Avaliação e manejo dos tumores pré-sacrais: uma revisão narrativa.

Abstract

Pre-sacral tumors are rare and complex, affecting approximately 1 in 40,000 patients, predominantly women with an average age of 30 years. These tumors develop in the retrorectal space, delimited by the rectum anteriorly, sacrum posteriorly, and iliac vessels and sacral nerve roots laterally, originating from abnormalities in embryonic development and encompassing various pathological conditions. Classifications vary, but the most common one divides tumors into congenital, neurogenic, osseous, and miscellaneous categories. A narrative literature review was conducted to address the challenges in the assessment and treatment of these rare lesions. Twenty-one articles from various databases and textbooks in Coloproctology were analyzed, focusing on information from the last five years related to the assessment and treatment of pre-sacral tumors. Initial evaluation requires a comprehensive physical examination and endoscopic assessment. Imaging studies, such as computed tomography and magnetic resonance imaging, are crucial for distinguishing between benign and malignant tumors, characterizing lesions, and surgical planning. Preoperative biopsy is reserved for solid, heterogeneous, or unresectable tumors. Standard treatment involves surgical resection, with anterior, posterior, and combination approaches. Due to the complexity, collaboration of a multidisciplinary team is often necessary to plan the surgical approach. The role of neoadjuvant and adjuvant therapies is not yet fully established. Although minimally invasive approaches and vigilant observation for small and benign lesions have emerged as areas of interest, further studies are needed to validate these practices. It is also essential to establish standardized postoperative follow-up protocols through ongoing research.