ASCRS Ch21 — Presacral Tumors

Citation: Kelley SR, Dozois EJ. "Presacral Tumors." In: Steele SR, et al. (eds.), The ASCRS Textbook of Colon and Rectal Surgery, 4th ed. Springer Nature Switzerland AG; 2022. pp. 375–396 (PDF pp. 380–401 of the combined textbook file — captured across two Read calls, PDF pp. 374–393 and PDF pp. 394–413; the first call's opening pages were incidentally captured during ASCRS Ch20's read and re-read here for accuracy, and the second call's tail incidentally captured the opening of ASCRS Ch22, not yet ingested). Source file: raw/ASCRS Textbook 4th Ed.pdf (full 1,198-page textbook; cite by page range within the single PDF). Second chapter of Part III ("Malignant Disease"), though most presacral tumors are in fact benign — the chapter itself is organized around the full congenital/neurogenic/osseous/miscellaneous, benign/malignant spectrum.

Type: Specialty textbook chapter (reference/background, not primary literature).

Scope

Twenty-first chapter of the sequential full-textbook ingest (see ASCRS Ch01 - Anatomy and Embryology for the ingest's scope/plan). Covers the presacral (retrorectal) space as a whole: anatomic considerations (sacral nerve root function data, pelvic-stability/sacrectomy consequences), clinical presentation and physical exam, imaging (MRI as gold standard, the "scimitar sign"), preoperative biopsy (indications, technique, contraindicated approaches), the Mayo classification system (congenital/neurogenic/osseous/miscellaneous × benign/malignant), each major entity (epidermoid/dermoid cysts, tailgut cysts, enterogenous/rectal duplication cysts, teratomas, chordomas, meningoceles, neurogenic tumors, osseous tumors, miscellaneous lesions, Currarino syndrome), management principles (function-sparing vs. en bloc), multidisciplinary team, neoadjuvant therapy, preoperative considerations, surgical approach (posterior/abdominal/combined by sacral level, the coccygectomy debate, flap reconstruction), minimally invasive approaches, outcomes (with an extensive chordoma-specific outcomes literature review), and follow-up/observation recommendations.

Key content

Filed as a single new comprehensive condition page, Presacral Tumors — mirroring the chapter's own organization across its many distinct tumor types, matching the pattern already used for Anorectal Sexually Transmitted Infections, Pruritus Ani, and Anal Cancer. Cross-links Colorectal Anatomy & Embryology (foundational presacral-space anatomy), explicitly disambiguates against Colorectal Anastomotic Complications's "chronic presacral sinus tract" content (a distinct, leak-specific entity in the same anatomic space, not a primary tumor), cross-links Gastrointestinal Stromal Tumors (GIST) (presacral/retrorectal GIST as a further rare GIST site, distinct from the anal-GIST content on Anal Cancer), and cross-links Anal Cancer and Rectal Cancer (shared VRAM-flap reconstruction technique and chemoradiotherapy reasoning-by-analogy for malignant presacral cysts). No forward references were pending specifically for this chapter.

Limitations

• Textbook chapter, not primary literature; the extensive chordoma-outcomes data (McMaster/SEER, Fuchs/Mayo, Pan/Xiangya/SEER, Kerekes systematic review) and other cited case series are the chapter authors' synthesis, not independently re-verified against the primary publications.
• The Mayo classification table (Table 21.1) is reproduced in condensed prose form on the resulting page rather than as a full table.
• The chapter's own practice recommendations (coccygectomy for teratomas specifically, observation thresholds for small neurogenic tumors, follow-up imaging intervals) reflect one high-volume referral center's approach (Mayo Clinic) rather than a consensus guideline — reported as the chapter's stated practice, not as a universal standard.

Relevance

Twenty-first entry in the ASCRS ingest, second chapter of Part III ("Malignant Disease"). Adds one new comprehensive condition page covering a genuinely rare but conceptually important anatomic-space tumor category. Chapter 22, "Sporadic and Inherited Colorectal Cancer: How Epidemiology and Molecular Biology Guide Screening and Treatment," is next — its opening pages (Introduction, Sporadic vs. Inherited CRC, epidemiology/molecular biology of sporadic CRC, Lynch syndrome and its variants, FAP, MUTYH-associated polyposis, serrated polyposis syndrome, hamartomatous polyposis syndromes) were incidentally captured in this chapter's second Read call but are not yet ingested into any wiki page.