Clinical Effects Of Presacral Tumor Resection Via Transparasacrococcygeal Approach

Objective:To analyze the surgical effects of presacral tumour resection via transparasacral apporoach retrospectively.Methods:According to the inclusion and exclusion criteria,a total of 23 patients diagnosed as presacral tumors at the Second Hospital of Jilin University from July 2015 to December 2019 were screened.The case data of these patients were retrospectively analyzed and their postoperative follow-up were performed.The follow-up period ranged from 4 months to 59 months(median 26 months).Results:Among the screened 23 patients,7 of which were males(30.43%),16 of which were females(69.57%),the mean age was 42.87± 10.43 years old.The youngest patient was 29 years old,and the oldest patients was 76 years old.The average BMI index was 23.06± 2.51kg/ m2.There were 19(82.61%)asymptomatic patients,while there were 2 cases(8.70%)of sensation of anal bloating,1 case(4.39%)of pain in the lower abdomen,and 1 case(4.39%)of skin bulge at the tail of the sacrococcygeal region.2 of the 23 patients had a history of abdominopelvic surgery.One had received transabdominal apporoach presacral cystectomy,and the other one underwent hysteromyoma resection.Tumors were palpable by digital rectal examination in all patients.All patients underwent CT and MRI examinations and the lesions were found successfully.15 patients underwent abdominal ultrasound examination.4 patients underwent vaginal gynecological ultrasound examination.4 patients underwent transrectal ultrasound examination.The lesions were also found by all kinds of ultrasound examination.All patients received painless colonoscopy,which eliminated primary tumors of colon and rectum and observed rectal compression.None preoperative biopsy was performed in all patients.In 2 patients,the head height of the tumor was higher than that of the third sacral vertebra(S3),and the average SSA of all patients was 38.4±6.67°All operations were performed smoothly.The average operation time was 80.43± 15.80 min,the average intraoperative blood loss was 73.48± 31.14 m L,and there were no cases of blood transfusion.The history of abdomino pelvic surgery did not affect the operation process and the difficulty of the operation.The average incision length was 8.57± 1.75 cm,and the maximum tumor diameter was 10.98± 1.65 cm.The tailbone resection rate and the complete tumor resection rate were both 100%.One patient's lipoma penetrated the sacrum,and was successfully completed by the MDT team composed of our department and orthopedics department.Overall,the mortality rate,the incidence of intestinal fistula,bleeding,abdominal and pelvic infections,lung infections,organ dysfunction and organ failure,dysuria,anal incontinence and presacral effusion rate were all 0%.Only one patient appeared wound red swelling.Postoperative pathological results: there were 10 cases(39.13%)of tail intestinal cysts,one of which was tail intestinal cyst with adenocarcinoma,5 cases(21.74%)of epidermal cysts,3 cases(13.04%)of teratoma,5 cases(21.74%)of lipomas.The average time to get out of bed after surgery was 2.78± 0.74 days,the average time to apply analgesics was 4.78±1.27 days,the average time to remove the drainage tube was 7.12±1.23 days,and the average time to recover drinking water after surgery was 2.78±0.79 days.The time for liquid food is 3.91±0.73 days,the average postoperative half-liquid food time is 4.78±0.95 days,the average catheter removal time is 2.74± 0.75 days,the average postoperative first exhaust time is 2.48±0.51 days,and the average postoperative first defecation is 3.39±0.58 days.The average total hospital stay was 14.17±2.53 days.The average postoperative hospital stay was 10.17± 2.53 days,and the average return-to-work time was 11.91± 2.83 days.The tumor recurrence rate is 0%.No patients were found with dysuria or anal incontinence.And there was no discomfort in the sacrococygeal region.Conclusion:The presacral tumor resection via transparasacral approach is a safe and effective method for the treatment of presacral tumors.It has the advantages of high safety,good curative effect,few complications,and low recurrence rate.It can be widely promoted and applied in the clinical scope.