognosis is directly related primarily to local control, which often is difficult to achieve for malignant lesions.


CONCLUSIONS
Retrorectal masses present a challenging surgical problem from diagnosis to treatment. A high index of suspicion and resultant early diagnosis, followed by thorough preoperative planning, is required for optimal management and outcome.
Department of Surgery, University of California Davis Medical Center, Sacramento, California 95817, USA.
Kristina G
KG
Hobson
Vafa
V
Ghaemmaghami
John P
JP
Roe
James E
JE
Goodnight
Vijay P
VP
Khatri
D006801:Humans; D015994:Incidence; D010386:Pelvic Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D011379:Prognosis; D012445:Sacrococcygeal Region