Comparative Analysis Of The Clinical Efficacy Of Laparoscopic And Conventional Open Approach For The Presacral Tumors Resection

Background:Presacral tumors, clinically rare lesions with diverse types, locate in the presacral space which is between the sacrum and rectum. The early diagnosis of presacral tumors is accidentally discovered according to physical examinations, due to the increased tumors induced the symptoms of pelvic oppression. Once the diagnosis was established, in principle, the presacral tumor should be surgically resected. Because of the special anatomical position, it’s difficult to completely resect the tumor. Patients with traditional surgical resection have the shortcomings of slow recovery, pelvic organs obvious interference, and long hospital stay. Therefore, the laparoscopic presacral tumor resection is another choice with minimally invasive, small human interference and quick recovery after surgery. However laparoscopic tumor resection is more difficulty, because of the complex anatomy and low incidence. Currently, there are small number of laparoscopic presacral tumor resection, most of which is mainly case reports.Objective:To compare the therapeutic effects of laparoscopic and conventional open approach for the presacral tumors resection, and analyze the safety and efficacy of laparoscopic presacral tumor resection.Methods:We reviewed the Medical Record Retrieval System of Qilu Hospital to collect the information of laparoscopic and conventional open approach for the presacral tumors, and the operation time, aspects of blood loss, postoperative pain, postoperative complications, postoperative hospital stay and recurrence were compared between the two groups.Results:A total of 17 presacral tumor patients were found. Seven patients were excluded from the study and other 10 patients were included. Four patients accepted laparoscopic surgery, and six patients accepted traditional open surgery (4 patients were through the tail approach, and 2 cases were through the abdominal approach). The differences of patient age, weight, BMI, ASA anesthetic grade, tumor size between the two groups were not significant (p> 0.05). The average amount of bleeding in laparoscopic group (20-30ml, average:25.00±5.77ml) was significantly lower compared with the traditional surgery group (100-400ml. average:208.33± 120.07ml) (P<0.05). The postoperative pain scores including 12h,24h,36h,48h and 72h of laparoscopic group were significantly lower than those in traditional surgery group (P<0.05). In addition, the postoperative hospital stay period of laparoscopic group (3-7 days, average:4.75 ± 1.71 days) were significantly shorter than that in traditional surgery group (9-13d, average:11.00 ± 1.41 days) (P<0.001). However, the differences of surgical operation time, intraoperative complications, postoperative complications, postoperative drinking test time, postoperative liquid diet time, and recurrence were not statistically significant (P> 0.05).Conclusion:Laparoscopic presacral tumor resections have advantages including less blood loss, postoperative pain and shorter postoperative hospital stay compared with traditional surgery. Under appropriate conditions, the laparoscopic resection is an ideal choice for the treatment of presacral tumors.