Surgical Management of Retrorectal Tumors A French Multicentric Experience of 270 Consecutives Cases

Mathilde Aubert (1) , Diane Mege (2) , Yann Parc (3) , Eric Rullier (4) , Eddy Cotte (5) , Guillaume Meurette (6) , Philippe Zerbib (7) , Bertrand Trilling (8, 9) , Bernard Lelong (10) , Charles Sabbagh (11, 12) , Zaher Lakkis (13) , Mehdi Ouaissi (14) , Gil Lebreton (15) , Philippe Rouanet (16) , Gilles Manceau (17) , Jean-Jacques Tuech (18) , Guillaume Piessen (7) , Laurent Bresler (19) , Laura Beyer-Berjot (20) , Quentin Denost (4) , Jeremie H. Lefevre (21) , Yves Panis (22) , French Res Grp Rectal Canc Surg Gr

1 AMU SMPM MED - Aix-Marseille Université - École de médecine
2 TIMONE - Hôpital de la Timone [CHU - APHM]
3 Service de chirurgie générale et digestive [CHU Saint-Antoine]
4 Hôpital Haut-Lévêque [CHU Bordeaux]
5 Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, Service de Chirurgie Digestive
6 CHU Nantes - Centre hospitalier universitaire de Nantes
7 CHU Lille
8 TIMC-IMAG - Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications Grenoble - UMR 5525
9 Département de chirurgie digestive et de l'urgence
10 CHU Pontchaillou [Rennes]
11 CHU Amiens-Picardie
12 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
13 Service de Chirurgie Digestive [CHRU Besançon]
14 CHU Trousseau [Tours]
15 CHU Caen
16 ICM - Institut du Cancer de Montpellier
17 HEGP - Hôpital Européen Georges Pompidou [APHP]
18 Service de chirurgie digestive [CHU Rouen]
19 Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy]
20 Hôpital Nord [CHU - APHM]
21 SU - Sorbonne Université
22 SU FM - Sorbonne Université - Faculté de Médecine

Objective: To report the largest multicentric experience on surgical management of retrorectal tumors (RRT). Background: Literature data on RRT is limited. There is no consensus concerning the best surgical approach for the management of RRT. Methods: Patients operated for RRT in 18 academic French centers were retrospectively included (2000-2019). Results: A total of 270 patients were included. Surgery was performed through abdominal (n = 72, 27%), bottom (n = 190, 70%), or combined approach (n = 8, 3%). Abdominal approach was laparoscopic in 53/72 (74%) and bottom approach was Kraske modified procedures in 169/190 (89%) patients. In laparoscopic abdominal group, tumors were more frequently symptomatic (37/53, 70% vs 88/169, 52%, P = 0.02), larger [mean diameter = 60.5 +/- 24 (range, 13-107) vs 51 +/- 26 (20-105) mm, P = 0.02] and located above S3 vertebra (n = 3/42, 7% vs 0%, P = 0.001) than those from Kraske modified group. Laparoscopy was associated with a higher risk of postoperative ileus (n = 4/53, 7.5% vs 0%, P = 0.002) and rectal fistula (n = 3/53, 6% vs 0%, P=0.01) but less wound abscess (n = 1/53, 2% vs 24/169, 14%, P = 0.02) than Kraske modified procedures. RRT was malignant in 8%. After a mean follow up of 27 +/- 39 (1-221) months, local recurrence was noted in 8% of the patients. After surgery, chronic pain was observed in 17% of the patients without significant difference between the 2 groups (15/74, 20% vs 3/30, 10%; P = 0.3). Conclusions: Both laparoscopic and Kraske modified approaches can be used for surgical treatment of RRT (according to their location and their size), with similar long-term results.

Domaines: Sciences du Vivant [q-bio]

Mathilde Aubert, Diane Mege, Yann Parc, Eric Rullier, Eddy Cotte, et al.. Surgical Management of Retrorectal Tumors A French Multicentric Experience of 270 Consecutives Cases. Annals of Surgery, 2021, 274 (5), pp.766-772. ⟨10.1097/SLA.0000000000005119⟩. ⟨hal-03566160⟩