title: Management approach and surgical strategies for retrorectal tumours: a systematic review.
abstract: OBJECTIVE
  The management strategy for retrorectal tumours is complex. Due to their rarity, few surgeons have expertise in management.
  
  
  METHODS
  A systematic literature review was conducted using the PubMed database. English language publications in the years 2011-2015 that assessed preoperative management, surgical strategies and chemoradiotherapy for presacral tumours were included. Two hundred and fifty-one abstracts were screened of which 88 met the inclusion criteria. After review of the full text, this resulted in a final list of 42 studies eligible for review.
  
  
  RESULTS
  In all, 932 patients (63.2% female, 36.8% male; P < 0.01) with a retrorectal tumour were identified. Most were benign (65.9% vs. 33.7%, P < 0.01). Imaging distinguished benign from malignant lesions in 88.1% of cases; preoperative biopsy was superior to imaging in providing an accurate definitive diagnosis (91.3% vs. 61.4%, P < 0.05) with negligible seeding risk. Biopsy should be performed in solid tumours. It is useful in guiding neoadjuvant therapy for gastrointestinal stromal tumours, sarcomas and desmoid type fibromatosis and may alter the management strategy in cases of diffuse large B-cell lymphoma and metastases. Biopsies for cystic lesions are not recommended. The gold standard in imaging is MRI. The posterior Kraske procedure is the most common surgical approach. Overall, the reported recurrence rate was 19.7%.
  
  
  CONCLUSIONS
  This review evaluated the management strategies for retrorectal tumours. A preoperative biopsy should be performed for solid tumours. MRI is the most useful imaging modality. Surgery is the mainstay of treatment. There is limited information on robotic surgery, single-port surgery, transanal endoscopic microsurgery, chemoradiotherapy and reconstruction.
authors.affiliation: Department of Colorectal Surgery, Bankstown Hospital, Sydney, New South Wales, Australia.
authors.forename: J W T
authors.initials: JW
authors.lastname: Toh
authors.affiliation: Department of Colorectal Surgery, Bankstown Hospital, Sydney, New South Wales, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Morgan
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000379:methods*; D019468:Disease Management; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D012186:Retroperitoneal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Retrorectal tumour; presacral tumour