title: Retrorectal Tumors: A Comprehensive Literature Review.
abstract: Retrorectal tumors are rare lesions that comprise a multitude of histologic types. Reports are limited to small single-institution case series, and recommendations on the ideal surgical approaches are lacking.
  
  
  
  The purpose of the study was to provide a comprehensive review of the epidemiology, pathologic subtypes, surgical approaches, and clinical outcomes of retrorectal tumors.
  
  
  
  We conducted a review of the literature using PubMed and searched the reference lists of published studies.
  
  
  
  A total of 341 studies comprising 1708 patients were included. Overall, 68 % of patients were female. The mean age was 44.6 ± 13.7 years. Of all patients, 1194 (70 %) had benign lesions, and 514 patients (30 %) had malignant tumors. Congenital tumors (60.5 %) were the most frequent histologic type. Other pathologic types were neurogenic tumors (14.8 %), osseous tumors (3.1 %), inflammatory tumors (2.6 %), and miscellaneous tumors (19.1 %). Biopsy was performed in 27 % of the patients. Of these patients, incorrect diagnoses occurred in 44 %. An anterior surgical approach (AA) was performed in 299 patients (35 %); a posterior approach (PA) was performed in 443 (52 %), and a combined approach (CA) was performed in 119 patients (14 %). The mean length of stay (LOS) of PA was 7 ± 5 days compared to 8 ± 7 days for AA and 11 ± 7 days for CA (p < 0.05). The overall morbidity rate was 13.2 %: 19.3 % associated with anterior approach, 7.2 % associated with posterior approach, and 24.7 % after a combined approach (p < 0.05). Overall postoperative recurrence rate was 21.6 %; 6.7 % after an anterior approach, 26.6 % after a posterior approach, and 28.6 % after a combined approach (p < 0.05). A minimally invasive approach (MIS) was employed in 83 patients. MIS provided shorter hospital stays than open surgery (4 ± 2 vs. 9 ± 7 days; p < 0.05). Differences in complication rate were 19.8 % in MIS and 12.2 % in open surgery and not statistically significant.
  
  
  
  Retrorectal tumors are most commonly benign in etiology, of a congenital nature, and have a female predominance. Complete surgical resection is the cornerstone of retrorectal tumor management. A minimal access surgery approach, when feasible, appears to be a safe option for the management of retrorectal tumors, with shorter operative time and length of stay.
authors.affiliation: Keimyung University College of Medicine, Daegu, Republic of Korea.
authors.forename: Seong Kyu
authors.initials: SK
authors.lastname: Baek
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA.|Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Grace Soon
authors.initials: GS
authors.lastname: Hwang
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA.
authors.forename: Alessio
authors.initials: A
authors.lastname: Vinci
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA.
authors.forename: Mehraneh D
authors.initials: MD
authors.lastname: Jafari
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA.
authors.forename: Fariba
authors.initials: F
authors.lastname: Jafari
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA.
authors.forename: Zhobin
authors.initials: Z
authors.lastname: Moghadamyeghaneh
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA. apigazzi@uci.edu.
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
mesh_terms: D013505:Digestive System Surgical Procedures; D006801:Humans; D007902:Length of Stay; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*