OUR APPROACH TO THE MANAGEMENT OF CONGENITAL PRESACRAL TUMORS IN ADULTS

This study reviews the recent overall experience in one colorectal sur gery department with congenital presacral tumors in adults. 24 patient s greater than 21 years of age, who underwent curative resection betwe en January 1980 and August 1992, were analyzed retrospectively. The gr owths were divided into two broad categories: developmental cysts and chordomas. The most common presenting symptom was pain (19/24). A preo perative evaluation regimen is outlined in the study and includes use of CT scanning, MRI imaging, and possibly the use of endoluminal ultra sound to document the relationship of presacral tumors to pelvic visce ra. There were 20 developmental cysts and 4 chordomas treated in this series. 15 of 19 developmental cysts were excised by a posterior appro ach alone, 2 were excised by an anterior approach alone, and 3 were tr eated by a combined approach. Trans-sacral excision was carried out in 4 patients with developmental cysts. One chordoma was resected poster iorly and the other 3 through a combined anterior and posterior approa ch. Three recurrences were diagnosed after excision of developmental c ysts at 8, 18, and 41 months postoperatively. Recurrence occurred in 3 of 4 chordoma patients after 25, 32, and 55 months. Reexcision was ca rried out in all patients. None of the developmental cyst cases develo ped a second recurrence but 2 of the 3 chordoma patients have recurred , but have undergone local irradiation, which has controlled their dis ease. A detailed surgical treatment plan is outlined in this article, emphasizing that total excision be the goal surgery, even if this requ ires a combined anterior and posterior approach. In cases of recurrenc e of both development cysts and chordoma, re-excision is a reasonable therapeutic option.