ORIGINAL RESEARCH article
Front. Surg.
Sec. Colorectal and Proctological Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1638820
This article is part of the Research TopicAdvances in Proctology and Colorectal Surgery Volume IIView all 13 articles
Presacral Tumors: A Retrospective Analysis of 112 Cases with Emphasis on Diagnostic Challenges and Surgical Outcomes
Provisionally accepted
- 1Anhui University of Chinese Medicine, Hefei, China
- 2Department of Anorectal surgery,Second affiliciated hospital, Anhui university of chinese medicine, Hefei, China., Hefei, China
- 3The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
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Background: Presacral tumors are rare entities with heterogeneous pathology including malignant potential. Due to nonspecific symptoms mimicking common anorectal diseases, misdiagnosis remains a major challenge that may delay treatment and worsen prognosis, particularly for malignant variants. This study analyzes diagnostic pitfalls and surgical outcomes in a large single-center cohort.Methods: We retrospectively reviewed 112 presacral tumor cases treated at our tertiary colorectal center (2015)(2016)(2017)(2018)(2019)(2020)(2021)(2022)(2023)(2024)(2025). Data included demographics, clinical presentation, misdiagnosis rates, imaging accuracy, surgical approaches, and complications.Statistical analysis utilized descriptive methods and Chi-square tests.Results: Among 112 patients (male 62, female 50; median age 52 years, range 18-93), 57% presented with anal/rectal pain, while 20.5% were asymptomatic. 85.7% of patients were referred from non-specialized centers. Misdiagnosis occurred in 29.5% (predominantly as anal fistula/abscess or pilonidal sinus). Preoperative imaging (MRI/CT) correctly diagnosed 60% of tumors >3 cm vs. 21.2% of smaller tumors (P<0.001). Surgical approaches: 93.8% underwent transsacral/transanal resection, 6.2% required laparoscopic/combined abdominoperineal resection. Major complications (Clavien-Dindo grade III) occurred in 4.5% of patients (n=5/112), including hemorrhage, rectal injury, and sacral nerve injury. No mortality occurred. Pathology revealed 11.6% malignancy risk.Conclusion: High misdiagnosis rates (29.5%) data support for heightened suspicion in patients with "refractory perianal sepsis", especially given the potential for malignancy. MRI showed significantly higher diagnostic accuracy for tumors >3 cm.Transsacral/transanal resection is safe and effective for most cases (93.8%), with low major morbidity. Centralized management in specialized centers optimizes outcomes.
Keywords: Presacral tumor, surgical approach, case series, Tertiary referral center, diagnostic error burden
Received: 31 May 2025; Accepted: 28 Jul 2025.
Copyright: © 2025 Chen, Deng, Li and Fang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Heng Deng, Department of Anorectal surgery,Second affiliciated hospital, Anhui university of chinese medicine, Hefei, China., Hefei, China
Ming Li, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
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