Retrospective Analysis And Discussion Of Diagnosis And Treatment Of 44 Cases Of Presacral Tumors

Objective: Presacral tumors are heterogeneous tumors that occur in the potential space between the rectum and the sacrum,and their incidence is extremely low,ranging from 0.0025%-0.014% annually worldwide which contributed to the lack of experience in diagnosis and treatment of the clinicians.In addition,the heterogeneous nature makes the diagnosis and treatment of presacral tumors challenging.This paper collected and retrospectively analyzed the clinical characteristics as well as diagnosis and treatment methods of patients with presacral tumors admitted to the First Affiliated Hospital of China Medical University in recent ten years aiming to provide valuable insights and reference for the medical profesionals in the future.Methods: A retrospective study that collected and reviewed data from patients who received treatment of presacral tumors at the First Affiliated Hospital of China Medical University between August 2009 and June 2019.A non-parametric Kruskal-Wallis ANOVA test or A Pearson's Chi-square test was used for analysis when suited.Results: A total of 44 patients(11 males(25%)and 33 females(75%)were diagnosed with anterior sacral/posterior rectal tumors,with a median age of 50 years.The median age of patients with benign tumor was significantly higher than that of patients with malignant tumor.The most common symptom was sacrococcygeal/perianal pain(56.8%).Of the 9 patients(20.5%)with lower limb symptoms,8(88.9%)were malignant.Most of the tumors were congenital(61.4%)and benign(59.1%).The most common type of tumor was the presacral cyst(40.9%),with a median tumor size of 5.6cm.The mass was found on digital rectal examination in 75% of patients.More than 90% of patients received one or more imaging tests.Among the patients who received surgery(70.5%),the posterior approach was the most popular(83.9%).The median follow-up time was 25 months.The tumor had a high recurrence rate(37.5%),and the recurrence rate of malignant tumor(71.4%)was significantly higher than that of benign tumor(28.6%).Conclution: The number of female presacral tumor patients was significantly higher than that of male patients.There was no significant difference in tumor size and sacrococcygeal symptoms between benign and malignant tumors.However,the possibility of osseous or malignant presacral tumors should be considered in patients with lower limb symptoms,and the cause should be identified as soon as possible to avoid delay in treatment.Pathological diagnosis is the gold standard of clinical diagnosis,and digital rectal examination,MRI and CT are also of great significance in its diagnosis.Complete surgical resection is the main treatment.Adjuvant chemoradiotherapy can improve the prognosis.In addition,the number of female patients in age 30 s and 50 s is the highest,suggesting that the occurrence of tumor may be relatedto the changes of female hormone level,but a large sample data is still needed for further study.