Presacral Tumors

Scott R. Kelley, Eric J. Dozois

Key Concepts

  • The presacral (retrorectal) space is the location of a wide range of rare tumors with incidence as low as 1 in 40,000–60,000 hospital admissions. Discovery in asymptomatic patients is increasing due to expanded use of cross-sectional imaging.
  • Advances in cross-sectional imaging and understanding of tumor biology have led to better outcomes for these challenging patients.
  • MRI is the best imaging study to assist in diagnosis and operative planning.
  • Most benign lesions have malignant potential and observation alone in some patients is acceptable when a dedicated surveillance protocol is in place.
  • When performed appropriately and selectively, a CT-guided biopsy of the lesion may assist in management of solid and heterogeneous cystic lesions.
  • The surgical principles that should guide a surgeon who manages these lesions are a function-sparing approach for benign lesions and an en bloc approach for malignant lesions.

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Last updated: December 15, 2022