Annals of surgery · 2021
Surgical Management of Retrorectal Tumors: A French Multicentric Experience of 270 Consecutives Cases.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Aubert Mathilde, Mege Diane, Parc Yann, Rullier Eric, Cotte Eddy, Meurette Guillaume, Zerbib Philippe, Trilling Bertrand, Lelong Bernard, Sabbagh Charles, Lakkis Zaher, Ouaissi Mehdi, Lebreton Gil, Rouanet Philippe, Manceau Gilles, Tuech Jean-Jacques, Piessen Guillaume, Bresler Laurent, Beyer-Berjot Laura, Denost Quentin, Lefèvre Jérémie H, Panis Yves, French Research Group of Rectal Cancer Surgery (GRECCAR)
Аннотация
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.
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.